Narrative review providing a systematic framework for evaluating and managing patients with metal-on-metal (MoM) total hip arthroplasty implants. Addresses the full workup — history, radiographs, serum metal ions, MARS MRI, hip aspiration — and guides revision decision-making using a risk-stratified algorithm.
When a patient with a MoM THA presents with groin pain, check serum cobalt and chromium: ≥7 ppb warrants MARS MRI regardless of symptoms, and revision should only proceed with objective clinical indications — not elevated ions or imaging findings alone.
At revision, document intraoperative soft-tissue destruction systematically using the Fabi classification, since abductor involvement (Type III) predicts instability and may require a constrained liner.
Narrative review providing a systematic framework for evaluating and managing patients with metal-on-metal (MoM) total hip arthroplasty implants. Addresses the full workup — history, radiographs, serum metal ions, MARS MRI, hip aspiration — and guides revision decision-making using a risk-stratified algorithm.
When a patient with a MoM THA presents with groin pain, check serum cobalt and chromium: ≥7 ppb warrants MARS MRI regardless of symptoms, and revision should only proceed with objective clinical indications — not elevated ions or imaging findings alone.
At revision, document intraoperative soft-tissue destruction systematically using the Fabi classification, since abductor involvement (Type III) predicts instability and may require a constrained liner.