TOTAL HIP PROSTHESIS WITHOUT CEMENT USING A METAL-ON-METAL BEARING IN SUBJECTS AGED LESS THAN 50 YEARS: RESULTS OF A PROSPECTIVE SERIES WITH MINIMAL 5 YEARS FOLLOW-UP

Abstract

Purpose: In young active subjects, total hip arthroplasty (THA) raises the risk of early polyethylene wear eventually warranting the use of alternative bearings. The purpose of this study was to analyze outcome in subjects aged less than 50 years implanted with a primary metal-on-metal prosthesis.

Material and methods: Between 1995 and 1998, thirty-nine THA with a metal-on-metal bearing were implanted without cement in 30 consecutive patients aged less than 50 years, mean age 23–50). There were nine bilateral implantations. The cementless implants had surface treatment without hydroxyapatite and 28 mm heads. The indication for THA was necrosis in twenty cases, osteoarthritis in nineteen, most in patients with hip dysplasia. The Devane classification placed 84% of the patients in levels 4 or 5, indicating heavy work and/or sports activities. Inclusion criteria were: 1) age less than 50 years, 2) significant activity (occupation and/or sports), 3) osteoarthritis or necrosis. Patients were included and followed prospectively. Serum cobalt level was measured at last follow-up. None of the patients were lost to follow-up.

Results: The Postel-Merle-d’Aubigné score (PMA) improved from 12.8±2.2 (7–15) before surgery to 17.2±1 (14–18) at 5.1 years (5–6.3). None of the patients complained of hip pain. Two patients has moderate inguinal pain related to a cupiliopsoas conflict. All patients achieved complete weight bearing on the fourth postoperative day excepting three who resumed weight bearing at six weeks due to an acetabular augmentation graft. There were no cases of implant migration and all implants exhibited signs of osteointegration on the radiograms. There were no postoperative dislocations and no cases of osteolysis could be identified, particularly in the eight patients who had increased serum cobalt (four bilateral implants) and who had no other statistically significant favouring factor.

Conclusion: The results at five years suggest that the second-generation metal-on-metal bearing is a reliable alternative when THA is proposed for young active subjects. Long-term follow-up of this cohort of subjects at high risk of wear is necessary to confirm these encouraging results.