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J Arthroplasty. 2015 Oct;30(10):1794-8. doi: 10.1016/j.arth.2015.04.036. Epub 2015 May 30.

The Symmetry of Adverse Local Tissue Reactions in Patients with Bilateral Simultaneous and Sequential ASR Hip Replacement.

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Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Department of Orthopaedic Surgery, Boston, Massachusetts.
Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts.
Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York.
Sportsmed SA, Stepney, South Australia.


The purpose of this study was to evaluate whether patients with bilateral metal-on-metal (MoM) hip replacements have symmetric adverse local tissue reactions (ALTRs) at follow-up. An MRI of both hips was performed at a mean time of six years after surgery in 43 patients. The prevalence and severity of ALTRs were found to be similar in simultaneous hips but differences were observed in sequential hips. The order and timing of sequential hip arthroplasties did not affect the severity of ALTRs. Thus, in addition to metal ion exposure from an earlier MoM implant other factors may also play a role in the progression of ALTRs. Bilateral implants should be given special consideration in risk stratification algorithms for management of patients with MoM hip arthroplasty.


ASR; adverse local tissue reaction; bilateral; hip arthroplasty; metal-on-metal

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