Elizabeth Hofheinz, M.P.H., M.Ed. • Sun, February 10th, 2013
“Like taking candy from a baby,” says Bill Maloney. “There is very little/zero indication for metal-metal articulations.” “But the benefits of metal-metal are well known: high stability because of the large diameter, low wear potential, and they are unbreakable,” states Tom Schmalzried.
This week’s Orthopaedic Crossfire® debate is “Metal-Metal Articulation: Cease and Desist.” For the proposition was William J. Maloney III, M.D. from Stanford Hospital and Clinics in Stanford, California. Against the proposition was Thomas P. Schmalzried, M.D. of The Joint Replacement Institute in Los Angeles, California. Moderating was Thomas S. Thornhill, M.D. from Harvard Medical School.
Dr. Maloney: “This is like taking candy from a baby. In the early to mid ‘90s we had terrible problems with osteolysis, especially in young, active patients with conventional polyethylene with cementless devices. Then new bearings were introduced: highly crosslinked polyethylene, metal-on-metal and ceramic-on-ceramic. The hypothesis was that if you reduce the wear volume it would mean a reduction in the incidence of osteolysis and the incidence of aseptic loosening.”
“Ten years later: femoral component fixation is solved, and we’re seeing unique complications with metal-metal articulations. There is a spectrum of adverse tissue reactions that have been described as a foreign body reaction; there’s a toxicity reaction with cell necrosis, there’s potentially a hypersensitivity reaction, and then there’s ALVAL [aseptic lymphocytic vasculitis associated lesion].”