Metasul metal-on-metal THRs have high rate of revision and incidences of radiolucent lines .
This report has been verified
by one or more authors of the
original publication.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(16):1 Bone Joint J. 2013 Jul;95-B(7):881-6. doi: 10.1302/0301-620X.95B7.31067399 hips undergoing total hip replacement were randomized to receive either Metasul metal-on-metal (MoM), metal-on-conventional polyethylene (MoP), or ceramic-on-polyethylene (CoP) bearings using a cemented triple-tapered polished femoral component (MS-30). The study aimed to compare the three types of bearings in clinical and radiological outcomes. The results taken at 2,5,and 7 years revealed that MoM group had the lowest Harris Hips scores, higher rates of revision, and higher incidence of radiolucent lines in unrevised hips.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Oui = 1
Incertain = 0,5
Non pertinent = 0
Non = 0
L'évaluation des critères de rapport permet d'évaluer la transparence avec laquelle les auteurs rapportent les caractéristiques méthodologiques et les caractéristiques de l'essai dans la publication. L'évaluation est divisée en cinq catégories qui sont présentées ci-dessous.
3/4
Randomization
2/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
3/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
L'indice de fragilité est un outil qui aide à l'interprétation des résultats significatifs, en fournissant une mesure de la force d'un résultat. L'indice de fragilité représente le nombre d'événements consécutifs qui doivent être ajoutés à un résultat dichotomique pour que le résultat ne soit plus significatif. Un petit nombre représente un résultat plus faible et un grand nombre un résultat plus fort.
Pourquoi cette étude était-elle nécessaire maintenant ?
Metasul metal-on-metal (MoM) articulation has shown lower wear rates than metal-on-polyethylene (MoP) bearings in Total Hip Replacement (THR), especially when used in cementless fixation. However, some evidence has reported that cemented MoM articualtions using 28 mm bearing have high rates of radiolucent lines (RLLs) and aseptic loosening. Hence, this RCT aimed to compare cemented Metasul MOM bearing with MoP and ceramic-on-polyethylene (CoP) bearings.
Quelle était la principale question de recherche ?
How do long term outcomes, such as incidences of radiolucent lines (RLLs), rate of revision, and clinical results, compare between cemented Metasul MoM, MoP, and ceramic-on-polyethylene (CoP) bearings used in total hip replacement?
- No difference was found in mean abduction angle (p=0.69) and HHS (p=0.104) at 7 years in 341 hips (86%) between the three bearing types.
- MoM hips had higher incidences of peri-acetabular radiolucent lines of greater and equal to 2mm (p<0.001),
- 12 revisions were performed, 8 in the MoM group, 3 in the MoP group and 1 in the CoP group. There was a significant difference in the number of revisions between the MoM and Mop/Cop groups (p<0.001).
- No aseptic loosening was seen in the MoP and CoP groups.
- 4infections occurred in the MoM group compared with 1 infection in the MoP group and 1 infection in the CoP group.
De quoi dois-je me souvenir en priorité ?
The trial indicated that at a 7 year follow up period, cemented metal-on-metal bearings resulted in higher incidence of radioluscent lines around the acetabular component than metal-on-polyethylene and ceramic-on-polyethylene bearings. The metal-on-metal bearing also required higher revision rates and had lower Harris Hip scores.
Comment cela affectera-t-il les soins prodigués à mes patients ?
The study suggests that patients with 28 mm Metasul metal-on-metal bearing should be followed with caution when compared to the other implants used. It is unclear how these results may be applied to other metal on metal implants. Continuing surveillance of the outcomes of differing implant designs and bearing surfaces is warranted.
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