{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T07:30:47Z","timestamp":1761982247800,"version":"build-2065373602"},"reference-count":44,"publisher":"British Editorial Society of Bone & Joint Surgery","issue":"7","license":[{"start":{"date-parts":[[2014,7,1]],"date-time":"2014-07-01T00:00:00Z","timestamp":1404172800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/online.boneandjoint.org.uk\/TDM"}],"content-domain":{"domain":["online.boneandjoint.org.uk"],"crossmark-restriction":true},"short-container-title":["The Bone &amp; Joint Journal"],"published-print":{"date-parts":[[2014,7]]},"abstract":"<jats:p> Large-head metal-on-metal (MoM) total hip replacements (THR) have given rise to concern. Comparative studies of small-head MoM THRs over a longer follow-up period are lacking. Our objective was to compare the incidence of complications such as infection, dislocation, revision, adverse local tissue reactions, mortality and radiological and clinical outcomes in small-head (28 mm) MoM and ceramic-on-polyethylene (CoP) THRs up to 12 years post-operatively. <\/jats:p><jats:p> A prospective cohort study included 3341 THRs in 2714 patients. The mean age was 69.1 years (range 24 to 98) and 1848 (55.3%) were performed in women, with a mean follow-up of 115 months (18 to 201). There were 883 MoM and 2458 CoP bearings. Crude incidence rates (cases\/1000 person-years) were: infection 1.3 vs 0.8; dislocation 3.3 vs 3.1 and all-cause revision 4.3 vs 2.2, respectively. There was a significantly higher revision rate after ten years (adjusted hazard ratio 9.4; 95% CI 2.6 to 33.6) in the MoM group, and ten of 26 patients presented with an adverse local tissue reaction at revision. No differences in mortality, osteolysis or clinical outcome were seen. <\/jats:p><jats:p> In conclusion, we found similar results for small-head MoM and CoP bearings up to ten years post-operatively, but after ten years MoM THRs had a higher risk of all-cause revision. Furthermore, the presence of an adverse response to metal debris seen in the small-head MOM group at revision is a cause for concern. <\/jats:p><jats:p> Cite this article: Bone Joint J 2014; 96-B:868\u201375. <\/jats:p>","DOI":"10.1302\/0301-620x.96b7.32369","type":"journal-article","created":{"date-parts":[[2014,7,1]],"date-time":"2014-07-01T14:55:28Z","timestamp":1404226528000},"page":"868-875","update-policy":"https:\/\/doi.org\/10.1302\/crossmark-policy","source":"Crossref","is-referenced-by-count":11,"title":["A comparative assessment of small-head metal-on-metal and ceramic-on-polyethylene total hip replacement"],"prefix":"10.1302","volume":"96-B","author":[{"given":"A.","family":"L\u00fcbbeke","sequence":"first","affiliation":[{"name":"Geneva University Hospitals, Rue\rGabrielle-Perret-Gentil 4, Geneva, CH-1211, Switzerland."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Gonzalez","sequence":"additional","affiliation":[{"name":"Geneva University Hospitals, Rue\rGabrielle-Perret-Gentil 4, Geneva, CH-1211, Switzerland."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G.","family":"Garavaglia","sequence":"additional","affiliation":[{"name":"Geneva University Hospitals, Rue\rGabrielle-Perret-Gentil 4, Geneva, CH-1211, Switzerland."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C.","family":"Roussos","sequence":"additional","affiliation":[{"name":"Geneva University Hospitals, Rue\rGabrielle-Perret-Gentil 4, Geneva, CH-1211, Switzerland."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Bonvin","sequence":"additional","affiliation":[{"name":"Geneva University Hospitals, Rue\rGabrielle-Perret-Gentil 4, Geneva, CH-1211, Switzerland."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R.","family":"Stern","sequence":"additional","affiliation":[{"name":"Geneva University Hospitals, Rue\rGabrielle-Perret-Gentil 4, Geneva, CH-1211, Switzerland."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R.","family":"Peter","sequence":"additional","affiliation":[{"name":"Geneva University Hospitals, Rue\rGabrielle-Perret-Gentil 4, Geneva, CH-1211, Switzerland."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P.","family":"Hoffmeyer","sequence":"additional","affiliation":[{"name":"Geneva University Hospitals, Rue\rGabrielle-Perret-Gentil 4, Geneva, CH-1211, Switzerland."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"42","reference":[{"key":"r1","doi-asserted-by":"publisher","DOI":"10.1243\/0954411001535381"},{"key":"r2","unstructured":"No authors listed. 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