A prospective study of 39 hips with between 1 and 4 years of follow-up

Background and purpose Operative findings during revision of metal-on-metal hip arthroplasty (MOMHA) vary widely and can involve massive soft tissue and bone disruption. As a result, planning of theater time and resources is difficult, surgery is chal-lenging, and outcomes are often poor. We describe our experi-ence with revision of MOMHA and provide recommendations for management.Patients and methods We present the findings and outcomes of 39 consecutive MOMHAs (in 35 patients) revised in a tertiary unit (median follow-up time 30 (12–54) months). The patients under-went a preoperative work-up including CT, metal artifact reduc-tion sequence (MARS) MRI, and blood metal ion levels. Results We determined 5 categories of failure. 8 of 39 hips had conventional failure mechanisms including infection and impinge-ment. Of the other 31 hips, 14 showed synovitis without signifi-cant disruption of soft tissue; 6 had a cystic pseudotumor with significant soft tissue disruption; 7 had significant osteolysis; and 4 had a solid pseudotumor. Each category of failure had specific surgical hazards that could be addressed preoperatively. There were 2 reoperations and 1 patient (2 hips) died of an unrelated cause. Median Oxford hip score (OHS) was 37 (9–48); median change (