Revision of metal-on-metal hip replacements and resurfacings for adverse reaction to metal debris: a systematic review of outcomes

Purpose: This systematic review assessed evidence on outcomes following revision of MoM hip resurfacings (HRs) and total hip replacements (THRs) for adverse reaction to metal debris (ARMD). Methods: Four electronic databases were searched between January 2009 and July 2013 to identify studies reporting clinical outcomes following revision of MoM HRs and THRs for ARMD. Only studies reporting cohorts with more than 10 metal-on-metal (MoM) hips revised for ARMD were included. Outcomes of interest following ARMD revision were: 1) complication rates; 2) re-revision rates; 3) surgical intervention other than re-revision; 4) functional outcome. Results: Of 148 unique studies identified, six studies were eligible for inclusion containing 216 MoM hips (197 HRs and 19 THRs) revised for ARMD. Mean follow-up time from ARMD revision ranged between 21-61 months. Complication rates were 4%-50% for HR and 68% for THR. Re-revision rates were 3%-38% for HR and 21% for THR. Dislocation (n = 14), ARMD recurrence (n = 11), and acetabular loosening (n = 9) were the three commonest complications and indications for re-revision. All six studies reported between one and three cases of ARMD recurrence during follow-up. One study specifically reported on performing procedures other than re-revision with 26% requiring closed reductions for dislocated THRs. Functional outcomes following ARMD revision were good or satisfactory in all but two studies. Conclusions: Limited evidence exists regarding outcomes following revision of MoM hips for ARMD, especially for THRs. This should be addressed in future studies and may be important when counselling asymptomatic individuals in whom revision is considered for raised blood metal ions.