Table Of ContentMetal-on-Metal Bearings
Lynne C. Jones • A. Seth Greenwald
Warren O. Haggard
Editors
Metal-on-Metal Bearings
A Clinical Practicum
2123
Editors
LynneC.Jones,Ph.D.,M.S. WarrenO.Haggard,Ph.D.
AssociateProfessorof ProfessorandHerffChairofExcellence,
OrthopaedicSurgery BiomedicalEngineeringDepartment
DirectorofResidentResearch TheUniversityofMemphis
JohnsHopkinsUniversity 330EngineeringTechnologyBuilding
SchoolofMedicine Memphis,TN38152-3210,USA
JHOC5255;Departmentof
OrthopaedicSurgery
601N.CarolineStreet
Baltimore,MD21287,USA
A.SethGreenwald,D.Phil.(Oxon)
Director
OrthopaedicResearchLaboratories
2310SuperiorAvenueEast
Cleveland,Ohio44114,USA
ISBN978-1-4614-8998-6 ISBN978-1-4614-8999-3(eBook)
DOI10.1007/978-1-4614-8999-3
SpringerNewYorkHeidelbergDordrechtLondon
LibraryofCongressControlNumber:2013951511
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Preface
Overamillionmetal-on-metalhipprostheseshavebeenimplantedsince1996, ac-
cording to the Hip Society [1]. Controversy arose with reports of adverse tissue
reactionsandincreasedratesofrevisionassociatedwithsomeoftheimplantdesigns
duringthe2000s.Today(2013),whilemanyorthopaedistshavediscontinuedusing
metal-on-metal implants, others continue to implant prostheses with this hard-on-
hard bearing. This book will review the current understanding of the history and
rationale for the development of metal-on-metal hips, the clinical experience, the
basicscience,andthefuture.Asanoutgrowthofseveralworkshopsonthetopic,this
bookrepresentsacollaborativeeffortbetweenmembersoftheOrthopaedicResearch
Society,theAmericanAcademyofOrthopaedicSurgeons(BiologicalImplantsCom-
mittee, Biomedical Engineering Committee, and the Orthopaedic Device Forum),
andtheSocietyForBiomaterials.
The book is divided into five sections. Part one provides a historical review of
metal-on-metalimplantsandposesthequestionsthathavebeenraisedconcerning
theiruse.Thesecondpartfocusesontheclinicalexperiencewithmodernmetal-on-
metalimplants.Itdiscussestheresultsofregistriesandoutcomestudiesaswellas
thesignificanceoftestingpatientsformetalionlevelsandhypersensitivity.Partthree
exploresthebiologicalresponsetometal-on-metalimplants.Beginningwithadis-
cussionofthebasictenetsofwoundhealing,inflammation,andimmuneresponses,
the implications of the adverse reactions seen around metal-on-metal implants are
then analyzed by experts in the field. Part four discusses the possible contribution
of the materials used in the manufacture of these implants, with special emphasis
onwearmechanismsandtribocorrosion.Theclosingchapterofthebookexplores
futuredirections.
We hope that this book will become a reference source for orthopaedic resi-
dents and fellows, orthopaedists, academics studying joint arthroplasty, and their
colleaguesinindustry.
References
1.LombardiAVJretal(2012)Thehipsociety:algorithmicapproachtodiagnosisandmanagement
ofmetal-on-metalarthroplasty.JBoneJointSurgBr94(11SupplA):14–18
v
Contents
PartI Introduction
1 OverviewofMetal-on-MetalImplants............................ 3
LynneC.Jones,WarrenO.HaggardandA.SethGreenwald
2 Bearing Surfaces for Joint Replacement: New Materials or New
Problems...................................................... 13
StuartGoodman
PartII Clinical
3 OutcomeStudiesforMetal-on-MetalBearings:WhatEvidence-Based
MedicineTellsUs .............................................. 23
MichaelA.MontandRobertPivec
4 MetalReactivity:ItsInfluenceonPrimaryandRevisionOutcomes .. 39
GeorgeGrammatopoulos,HemantPandit,AdrianLow
andDavidMurray
5 AreMetalIonLevelsaTriggerforSurgicalIntervention? .......... 63
DavidLangton
6 MetalSensitivity:IsItPossibletoDetermineClinically?............ 83
NadimJ.HallabandPaulH.Wooley
PartIII Biology
7 WoundHealing,ChronicInflammation,andImmuneResponses .... 109
PaulH.WooleyandNadimJ.Hallab
8 BenignResponsestoOrthopaedicImplants:Really? ............... 135
H.JohnCooperandJoshuaJ.Jacobs
vii
viii Contents
9 WhatDoestheHistologyTellUs? ................................ 153
ThomasW.Bauer
PartIV Biomechanics
10 WhyMetal-on-Metal:WhatLaboratoryTestsHaveShownUs ...... 165
PeterThomas,BurkhardSummer,MarcThomsen,VeitKrenn
andJanPhilippeKretzer
11 WhatDotheRetrievalsReallyTellUs? ........................... 173
RobinPourzal,RobertM.UrbanandMarkusA.Wimmer
FutureDirections.................................................. 195
A.SethGreenwald,WarrenO.Haggard,andLynneC.Jones
Index ............................................................ 199
Contributors
ThomasW.Bauer DepartmentsofPathology,OrthopaedicSurgeryandTheSpine
Center,TheClevelandClinic,Cleveland,OH,USA
H. John Cooper Department of Orthopaedic Surgery, Lenox Hill Hospital, New
York,NY,USA
George Grammatopoulos Nuffield Department of Orthopaedics, Rheumatology
andMusculoskeletalSciences,UniversityofOxford,Headington,Oxford,UK
Stuart Goodman Departments of Orthopaedic Surgery and Bioengineering,
StanfordUniversity,Stanford,USA
A.SethGreenwald OrthopaedicResearchLaboratories,Cleveland,OH,USA
Warren O. Haggard Biomedical Engineering Department, The University of
Memphis,Memphis,TN,US
Nadim J. Hallab OrthopedicAnalysis LLC, BioEngineering Solutions Inc, Oak
Park,IL,USA
DepartmentofOrthopedicSurgery,RushUniversity,Chicago,IL,USA
OrthopedicAnalysisLLC,Chicago,IL,USA
BioEngineerngSolutionsInc.,OakPark,IL,USA
Joshua J. Jacobs Department of Orthopaedic Surgery, Rush University Medical
Center,Chicago,IL,USA
Lynne C. Jones Department of Orthopaedic Surgery, Johns Hopkins University
SchoolofMedicine,Baltimore,MD,US
ix
x Contributors
Veit Krenn MVZ for Cytology, Histology and Molecular Diagnostic, Trier,
Germany
JanPhilippeKretzer LaboratoryofBiomechanicsandImplantResearch, Clinic
forOrthopedicsandTraumaSurgery,DepartmentofOrthopedics,TraumaSurgery
andParaplegiology,HeidelbergUniversityHospital,Heidelberg,Germany
David Langton North Tees Explant Centre (NTEC), Farndale House, University
HospitalofNorthTees,Stockton-on-Tees,UK
Adrian Low Nuffield Department of Orthopaedics, Rheumatology and
MusculoskeletalSciences,UniversityofOxford,Headington,Oxford,UK
Michael A. Mont Rubin Institute for Advanced Orthopedics, Center for Joint
PreservationandReplacement,SinaiHospitalofBaltimore,Baltimore,MD,USA
David Murray Nuffield Department of Orthopaedics, Rheumatology and
MusculoskeletalSciences,UniversityofOxford,Headington,Oxford,UK
Hemant Pandit Nuffield Department of Orthopaedics, Rheumatology and
MusculoskeletalSciences,UniversityofOxford,Headington,Oxford,UK
Robin Pourzal Department of Orthopedic Surgery, Rush University Medical
Center,Chicago,IL,USA
Robert Pivec Rubin Institute for Advanced Orthopedics, Center for Joint
PreservationandReplacement,SinaiHospitalofBaltimore,Baltimore,MD,USA
Burkhard Summer Clinic for Dermatology and Allergology, Ludwig-
Maximilians-University,Munich,Germany
Peter Thomas Clinic for Dermatology and Allergology, Ludwig-Maximilians-
University,Munich,Germany
MarcThomsen Clinics for Orthopedics andTrauma Surgery, DRK-Hospital and
CityHospital,Baden-Baden,Germany
Robert M. Urban Department of Orthopedic Surgery, Rush University Medical
Center,Chicago,IL,USA
Markus A. Wimmer Section of Tribology, Department of Orthopedic Surgery,
RushUniversityMedicalCenter,Chicago,IL,USA
PaulH.Wooley UniversityofKansasMedicalSchool,Wichita,KS,USA
Part I
Introduction
