Verhoogde mortaliteit bij patiënten met een metaal-op-metaal heupprothese*

Objective

To determine the mortality and the morbidity in patients with metal-on-metal articulations (MOM THA) when compared to patients with non-metal-on-metal articulations (non-MOM THA) after primary total hip arthroplasty.

Design

Systematic review, meta-analyses and meta-regression (registration: PROSPERO 2014:CRD42014007417).

Method

Search of PubMed, MEDLINE, EMBASE, Web of Science, Cochrane, CINAHL, AcademicSearchPremier, ScienceDirect, Wiley and clinical trial registers. We included randomised controlled trials and observational studies of primary total hip arthroplasty comparing MOM THA with non-MOM THA. We used meta-regression to identify and evaluate potential modifying variables such as follow-up duration.

Results

Forty-seven studies were included, comprising over 4,000 THA in randomised trials and over 500,000 THA in observational studies. For mortality, random effects analysis revealed a higher pooled risk difference (RD) of 0.7% (95%-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). Further subgroup analyses and meta-regression random effects models revealed no evidence for other modifying variables (study level covariates, e.g. resurfacing vs. non-resurfacing MOM) than follow-up duration.

Conclusion

Meta-analysis suggests there may be an increased long-term risk of mortality associated with MOM THA compared to patients with non-MOM THA.

Conflict of interest and financial support: R. Nelissen is a member of the International Medical Device Regulators Forum, a board member of LROI and the chairman of the European Network Orthopaedic Registries. ICMJE forms provided by the authors are available online along with the full text of this article.