Comparative Mid-term Follow-up Study of Primary Total Hip Arthroplasty with Metal-on-metal and Metal-on-polyethylene Bearings

Abstract

Objective: To compare mid-term clinical results of total hip arthroplasty (THA) with metal-on-metal (MoM) and metal-on-polyethylene (MoP) bearings and to evaluate the biological safety of the two kinds of prostheses. Methods: Thirty-two patients who received a primary THA with an MoM articulation between January 2008 and December 2010 were selected to form the MoM group retrospectively. The MoP group consisted of 32 patients who received a THA with an MoP prosthesis during the same period. Clinical assessments, imaging examinations, laboratory tests, and metal ion concentration detections were conducted on each patient. Another 32 healthy volunteers were recruited as the control group. Results: Twenty-seven patients in the MoM group and 28 patients in the MoP group completed the follow-up, with a mean follow-up time of 74.6 and 75.9 months, respectively. The mean Harris score at the latest follow-up was 91.5 ± 5.1 in the MoM group versus 88.9 ± 4.0 in the MoP group (P = 0.22). The MoM group showed a better range of motion in flexion, abduction, and external rotation. Co and Cr levels in the MoM group were 2.5-fold and 2.0-fold of these in the MoP group. A mild change of liver function was observed in both groups, while the values of renal function and humoral immunity stayed static. Elevated proportions of Th1 and Th17 cells and decreased proportion of Th2 cells were observed in the MoM group. The occurrence rate of pseudotumors in the MoM and MoP groups was 40.74% ± 9.45% and 14.28% ± 6.61%, respectively (P < 0.05). Conclusion: At the mid-term follow-up, clinical results were satisfied in both groups. MoM prosthesis could result in elevated serum metal ion levels and there is a higher risk of pseudotumor. Long follow-up is needed to evaluate the safety of MoM prostheses.