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Gluteal muscle fatty atrophy is not associated with elevated blood metal ions or pseudotumors in patients with a unilateral metal-on-metal hip replacement.

Reito A, Elo P, Nieminen J, Puolakka T, Eskelinen A - Acta Orthop (2015)

Bottom Line: Muscle atrophy was neither associated with elevated blood metal ion levels (> 5 ppb) nor with the presence of a clear (solid- or mixed-type) pseudotumor seen in MRI.A combination of moderate-to-severe atrophy in MRI, elevated blood metal ion levels, and MRI-confirmed mixed or solid pseudotumor was rare.However, our results suggest that gluteal muscle atrophy seen in MRI is not associated with either the presence or severity of ARMD, at least not in patients who have been operated on using the posterior approach.

View Article: PubMed Central - PubMed

Affiliation: a Coxa Hospital for Joint Replacement , Tampere , Finland .

ABSTRACT

Background and purpose: There are no international guidelines to define adverse reaction to metal debris (ARMD). Muscle fatty atrophy has been reported to be common in patients with failing metal-on-metal (MoM) hip replacements. We assessed whether gluteal muscle fatty atrophy is associated with elevated blood metal ion levels and pseudotumors.

Patients and methods: 263 consecutive patients with unilateral ASR XL total hip replacement using a posterior approach and with an unoperated contralateral hip were included in the study. All patients had undergone a standard screening program at our institution, including MRI and blood metal ion measurement. Muscle fatty atrophy was graded as being absent, mild, moderate, or severe in each of the gluteal muscles.

Results: The prevalence of moderate-to-severe gluteal muscle atrophy was low (12% for gluteus minimus, 10% for gluteus medius, and 2% for gluteus maximus). Muscle atrophy was neither associated with elevated blood metal ion levels (> 5 ppb) nor with the presence of a clear (solid- or mixed-type) pseudotumor seen in MRI. A combination of moderate-to-severe atrophy in MRI, elevated blood metal ion levels, and MRI-confirmed mixed or solid pseudotumor was rare. Multivariable regression revealed that "preoperative diagnosis other than osteoarthrosis" was the strongest predictor of the presence of fatty atrophy.

Interpretation: Gluteal muscle atrophy may be a clinically significant finding with influence on hip muscle strength in patients with MoM hip replacement. However, our results suggest that gluteal muscle atrophy seen in MRI is not associated with either the presence or severity of ARMD, at least not in patients who have been operated on using the posterior approach.

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Related in: MedlinePlus

Flow chart of patient selection.
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Figure 0001: Flow chart of patient selection.

Mentions: DePuy Orthopaedics voluntarily recalled their ASR MoM hip system in August 2010. After the UK Medicines and Healthcare Products Regulatory Agency announced a medical device alert regarding ASR hip arthroplasty implants in September 2010, we established a mass screening program to identify possible articulation-related complications in patients who had received an ASR XL prosthesis during hip arthroplasty at our institution. All the patients who attended screening received an Oxford hip score questionnaire, underwent a thorough clinical examination (including the Harris hip score) at our outpatient clinic, and were referred for measurement of WB cobalt and chromium levels. In addition, AP and lateral radiographs of the hip and an AP pelvic radiograph were taken before each visit. All patients were referred for magnetic artifact reduction sequence (MARS) MRI. If MARS MRI was contraindicated or could not be done because of patient-related factors (such as claustrophobia), the patient underwent ultrasonography (US) of the affected hip.


Gluteal muscle fatty atrophy is not associated with elevated blood metal ions or pseudotumors in patients with a unilateral metal-on-metal hip replacement.

Reito A, Elo P, Nieminen J, Puolakka T, Eskelinen A - Acta Orthop (2015)

Flow chart of patient selection.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4940588&req=5

Figure 0001: Flow chart of patient selection.
Mentions: DePuy Orthopaedics voluntarily recalled their ASR MoM hip system in August 2010. After the UK Medicines and Healthcare Products Regulatory Agency announced a medical device alert regarding ASR hip arthroplasty implants in September 2010, we established a mass screening program to identify possible articulation-related complications in patients who had received an ASR XL prosthesis during hip arthroplasty at our institution. All the patients who attended screening received an Oxford hip score questionnaire, underwent a thorough clinical examination (including the Harris hip score) at our outpatient clinic, and were referred for measurement of WB cobalt and chromium levels. In addition, AP and lateral radiographs of the hip and an AP pelvic radiograph were taken before each visit. All patients were referred for magnetic artifact reduction sequence (MARS) MRI. If MARS MRI was contraindicated or could not be done because of patient-related factors (such as claustrophobia), the patient underwent ultrasonography (US) of the affected hip.

Bottom Line: Muscle atrophy was neither associated with elevated blood metal ion levels (> 5 ppb) nor with the presence of a clear (solid- or mixed-type) pseudotumor seen in MRI.A combination of moderate-to-severe atrophy in MRI, elevated blood metal ion levels, and MRI-confirmed mixed or solid pseudotumor was rare.However, our results suggest that gluteal muscle atrophy seen in MRI is not associated with either the presence or severity of ARMD, at least not in patients who have been operated on using the posterior approach.

View Article: PubMed Central - PubMed

Affiliation: a Coxa Hospital for Joint Replacement , Tampere , Finland .

ABSTRACT

Background and purpose: There are no international guidelines to define adverse reaction to metal debris (ARMD). Muscle fatty atrophy has been reported to be common in patients with failing metal-on-metal (MoM) hip replacements. We assessed whether gluteal muscle fatty atrophy is associated with elevated blood metal ion levels and pseudotumors.

Patients and methods: 263 consecutive patients with unilateral ASR XL total hip replacement using a posterior approach and with an unoperated contralateral hip were included in the study. All patients had undergone a standard screening program at our institution, including MRI and blood metal ion measurement. Muscle fatty atrophy was graded as being absent, mild, moderate, or severe in each of the gluteal muscles.

Results: The prevalence of moderate-to-severe gluteal muscle atrophy was low (12% for gluteus minimus, 10% for gluteus medius, and 2% for gluteus maximus). Muscle atrophy was neither associated with elevated blood metal ion levels (> 5 ppb) nor with the presence of a clear (solid- or mixed-type) pseudotumor seen in MRI. A combination of moderate-to-severe atrophy in MRI, elevated blood metal ion levels, and MRI-confirmed mixed or solid pseudotumor was rare. Multivariable regression revealed that "preoperative diagnosis other than osteoarthrosis" was the strongest predictor of the presence of fatty atrophy.

Interpretation: Gluteal muscle atrophy may be a clinically significant finding with influence on hip muscle strength in patients with MoM hip replacement. However, our results suggest that gluteal muscle atrophy seen in MRI is not associated with either the presence or severity of ARMD, at least not in patients who have been operated on using the posterior approach.

Show MeSH
Related in: MedlinePlus