Thomas P. Schmalzried, MD, presented his experience at the International
Congress for Joint Reconstruction San Diego 2012 meeting…

Although there has been no standard of review established in the United States,
Schmalzried noted routine follow-up should be considered good practice…

…Schmalzried mentioned the special risks inherent in metal-on-metal hip
replacements, including higher monoblock loosening rates and adverse local
tissue reactions (ALTRs)…

“Head size seems to matter when we talk about total hip replacement in
metal-on-metal bearings,” Schmalzried said. “Loosening is the issue you get when
you start looking at large diameter bearings. The majority are greater than 36
mm.”

…The risk factors for revision, Schmalzried said, include a lateral opening
angle of 55° or greater, increased combined anteversion and monoblock sockets
with large heads. Variables related to this, he added, include female patients,
due to their smaller size, and dysplastic anatomy …

…According to Schmalzried, revision should be considered in patients who
display poor clinical results, such as pain or mechanical symptoms…

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