Overview of metal-on-metal hip joint replacements, recognizing the signs and symptoms of failure

Alexander Rahill


Metal-on-metal total hip replacement and metal-on-metal hip resurfacing implants came into the orthopaedic zeitgeist in the early 2000s, reaching their peak usage around 2006 (1). Metal-on-metal hip joint replacements were designed to be more durable to withstand the rigors of younger patients. Unfortunately, by 2006 the promising initial data regarding metal-on-metal hip joint replacements was engulfed by figures reporting increased rates of joint revision (1). This revision data led to product recalls and a move away from using metal-on-metal implants in total hip replacements and hip resurfacing operations. Nevertheless, many patients still have these components in-situ, which makes it important for physicians to understand the background of metal-on-metal components, how they fail and what investigations should be arranged in order to recognize component failure as early as possible.


One of the most dependent factors for the failure of metal-on-metal hip joint replacements is inflammatory pseudotumour, which develop more frequently around metal-on-metal hip arthroplasty components, compared to metal-on-polyethylene components. The development of pseudotumours is thought to be the nidus for metal-on-metal implant failure, because the pseudotumour destroys the soft tissue, which is in turn thought to lead to aseptic loosening and, increased wear rates on the articulating components. 70% of patients who develop a pseudotumour will require a hip joint arthroplasty revision operation (2, 3). Recognizing impending implant failure early reduces the soft tissue destruction around the implant, and makes revision of the total hip replacement, if required, technically easier to perform and more likely to be successful. Where a physician suspect’s metal-on-metal total hip replacement failure, we recommend physicians order serum cobalt concentration level tests, a plain X-Ray and a CT of the local area, looking for signs of implant failure. If signs are found, the patient should be referred back to their orthopaedic surgeon for further opinion and management. 


Metal-on-metal, hip joint replacement,

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DOI: http://dx.doi.org/10.18103/imr.v3i7.492


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