Navigation Links
Hip implant patients with unexplained pain likely to have tissue damage

The cause of unexplained pain among metal-on-metal hip implant patients is more likely to be tissue damage than wear of the implant, Hospital for Special Surgery researchers have found. The study, performed by Dr. Danyal Nawabi, orthopedic surgery fellow, and research collaborators at HSS, will be reported at the upcoming annual meeting of the American Academy of Orthopaedic Surgeons, March 19-23, in Chicago.

Researchers set out to determine causes of unexplained pain among patients with metal-on-metal hip implants (in which the ball and socket are both made of metal) who came to the hospital for revision surgery. Metal-on-metal implants have potential advantages, said Timothy Wright, Ph.D., Kirby Chair of Orthopedic Biomechanics at Hospital for Special Surgery (HSS): "If they remain well lubricated, as happens with the oil in your car, it minimizes wear." In addition, surgeons can implant a bigger head, or ball, making the hip joint more stable. But nationwide, failure of metal-on-metal hip devices due to unexplained pain is rising.

The research group, which did not have any ties to hip implant manufacturers, was led by Dr. Douglas Padgett, chief of the Adult Reconstruction and Joint Replacement Division and chief of the Hip Service at HSS, and Dr. Hollis Potter, chief of the Division of Magnetic Resonance imaging (MRI). They compared 50 patients (33 with total hip arthroplasties and 17 with hip resurfacing arthroplasties) who came to HSS for revision surgery because of unexplained pain, to a control group of 48 patients (23 with total hip arthroplasties and 25 with hip resurfacing arthroplasties) who came to HSS for revision surgery because of loosening, malalignment, infection or fracture. The investigators combined results from clinical examinations of the patients, magnetic resonance imaging, wear analysis studies on the removed implants, and pathology studies of tissues removed at surgery, including the degree of aseptic lymphocytic vasculitis-associated lesions (ALVAL), a sign of adverse tissue reactions to metal debris.

Thirty patients with unexplained pain (60% of the group) had an ALVAL score of at least 5 on a 10-point scale, indicating moderate to high adverse tissue reactions. Twelve percent of patients had some buildup of metal deposits in their soft tissue. The average synovial thickness was three times higher in the unexplained pain group compared to the control group, and the average synovial fluid volume was five times higher in the unexplained pain group compared to the control group. Ten times as many patients in the unexplained pain group had high-grade tissue damage scores compared to the control group.

Researchers found no differences between the unexplained pain group and the control group in terms of age, sex, body mass index, length of implantation, or size or positioning of the implants. Implants in both groups showed similar signs of wear.

"We found that some patients had a significant amount of tissue damage but not a lot of wear," Dr. Wright said, "suggesting that factors other than wear are contributing to the problem regardless of whether the patients have pain. We have used the information from our study to develop guidelines for patients and surgeons."

"Hip implant patients with unexplained pain should be followed closely by their surgeon," added Dr. Padgett. "Early identification of patients with unexplained pain is vital to avoid significant tissue damage. The work by Dr. Potter using novel MRI protocols has proven to be invaluable in diagnosing and monitoring these patients."

HSS doctors perform more than 9,000 joint replacement surgeries per year, of which about 10 percent are revision surgeries. Many patients who have had their joint replacement surgeries elsewhere come to HSS for revision surgery.


Contact: Phyllis Fisher
Hospital for Special Surgery

Related medicine news :

1. DePuy ASR Hip Replacement Lawsuit Lawyers at Wright & Schulte LLC Report Latest Developments in DePuy ASR Hip Implant Recall Lawsuits
2. Dr. Polo to Offer Much-Anticipated, New Gummy Bear Implants for Superior Breast Augmentation and Breast Reconstruction
3. Metal-on-Metal Hip Implants: Bernstein Liebhard LLP Comments on New Study Finding Increased Metal Ion Levels May Predict Problems with Metal-on-Metal Hip Replacements
4. Midtown Dentistry releases new Dental Education Video - "WHY DENTAL IMPLANTS?"
5. Tiny implants signal new way to treat cancer tumors
6. Dr. Rhys Branman Announces Availability of Mentor Ultra High Profile Implants
7. Stryker Hip Recall Lawyers at Wright & Schulte LLC Investigating Claims, as Stryker Hip Implant Lawsuits in New Jersey Hit 80
8. Law Firm Issues Biomet Hip Infographic Warning Consumers About the Dangers of Biomet Hip Implants
9. Mayo Clinic study finds electric car does not interfere with implanted cardiac devices
10. Weight loss linked to higher risk with implanted defibrillators
11. Glidewell Laboratories Announces Customized Implant Component Stocking Inventory
Post Your Comments:
(Date:11/25/2015)... ... November 25, 2015 , ... Privately ... has undertaken significant expansion of its current state of the art research, development ... PharmaTech’s strategy to increase its manufacturing capacity as well as to support its ...
(Date:11/25/2015)... ... November 25, 2015 , ... Many people know of the ... gain, cold hands, and dry skin. But many people who find their cholesterol levels ... regimen instead of their thyroid, especially if they don’t have any of the other ...
(Date:11/25/2015)... ... November 25, 2015 , ... ... on providing comprehensive solutions involving adult stem cell therapies to patients with chronic ... the “Regenestem” name as a Registered Trademark (RTM). , Organizations are required to ...
(Date:11/25/2015)... ... November 25, 2015 , ... ... prices in an early celebration of the early holiday shopping season. Starting Wednesday ... each (normally $33.95 ea). Black Friday promotional pricing is in addition to any ...
(Date:11/24/2015)... ... November 24, 2015 , ... Eric C. ... the many benefits of the revolutionary BIOLASE WaterLase iPlus 2.0™ system. This advanced ... traditionally used by a dentist in Gettysburg, PA . From routine visits ...
Breaking Medicine News(10 mins):
(Date:11/25/2015)... announced the issue of United States patent No. 9,192,509  entitled: " Methods ... the company,s AVACEN 100 dry heat therapy medical device and specific methods of use, referred to ... Photo - ... ... ...
(Date:11/25/2015)... , Nov. 25, 2015 USP ... hazardous drug preparations (e.g. pharmacists, pharmacy technicians, nurses, ... veterinary technicians). The chapter also covers all entities ... (e.g., pharmacies, hospitals, other healthcare institutions, patient treatment ... --> --> What ...
(Date:11/25/2015)... Nov. 25, 2015  Mindray Medical ... MR ), a leading developer, ... worldwide, today announced that it will ... of shareholders at the Company,s Hong Kong office ... Prince Edward West Road, Mongkok KL, Hong ...
Breaking Medicine Technology: