Total hip resurfacing/replacement with metal-on-metal prosthesis in young patients: studying efficacy


  • Syed M. Adil Department of Orthopedics, Military Hospital Kirkee, Pune, Maharashtra, India
  • Dilip Kumar Deepak Department of Orthopedics, Armed Forces Medical College, Pune, Maharashtra, India
  • Anuj Singh Department of Anesthesiology, Base Hospital, Delhi, India



Metal over metal, Harris hip score, Avascular necrosis, Osteolysis


Background: This prospective case series study was carried out to review the literature and compare the efficacy of usage of metal over metal prosthesis in young patients undergoing hip replacement versus conventional metal over polyethylene prosthesis.

Methods: The study was conducted at tertiary care hospital of Indian armed forces with sample size of n=25, to assess early functional outcome of total hip replacement with metal-on-metal prosthesis. Analysis was carried out in terms of improvement in functional status, pain relief, achieving greater range of motion and joint stability.

Results: Mean follow up period was 26 months. The average pre-op Harris hip score was 38.96. The average post-op and last follow up Harris hip score was 84.92 and 86.1. The average pre and post op Harris hip scores of the patients with Idiopathic AVN were 39.7 and 82.5 respectively and the average pre and post op Harris hip scores of the patients with post-traumatic AVN were 37.4 and 86.2. The average pre op and post op Harris hip scores of the patients with non union fracture neck of femur were 36.5 and 86.7 respectively. None of the patient had aseptic loosening, heterotopic ossification or migration of the components, stem failure. There were no cases of dislocation of prosthesis, aseptic loosening, osteolysis, heterotrophic ossification.

Conclusions: This observational study demonstrated better clinical acceptability and profile of metal on metal prosthesis in young patients, having undergone hip replacement.


Bizot P, Nizard R, Hamadouche M, et al. Prevention of wear and osteolysis: alumina-on-alumina bearing. Clin Orthop Relat Res. 2001;393:85-93.

Amstutz HC. Metal on Metal Hip Protheses: Past Performance and Future Directions. Clin Orthop Relat Res. 1996;329:S2-3.

Aaron E, Augio Wang. Hip Simulator wear comparison of metal-on-metal, ceramic-on-ceramic and crosslinked UHMWPE bearings. Wear. 2013; 259(7): 992-5.

Cuckler JM. The rationale for metal on metal total hip arthroplasty Clin Orthop Relat Res. 2005;441:132-6.

Long WT. The Clinical Performance of Metal-on-Metal as an Articulation Surface in Total Hip Replacement. Iowa Orthop J. 2005;25:10-6.

Anissian HL, Stark A, Gustafson A, Good V, Clarke IC. Comparison of wear properties in polyethylene on metal with that of metal on meyal articulations using joint simulator studies. Acta Orthop Scand. 1999; 70(6):578-82

Tharani R, Dorey FJ, Schmalzried TP. The risk of cancer following total hip or knee arthroplasty. J Bone Joint Surg Am. 2001;83:774-80

Delaunay CP, Bonnomet F, Clavert P, Laffargue P, Migaud H. THA using metal-on-metal articulation in active patients younger than 50 years. Clin Orthopaed Related Res. 2008;466(2):340-6

Boughebrib OE, Haveta P, Triclotc JF, Lardancheta A. Gabriona Large diameter head metal-on-metal bearings total hip arthroplasty: Preliminary results. Orthopaed Traumatol Surg Res. 2009;96:14-20.

Holloway I, Walter WL, Zicat B, William K. Walter Osteolysis with a cementless second generation metal-on-metal cup in total hip replacement. Int Orthop. 2009;33(6):1537-42.

McCalden RW, MacDonald SJ, Rorabeck CH, Bourne RB. Wear rate of highly cross-linked polyethylene in total hip arthroplasty. A randomized controlled trial. J Bone Joint Surg Am. 2009;91(4): 773-82.

Cuckler JM. The rationale for metal-on-metal total hip arthroplasty. Clin Orthop Relat Res. 2005;441: 132-6.

Smith TM, Berend KR, Lombardi AV, Emerson RH, Mallory Metal-on-metal hip arthroplasty with large heads may prevent early dislocation. Clin Orthopaed Related Res. 2005;441:137-42.

Haan,C. Pattyn HS, Murray DW, Campbell PA. Correlation between inclination of the acetabular component and metal ion levels in metal-on-metal hip resurfacing replacement. Bone Joint J. 2008.

William T, Long MD, Dastane M, Harris MJ, Wan Z, Lawrence D et al. Failure of the durom metasul acetabular component. Clin Orthop Relat Res. 2010; 468:400-5.

Schwartz JT Jr, Mayer JG, Engh CA. Femoral fracture during non-cemented total hip arthroplasty. J Bone Joint Surg Am. 1989;71:1135-42.

Jasty M, Webster W, Harris W. Management of limb length inequality during total hip replacement. Clin Orthop Relat Res. 1996;(333):165-71.

Rosendahl S, Christoffersen JK, Norgaard M. Par articular ossification following hip replacement. Acta Orthop Scand. 1977;48:400-4.

Brown M, Larson B, Shen F, Moskal JT.Thigh Pain After Cementless Total Hip Arthroplasty: Evaluation and Management J Am Acad Orthop Surg. 2002;10: 385-92.

Gayana M, Pandit H, Kliskey K, Murray D, Gill HS. Necrotic and inflammatory changes in metal-on-metal resurfacing hip arthroplasties Relation to implant failure and pseudotumor formation. Acta Orthopaed. 2009;80:653-9.

Langton DJ, Jameson SS, Joyce TJ, Hallab NJ, Natu S, Nargol A. Early failure of metal-on-metal bearings in hip resurfacing and large-diameter total hip replacement A consequencw of excess wear. Bone Joint J. 2010.






Original Research Articles