Outcomes after revision of metal on metal hip resurfacing to total arthroplasty using the direct anterior approach

Abstract

Background: Function after revision total hip arthroplasty (THA) in failed metal-on-metal (MoM) hip resurfacing arthroplasty (HRA) is variable, but post-operative complication rates are reportedly high. We hypothesized HRA conversion to THA using the direct anterior approach (DAA) would be associated with optimal outcome. Methods: Seventeen MoM-HRAs in 15 patients (seven males, eight females) were revised through the DAA. The mean age was 45 years (28–59 yrs). The most common indications for revision were aseptic loosening of the acetabular component or of the femoral component and femoral neck fracture. In 16 hips, a conversion to a ceramic-on-ceramic (CoC) (13 hips) or to a metal-on polyethylene (MOP) (2), or to a large-head MoM (1) THA was done. An isolated femoral revision was done in one hip. Results: After 6.7 ± 3 years, no hip had required a re-revision. The Postel-Merle d’Aubigne (PMA) functional score improved from 9 (4–14) to 16 (12–18) (p < 0.001). An intra-operative fracture of the greater trochanter (one hip) and dysesthesia of the lateral femoral cutaneous nerve (four hips) were reported. Mean serum chromium concentration decreased from 33.2 μg/L (11.8–62 μg/L) pre-operatively to 5.8 μg/L (0.4–35.5 μg/L) post-operatively (p < 0.001), and mean serum cobalt concentration decreased from 35.8 μg/L (6.3–85.5 μg/L) to 4.7 μg/L (0.26–25.7 μg/L) (p = 0.003). Conclusion: Revision of failed MoM-HRA using the DAA resulted in an acceptable clinical outcome, no specific complication and no further surgery. A consistent decline in serum ion levels may be expected following HRA conversion to THA.