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Current surveillance for metal-on-metal hip resurfacing (MoMHR) patients is not evidence based. This study established changes that occurred in 152 asymptomatic MoMHRs using repeat ultrasound and patient-reported outcomes. Factors associated with (1) ultrasound progression and (2) developing new pseudotumors were analyzed. Patients underwent repeat assessments 4.3 years later. Ultrasound progression was observed in 19% (n = 29), with 10% (n = 15) developing new pseudotumors. Key predictors of ultrasound progression included high blood cobalt (P = .00013) and chromium (P = .00065), and high initial ultrasound grade (P = .003) and volume (P = .036). No asymptomatic MoMHRs with initially normal metal ions (<2 μg/L) and normal ultrasounds (33% of cohort) developed new pseudotumors. This patient subgroup does not require repeat follow-up within 5 years.

Original publication




Journal article


The Journal of arthroplasty

Publication Date





146 - 151


Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom, OX3 7LD.


Humans, Disease Progression, Granuloma, Plasma Cell, Ions, Chromium, Cobalt, Metals, Arthroplasty, Replacement, Hip, Longitudinal Studies, Follow-Up Studies, Prospective Studies, Prosthesis Design, Hip Prosthesis, Aged, Middle Aged, Female, Male