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Metal Ions

In the 1990’s as hip replacements became a commonly performed and more popular procedure, we found that more and more younger and more active patients benefited from total hip arthroplasty. Unfortunately, these younger more active patients experienced significant problems with wear of the polyethylene bearing. Some of these only lasted a few years. As a result of this experience, "alternate" bearing surfaces were developed, including ceramic on ceramic and metal on metal. Ceramic at the time was manufactured in such a way as to be brittle and at risk of fracture. The metal on the other hand, which is Chrome-Cobalt-Molybdenum was extremely durable, with virtually no possibility of wearing out. Unfortunately, after years of success and extensive worldwide use, reports began to surface of patient who had developed a severe inflammatory reaction to the implant. Some of these patients developed what became known as a pseudotumor which is a reactive mass formed by the body in response to an excess of metal ions. This is not a case of large particles of material as is seen in polyethylene failure, but rather a tissue reaction to the ions of the metal (Chrome and Cobalt). Initially, reports out of Europe pointed to a single manufacturer and this led to a recall of the Sulzer implant in the U.S. I used the Biomet metal on metal implant in over 1000 cases. The Biomet implant, although it is a metal on metal implant was different from the Sulzer product in many ways including different compositions in the metal alloy, different treatments to the metal, different tolerances between the ball and socket and even a different shape of the socket. As a result, the metal ion induced failures have been low and the product was not the subject of recall. However, due to metal ion concerns most surgeons have stopped using all devices with metal on metal articulation.

Due to failures of polyethylene in the 1990’s, the manufacturers did extensive research and product development to improve the wear properties of the material. The plastic is now much more durable and resistant to wear. It is now used commonly in young and active patients with excellent results.

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