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    Muscle atrophy and metal-on-metal hip implants

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    Authors
    Berber, Reshid
    Khoo, Michael
    Cook, Erica Jane
    Guppy, Andrew
    Hua, Jia
    Miles, Jonathan
    Carrington, Richard
    Skinner, John
    Hart, Alister
    Affiliation
    Royal National Orthopaedic Hospital
    University of Bedfordshire
    Middlesex University
    Issue Date
    2015-06
    Subjects
    muscle atrophy
    hip implants
    
    Metadata
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    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.
    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
    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
    ae974a485f413a2113503eed53cd6c53
    10.3109/17453674.2015.1006981
    Scopus Count
    Collections
    IHR Institute for Health Research

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