Part I: Introduction
Chapter 1: Introduction
Chapter 2: Bearing Surfaces for Joint Replacement: New Materials or New Problems?
Part II: Clinical
Chapter 3: Outcome Studies for Metal-on-Metal Bearings: What Evidence-Based Medicine Tells Us
Chapter 4: Metal Reactivity: Its Influence on Primary and Revision Outcomes
Chapter 5: Are metal ion levels a trigger for surgical intervention?
Chapter 6: Metal Sensitivity: Is it possible to Determine Clinically?
Part III: Biology
Chapter 7: Wound healing, chronic inflammation, and immune responses
Chapter 8: Benign Responses to Orthopaedic Implants: Really?
Chapter 9: What does the Histology Tell Us?
Part IV: Biomechanics
Chapter 10: Why metal-on-metal -what laboratory tests have shown us
Chapter 11: What do the Retrievals really tell us?
This book addresses the background and significance of the factors potentially influencing the clinical and biological outcomes of metal-on-metal hip implants. Metal-on-metal bearings were introduced and evaluated as an alternative to other bearing couples, particularly metal-on-polyethylene, due to their enhanced wear resistance as determined in laboratory testing. Initially, reports of short-term clinical outcomes were favorable and an increasing number of metal-on-metal prostheses were implanted. Subsequently, isolated case findings describing adverse tissue responses around the articulation became the harbinger of an increasing number of reports describing pseudotumors and other significant lymphocytic-based responses associated with metal-on-metal prostheses. Questions have been raised as to whether this is an implant, design, or patient-specific response. The reasons why some patients have a negative biological response and pathology while others do not remain to be determined, but tens of thousands of patients in the US, the UK, and around the world are considered to be at risk. Leading researchers and clinicians describe the issues related to the nature of the biological and pathological responses and the protocols that should be followed to determine if an adverse response is occurring. This book is essential reading for researchers, engineers, and orthopaedic surgeons who are involved in the design, evaluation, and implantation of metal-on-metal prostheses.
Presents an historical overview of the use of metal-on-metal articulations
Collects for the first time the information necessary to assess clinically and biologically relevant patient outcomes
Addresses the practical questions that are being raised by surgeons, researchers, and engineers
Features contributions by acknowledged leaders in their fields
Describes what the clinician needs to know in order to practice evidence-based medicine
Projects directions for clinical, biological, and biomechanical research efforts