Ultrasound-based decision making following metal-on-metal hip arthroplasty

Background: Metal-on-Metal (MoM) total hip arthroplasty (THA) represents a very controversial procedure because of the possibility of postoperative adverse local tissue reaction (ALTR). This study investigates the reliability of the ultrasound scan as a diagnostic tool to quantify a clinically useful threshold in the level of periprosthetic fluid collection to suggest implant revision. Methods: This study includes 116 patients (123 implants) who received an Articular Surface Replacement XL (ASRTMXL, De Puy Synthes, USA) MoM THA. The study group included 56 males and 60 females with a mean age of 66.6 years (range, 15–86 years). All patients were clinically and radiologically annually evaluated (according to the Harris Hip Score) up to a mean follow-up of 7.5 years (min. 1.4 – max. 10.3 years) from the primary surgery: all patients underwent standard ultrasound evaluation of the affected hip and Cobalt/Chromium blood detection testing according to a custom-made diagnostic algorithm for MoM THA revision. Results: At final follow-up, 51 (43.1%) of 117 implants underwent revision after a mean of 6 years (1.79–9.26) from the primary ASR implant. The authors found a statistically significant correlation between Cr (p = 0.015) and Co (p = 0.009) blood values and different ultrasound grades. Statistical analysis showed a significant association between periprosthetic fluid collection and revision surgery (p < 0.0001) and the final revision risk was estimated to be 7 times greater in patients with ultrasound grade ≥ 2 (peri-prosthetic collection ≥ 20 mm). Conclusions: This study confirms the reliability of ultrasound evaluation in detecting clinically significant peri-prosthetic joint effusions: a new diagnostic algorithm for MoM THA revision is here presented. Longer follow up studies are mandatory to better understand the potential advantages of this diagnostic protocol.