Journal Article

Increased Mortality in Metal-on-Metal versus Non-Metal-on-Metal Primary Total Hip Arthroplasty at 10 Years and Longer Follow-Up: A Systematic Review and Meta-Analysis

Meessen, J. M. T. A., Schoones, J. W., Nelissen, R. G. H. H., van der Heide, H. J. L., Fiocco, M., Pijls, B. G., Sedrakyan, A.

2016

Overview

There are concerns about increased mortality in patients with metal-on-metal bearings in total hip arthroplasty (THA). To determine the mortality and the morbidity in patients with metal-on-metal articulations (MOM THA) compared to patients with non-metal-on-metal articulations (non-MOM THA) after primary total hip arthroplasty. Search of PubMed, MEDLINE, EMBASE, Web of Science, Cochrane, CINAHL, AcademicSearchPremier, ScienceDirect, Wiley and clinical trial registers through March 2015, augmented by a hand search of references from the included articles. No language restrictions were applied. Two reviewers screened and identified randomised controlled trials and observational studies of primary total hip arthroplasty comparing MOM THA with non-MOM THA. Two reviewers independently extracted study data and assessed risk of bias. Risk differences (RD) were calculated with random effect models. Meta-regression was used to explore modifying factors. Difference in mortality and difference in morbidity expressed as revisions and medical complications between patients with MOM THA and non-MOM THA. Forty-seven studies were included, comprising 4,000 THA in randomised trials and over 500,000 THA in observational studies. For mortality, random effects analysis revealed a higher pooled RD of 0.7%, 95%, confidence interval (CI) [0.0%, 2.3%], I-square 42%; the heterogeneity was explained by differences in follow-up. When restricted to studies with long term follow-up (i.e. 10 years or more), the RD for mortality was 8.5%, 95%, CI [5.8%, 11.2%]; number needed to treat was 12. Further subgroup analyses and meta-regression random effects models revealed no evidence for other moderator variables (study level covariates, e.g. resurfacing vs. non-resurfacing MOM) than follow-up duration. The quality of the evidence presented in this meta-analysis was characterized as moderate according to the CLEAR-NPT (for non-pharmacological trials) and Cochrane risk of bias Table. Meta-analysis suggests there may be an increased long-term risk of mortality and revision surgery for patients with MOM THA compared to patients with non-MOM THA. PROSPERO 2014:CRD42014007417.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Arthroplasty, Replacement, Hip - adverse effects / Arthroplasty, Replacement, Hip - methods / Arthroplasty, Replacement, Hip - mortality / Bias / Biology and Life Sciences / Biomedical materials / Clinical trials / Comparative analysis / Complications / Confidence intervals / Follow-Up Studies / Health aspects / Heterogeneity / Hip / Hip joint / Hip Prosthesis - adverse effects / Hip Prosthesis - statistics & numerical data / Hip replacement arthroplasty / Humans / Joint surgery / Medicine and Health Sciences / Meta-analysis / Metal-on-Metal Joint Prostheses - adverse effects / Metal-on-Metal Joint Prostheses - statistics & numerical data / Metals / Methods / Morbidity / Mortality / Mortality - trends / Mortality risk / Observational studies / Patients / People and Places / Pharmacology / Physical Sciences / Prosthesis Failure - trends / Randomization / Regression analysis / Reoperation - mortality / Reoperation - statistics & numerical data / Research and Analysis Methods / Resurfacing / Risk assessment / Risk factors / Statistical analysis / Subgroups / Surfacing / Surgery / Surgical implants / Systematic review / Total hip arthroplasty / United States