Use this URL to cite or link to this record in EThOS: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.687922
Title: The role of metal ions in metal-on-metal total hip replacement
Author: Ebreo, Darren
ISNI:       0000 0004 5915 9761
Awarding Body: University of East Anglia
Current Institution: University of East Anglia
Date of Award: 2016
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Abstract:
Metal-on-metal (MoM) total hip replacement (THR) offered theoretical advantages of decreased wear and increased functional outcomes. MoM bearings have been associated with sterile inflammatory masses and significant soft tissue destruction with poorer outcomes following revision surgery. The natural history of adverse reactions to metal debris (ARMD) is unknown, but may represent contributions from bearing surface wear, taper junction wear, and corrosion. Immunological and genetic factors may influence susceptibility to development of ARMD. Between 1997 and 2004, 652 Ultima TPS THRs (DePuy) were implanted in 545 patients who went on to experience a high rate of early implant failure (13.8%). Management of these patients has evolved beyond regular clinical follow up with plain radiographs to include surveillance monitoring of trends in levels of blood metal ions and staging of disease using metal artefact reduction (MAR) MRI. This study investigated: • The natural history of ARMD in 28mm MoM THR using MAR MRI. • The possibility of diurnal variation of cobalt (Co) and chromium (Cr). • Differences in gene expression profiles of patients undergoing revision of a metal-on-polyethylene (MoP) THR for aseptic loosening and those with ARMD arising from MoM THR. In patients whose MARS MRI staging on initial scan is normal or where mild evidence of disease is demonstrated, further deterioration is unlikely. Where it does occur, the rate of deterioration is slow and there may be a latent period of many years. There is no diurnal variation in levels of cobalt (Co) in plasma or urine. There is diurnal variation in levels of plasma chromium, but this is not clinically significant. Patterns of gene expression in patients with aseptic loosening of a metal-onpolyethylene (MoP) THR, and patients with ARMD from a MoM THR investigated by a microarray experiment were found to be similar on a genome-wide level suggesting that they may share common factors in their aetiologies. These studies have helped to describe the natural history of ARMD on a cellular and radiological level, and have provided a contribution to the evidence base that will inform as to the optimum strategy for monitoring these patients before they develop catastrophic complications.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID: uk.bl.ethos.687922  DOI: Not available
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