2.50
Hdl Handle:
http://hdl.handle.net/10547/558752
Title:
Muscle atrophy and metal-on-metal hip implants
Authors:
Berber, Reshid; Khoo, Michael; Cook, Erica Jane; Guppy, Andrew; Hua, Jia; Miles, Jonathan; Carrington, Richard; Skinner, John; Hart, Alister
Abstract:
Background and purpose — Muscle atrophy is seen in patients with metal-on-metal (MOM) hip implants, probably because of inflammatory destruction of the musculo-tendon junction. However, like pseudotumors, it is unclear when atrophy occurs and whether it progresses with time. Our objective was to determine whether muscle atrophy associated with MOM hip implants progresses with time. Patients and methods — We retrospectively reviewed 74 hips in 56 patients (32 of them women) using serial MRI. Median age was 59 (23–83) years. The median time post-implantation was 83 (35–142) months, and the median interval between scans was 11 months. Hip muscles were scored using the Pfirrmann system. The mean scores for muscle atrophy were compared between the first and second MRI scans. Blood cobalt and chromium concentrations were determined. Results — The median blood cobalt was 6.84 (0.24–90) ppb and median chromium level was 4.42 (0.20–45) ppb. The median Oxford hip score was 34 (5–48). The change in the gluteus minimus mean atrophy score between first and second MRI was 0.12 (p = 0.002). Mean change in the gluteus medius posterior portion (unaffected by surgical approach) was 0.08 (p = 0.01) and mean change in the inferior portion was 0.10 (p = 0.05). Mean pseudotumor grade increased by 0.18 (p = 0.02). Interpretation — Worsening muscle atrophy and worsening pseudotumor grade occur over a 1-year period in a substantial proportion of patients with MOM hip implants. Serial MRI helps to identify those patients who are at risk of developing worsening soft-tissue pathology. These patients should be considered for revision surgery before irreversible muscle destruction occurs.
Affiliation:
Royal National Orthopaedic Hospital; University of Bedfordshire; Middlesex University
Citation:
Berber, R., Khoo, M., Cook, E., Guppy, A., Hua, J., Miles, J., Carrington, R., Skinner, J., Hart, A. (2015) 'Muscle atrophy and metal-on-metal hip implants' Acta Orthopaedica 86 (3):351
Publisher:
Informa Healthcare
Journal:
Acta Orthopaedica
Issue Date:
Jun-2015
URI:
http://hdl.handle.net/10547/558752
DOI:
10.3109/17453674.2015.1006981
Additional Links:
http://informahealthcare.com/doi/abs/10.3109/17453674.2015.1006981
Type:
Article
Language:
en
ISSN:
1745-3674; 1745-3682
Appears in Collections:
IHR Institute for Health Research

Full metadata record

DC FieldValue Language
dc.contributor.authorBerber, Reshiden
dc.contributor.authorKhoo, Michaelen
dc.contributor.authorCook, Erica Janeen
dc.contributor.authorGuppy, Andrewen
dc.contributor.authorHua, Jiaen
dc.contributor.authorMiles, Jonathanen
dc.contributor.authorCarrington, Richarden
dc.contributor.authorSkinner, Johnen
dc.contributor.authorHart, Alisteren
dc.date.accessioned2015-07-02T11:00:51Zen
dc.date.available2015-07-02T11:00:51Zen
dc.date.issued2015-06en
dc.identifier.citationBerber, R., Khoo, M., Cook, E., Guppy, A., Hua, J., Miles, J., Carrington, R., Skinner, J., Hart, A. (2015) 'Muscle atrophy and metal-on-metal hip implants' Acta Orthopaedica 86 (3):351en
dc.identifier.issn1745-3674en
dc.identifier.issn1745-3682en
dc.identifier.doi10.3109/17453674.2015.1006981en
dc.identifier.urihttp://hdl.handle.net/10547/558752en
dc.description.abstractBackground and purpose — Muscle atrophy is seen in patients with metal-on-metal (MOM) hip implants, probably because of inflammatory destruction of the musculo-tendon junction. However, like pseudotumors, it is unclear when atrophy occurs and whether it progresses with time. Our objective was to determine whether muscle atrophy associated with MOM hip implants progresses with time. Patients and methods — We retrospectively reviewed 74 hips in 56 patients (32 of them women) using serial MRI. Median age was 59 (23–83) years. The median time post-implantation was 83 (35–142) months, and the median interval between scans was 11 months. Hip muscles were scored using the Pfirrmann system. The mean scores for muscle atrophy were compared between the first and second MRI scans. Blood cobalt and chromium concentrations were determined. Results — The median blood cobalt was 6.84 (0.24–90) ppb and median chromium level was 4.42 (0.20–45) ppb. The median Oxford hip score was 34 (5–48). The change in the gluteus minimus mean atrophy score between first and second MRI was 0.12 (p = 0.002). Mean change in the gluteus medius posterior portion (unaffected by surgical approach) was 0.08 (p = 0.01) and mean change in the inferior portion was 0.10 (p = 0.05). Mean pseudotumor grade increased by 0.18 (p = 0.02). Interpretation — Worsening muscle atrophy and worsening pseudotumor grade occur over a 1-year period in a substantial proportion of patients with MOM hip implants. Serial MRI helps to identify those patients who are at risk of developing worsening soft-tissue pathology. These patients should be considered for revision surgery before irreversible muscle destruction occurs.en
dc.language.isoenen
dc.publisherInforma Healthcareen
dc.relation.urlhttp://informahealthcare.com/doi/abs/10.3109/17453674.2015.1006981en
dc.rightsArchived with thanks to Acta Orthopaedicaen
dc.subjectmuscle atrophyen
dc.subjecthip implantsen
dc.titleMuscle atrophy and metal-on-metal hip implantsen
dc.typeArticleen
dc.contributor.departmentRoyal National Orthopaedic Hospitalen
dc.contributor.departmentUniversity of Bedfordshireen
dc.contributor.departmentMiddlesex Universityen
dc.identifier.journalActa Orthopaedicaen
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