Metallosis in Metal-on-Metal PPF Total Hip Arthroplasties

  • Robert Legenstein
  • W. Huber
  • P. Boesch
Part of the Ceramics in Orthopaedics book series (CIO)


Metallosis in total hip arthroplasty (THA) is a not commonly reported complication. We followed 173 consecutive patients, who had received primary, single and non-cemented proximal press fit (PFF) THA with metal-on-metal bearings made of low carbon content in 1995. Follow-up results are available for a total of 161 (93.1%) patients. The mean age of the patients was 63.3 years (31 to 76). The mean duration of follow-up was 94.5 months (range, 57 to 112). The median Harris hip score at follow-up was 95 points.

36 (20.8%) metallosis cases were observed. 18 cases because of metallosis were revised. Dislocation in metallosis cases occurred in 25%. Revisions were obtained because of 2 femur fractures (1 with metallosis) and 5 infections. The results with metal-on-metal bearings were not satisfactory. Toxic metal concentrations in joint effusions were found. We do not implant or recommend metal-on-metal bearings in total hip arthroplasty anymore.


Heterotopic Ossification Cobalt Chromium Periprosthetic Osteolysis Radiolucent Area Inguinal Pain 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    McKee GK. Total hip replacement — past, present and future. Biomaterials 1982; 3:130–135.PubMedCrossRefGoogle Scholar
  2. 2.
    Weber BG. Experience with the metasul total hip bearing system. Clin Orthop Relat Res 1996;329S:569–577.Google Scholar
  3. 3.
    Wagner M, Clin Orthop Relat Res 2000;379:123–133.PubMedCrossRefGoogle Scholar
  4. 4.
    Willert H-G, Buchhorn GH, Göbel D, Köster G, Schaffner S, Schenk R, Semlitsch M. Wear behavior and histopathology of classic cemented metal on metal hip endoprostheses. Clin Orthop Relat Res 1996;329S:160–186.CrossRefGoogle Scholar
  5. 5.
    Chan FW, Bobyn JD, Medley JB, Krygier JJ, Tanzer M. Wear and lubrication of metal-on-metal hip implants. Clin Orthop Relat Res 1999;369:10–24.PubMedCrossRefGoogle Scholar
  6. 6.
    Beaule PE, Campell P, Mirra J, Hooper JC, Schmalzried TP. Osteolysis in a cementless, second generation metal-on-metal hip replacement. Clin Orthop Relat Res 2001;386:159–165.PubMedCrossRefGoogle Scholar
  7. 7.
    Willert H-G, Buchhorn GH, Fayyazi A, Lohmann CH. Histolopathologische Veränderungen bei Metal/Metall-Gelenken geben Hinweise auf eine zellvermittelte Überempfindlichkeit. Osteologie 2000;9(3):165–169.Google Scholar
  8. 8.
    Doorn PF, Mirra JM, Campell PA, Amstutz HC. Tissue reaction to metal on metal total hip prostheses. Clin Orthop Relat Res 1996;329S:187–205.CrossRefGoogle Scholar
  9. 9.
    Justy M, Goetz DD, Bragdon CR, Lee KR, Hanson AE, Elderi JR, Harris WH. Wear of polyethylene acetabular components in total hip arthroplasty. J Bone Joint Surg. Am. 1996;79:349–358.Google Scholar
  10. 10.
    Brooker AF et al. Ectopic ossification following total hip replacement. J Bone Joint Surg. Am. 1973;55:1629–1632.PubMedGoogle Scholar
  11. 11.
    Schmidt et al. Cobald Chromium Molybdenum Metal Combination for Modular Hip Prostheses. Clin Orthop Relat Res 1996;329:35–47.CrossRefGoogle Scholar
  12. 12.
    Mc Kellop et al. In vivo war of 3 types of metal on metal hip prostheses during two decades of use. Clin Orthop Relat Res 1996;329:128–140.CrossRefGoogle Scholar
  13. 13.
    Medley JB, Chan FW, Krygier JJ, Bobyn JD. Comparison of alloys and designs in a hip simulator study of metal on metal implants. Clin Orthop Relat Res 1996;329S:148–159.CrossRefGoogle Scholar
  14. 14.
    Meritt et al. Distribution of cobalt chromium wear and corrosion products and biologic reactions. Clin Orthop Relat Res 1996;329:233–243.CrossRefGoogle Scholar
  15. 15.
    Jacobs et al. Cobalt chromium concentrations in patients with metal on metal total hip replacements. Clin Orthop Relat Res 1996;329:256–263.CrossRefGoogle Scholar
  16. 16.
    Brodner et al. Elevated serum cobalt with metal on metal articulating surfaces. J Bone Joint Surg. Br. 1997;79:316–321.PubMedCrossRefGoogle Scholar
  17. 17.
    Kriebich et al. Systemic release of cobalt and chromium after uncemented total hip replacement. J Bone Joint Surg. Br. 1996;78:18–21.Google Scholar
  18. 18.
    Boehler M, Kanz F, Schwarz B, Steffan I, Walter A, Plenk H Jr, Knahr K. Adverse tissue reactions to wear particels from Co-alloy articulations, increased by alumina-blasting particle contamination from cementless Ti-based total hip implants. J Bone Joint Surg. Br. 2002;84:128–136.CrossRefGoogle Scholar
  19. 19.
    Reinisch G, Judmann KP, Lhotka Ch, Lintner F, Zweymüller KA. Retriviel study of uncemented metal-metal hip prostheses revised for early loosening. Biomaterials 2003;24:1081–1091.PubMedCrossRefGoogle Scholar
  20. 20.
    Korovessis P, Petsinis G, Repanti Maria. Zweymüller with metal-on-metal articulation: clinical, radiological and histological analysis of short-term results. Arch Orthop Trauma Surg 2003;123:5–11.PubMedGoogle Scholar
  21. 21.
    Gruen TA, McNeice GM, Amstutz HC Modes of failure of cemented stem-type femoral components. Clin Orthop 1979;141:17–27.PubMedGoogle Scholar
  22. 22.
    DeLee JC, Charnley J Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop 1976;121: 20.PubMedGoogle Scholar
  23. 23.
    Tönnis D, Arning A, Bloch M, Heinecke A, Kalchschmidt K. Triple pelvic osteotomy. J Paediatr Orthop Part B 1994;3:54–67.Google Scholar
  24. 24.
    Harris W H. Traumatic arthritis of the hip after dislocation and acetabular fracture — Treatment by mold arthroplasty. J Bone Joint Surg 1969;51-A:737–755.Google Scholar
  25. 25.
    Bertram. Spurenelemente Analytik, ökotokikologische und medizinisch-klinische Bedeutung. Verlag Urban&Schwarzenberg.Google Scholar
  26. 26.
    Lison D, Lauwerys R, Demendts M, Nemery B. Experimental research into the pathogenesis of cobalt/hard metal lung disease. Eur Respir J 1996;9:1024–1028.PubMedCrossRefGoogle Scholar
  27. 27.
    Jones DA, Lucas HK, O’Driscoll M, Price CH, Wibberley B. Cobalt toxicity after McKee hip arthroplasty. J Bone Joint Surg Br. 1975;57(3):289–296.PubMedGoogle Scholar
  28. 28.
    Huk OL, Catelas I, Mwale F, Antoniou J, Zukor DJ, Petit A. Induction of apoptosis and necrosis by metal ions in vitro. J Arthroplasty 2004;19(8Suppl):84–87.PubMedCrossRefGoogle Scholar
  29. 29.
    Schaffer AW, Pilger A, Engelhardt C, Zweymüller K, Ruediger HW. Increased blood cobalt and chromium after total hip replacement. J Toxicol Clin Toxicol. 1999;37(7)839–844.PubMedCrossRefGoogle Scholar
  30. 30.
    Haynes DR, Rogers SD, Hay S, Pearcy MJ, Howie DW. The differences in toxicicty and release of bone-resorbing mediators induced by titanium and cobalt-chromium-alloy wear particles. J Bone Joint Surg Br. 1975;75(6):825–834.Google Scholar
  31. 31.
    Nemery B, Bast A, Behr J et al. Interstitial lung disease induced by exogenous agents: factors governing susceptibility. Eur Respir J 2001;18:30–42.Google Scholar

Copyright information

© Steinkopff Verlag 2007

Authors and Affiliations

  • Robert Legenstein
    • 1
  • W. Huber
  • P. Boesch
  1. 1.Orthopaedic ClinicHospital Wiener NeustadtWiener NeustadtAustria

Personalised recommendations