1
|
Dhawan R, Young DA, Van Eemeren A, Shimmin A. Birmingham Hip Resurfacing at 20 years. Bone Joint J 2023; 105-B:946-952. [PMID: 37652450 DOI: 10.1302/0301-620x.105b9.bjj-2022-0713.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Aims The Birmingham Hip Resurfacing (BHR) arthroplasty has been used as a surgical treatment of coxarthrosis since 1997. We present 20-year results of 234 consecutive BHRs performed in our unit. Methods Between 1999 and 2001, there were 217 patients: 142 males (65.4%), mean age 52 years (18 to 68) who had 234 implants (17 bilateral). They had patient-reported outcome measures collected, imaging (radiograph and ultrasound), and serum metal ion assessment. Survivorship analysis was performed using Kaplan-Meier estimates. Revision for any cause was considered as an endpoint for the analysis. Results Mean follow-up was 20.9 years (19.3 to 22.4). Registry data revealed that 19 hips (8.1%) had been revised and 26 patients (12%) had died from causes unrelated to the BHR. Among the remaining 189 hips, 61% were available for clinical follow-up at 20 years (n = 115) and 70% of patients had biochemical follow-up (n = 132). The cumulative implant survival rate at 20 years for male patients was 96.5% (95% confidence interval (CI) 93.5 to 99.6), and for female patients 87% (95% CI 79.7 to 94.9). The difference was statistically significant (p = 0.029). The mean Oxford Hip Score, Hip disability and Osteoarthritis Outcome Score, and Forgotten Joint Score were 45 (29 to 48), 89 (43 to 100), and 84 (19 to 100), respectively. The mean scores for each of the five domains of the EuroQol five-dimension three-level questionnaire were 1.2, 1.0, 1.2, 1.3, and 1.1, and mean overall score 82.6 (50 to 100). Ultrasound showed no pseudotumour. Mean cobalt and chromium levels were 32.1 nmol/l (1 to 374) and 45.5 nmol/l (9 to 408), respectively. Conclusion This study shows that BHRs provide excellent survivorship and functional outcomes in young male patients. At 20 years, soft-tissue imaging and serum metal ion studies suggest that a metal-on-metal resurfacing implant can be well tolerated in a group of young patients.
Collapse
Affiliation(s)
- Rohit Dhawan
- Melbourne Orthopedic Group, Melbourne, Victoria, Australia
| | - David A Young
- Melbourne Orthopedic Group, Melbourne, Victoria, Australia
| | | | - Andrew Shimmin
- Melbourne Orthopedic Group, Melbourne, Victoria, Australia
- Monash University, Melbourne, Australia
| |
Collapse
|
2
|
Pautasso A, Zorzolo I, Bellato E, Pellegrino P, Ferrario A, Pira E, Castoldi F. Allergic reaction and metal hypersensitivity after shoulder joint replacement. Musculoskelet Surg 2023; 107:55-68. [PMID: 34719773 PMCID: PMC10020248 DOI: 10.1007/s12306-021-00729-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 09/17/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE Metal ion release may cause local and systemic effects and induce hypersensitivity reactions. The aim of our study is first to determine if implant-related hypersensitivity correlates to patient symptoms or not; second, to assess the rate of hypersensitivity and allergies in shoulder arthroplasty. METHODS Forty patients with shoulder replacements performed between 2015 and 2017 were studied with minimum 2-year follow-up; no patient had prior metal implants. Each patient underwent radiographic and clinical evaluation using the Constant-Murley Score (CMS), 22 metal and cement haptens patch testing, serum and urine tests to evaluate 12 metals concentration, and a personal occupational medicine interview. RESULTS At follow-up (average 45 ± 10.7 months), the mean CMS was 76 ± 15.9; no clinical complications or radiographic signs of loosening were detected; two nickel sulfate (5%), 1 benzoyl peroxide (2.5%) and 1 potassium dichromate (2.5%) positive findings were found, but all these patients were asymptomatic. There was an increase in serum aluminum, urinary aluminum and urinary chromium levels of 1.74, 3.40 and 1.83 times the baseline, respectively. No significant difference in metal ion concentrations were found when patients were stratified according to gender, date of surgery, type of surgery, and type of implant. CONCLUSIONS Shoulder arthroplasty is a source of metal ion release and might act as a sensitizing exposure. However, patch test positivity does not seem to correlate to hypersensitivity cutaneous manifestations or poor clinical results. Laboratory data showed small constant ion release over time, regardless of gender, type of shoulder replacement and implant used. LEVELS OF EVIDENCE Level II.
Collapse
Affiliation(s)
- A. Pautasso
- University of Turin, Via Gianfranco Zuretti 29, 10126 Turin, Italy
| | - I. Zorzolo
- University of Turin, Via Gianfranco Zuretti 29, 10126 Turin, Italy
| | - E. Bellato
- Orthopaedic and Traumatology Department, San Luigi Gonzaga Hospital, University of Turin, Regione Gonzole 10, 10043 Orbassano, Italy
| | - P. Pellegrino
- Oncologic Orthopaedic Department, Orthopaedic and Trauma Center – Città della Salute e della Scienza, University of Turin, Via Gianfranco Zuretti 29, 10126 Turin, Italy
| | - A. Ferrario
- Occupational Medicine Division, Department of Public Health and Pediatric Sciences, Orthopaedic and Trauma Center – Città della Salute e della Scienza, University of Turin, Via Gianfranco Zuretti 29, 10126 Turin, Italy
| | - E. Pira
- University of Turin, Via Gianfranco Zuretti 29, 10126 Turin, Italy
- Occupational Medicine Division, Department of Public Health and Pediatric Sciences, Orthopaedic and Trauma Center – Città della Salute e della Scienza, University of Turin, Via Gianfranco Zuretti 29, 10126 Turin, Italy
| | - F. Castoldi
- University of Turin, Via Gianfranco Zuretti 29, 10126 Turin, Italy
- Orthopaedic and Traumatology Department, San Luigi Gonzaga Hospital, University of Turin, Regione Gonzole 10, 10043 Orbassano, Italy
| |
Collapse
|
3
|
Abdel Hamid OI, Attia ME, Hirshon JM, El-Shinawi M, El-Hussaini M, El-Setouhy M. Psychiatric Disorders and Genotoxicity Following Primary Metal on Polyethylene Total Hip Arthroplasty and Their Correlation to Cobalt/Chromium Levels. Drug Healthc Patient Saf 2022; 14:97-111. [PMID: 35880007 PMCID: PMC9308046 DOI: 10.2147/dhps.s360643] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 07/04/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Hip arthroplasty (HA) using implantable metal components is among the commonest orthopedic interventions. However, it can be followed by several complications following corrosion and the release of metal ions. Several studies proved that damaged genomic DNA may contribute to the pathophysiology of mental disorders. Aim The current work aims to evaluate the psychiatric disorders in metal on polyethylene hip arthroplasty (MOP-HA) patients and its correlation to cobalt/chromium (Co/Cr) levels and genotoxicity. Methods The work was a longitudinal follow-up study including 34 adults with unilateral primary MOP-HA meeting the inclusion and exclusion criteria. Preoperatively, 6, 12-months-postoperatively, patients were examined for cognitive impairment using mini-mental-state-examination (MMSE), depression using major-depressive-inventory (MDI), and blood samples were collected for estimation of Co/Cr, detection of genotoxicity by single-cell-gel-electrophoresis (comet assay) and serum 8-hydroxy-2'-deoxyguanosine (8-OHdG). Results Cognitive impairment was reported in 18.5% and 14.8% at 6-months, and 12-months postoperative, respectively. Depressive disorder was recorded in 22.2% at 6-months and 14.8% at 12-months postoperative. The marginal homogeneity tests proved a non-significant difference. There was a non-significant difference in preoperative, 6-months, 12-months postoperative MMSE, and MDI scores. There were significantly increased Co/Cr levels at 6-months postoperative. The levels decreased at 12-months postoperative, however, still significantly higher than preoperative values. There was a significant increase in serum 8-OHdG and the levels were positively correlated to cobalt levels at both 6 and 12-months-postoperative. There was a non-significant difference among preoperative, 6-months, and 12-months postoperative comet assay measurements. Conclusion From previous findings, we can conclude that will-functioning MOP hip arthroplasty can induce increased ion levels and positively correlated increase in biochemical markers of genotoxicity (8-OHdG).
Collapse
Affiliation(s)
- Omaima I Abdel Hamid
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed E Attia
- Orthopedics Departments, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Jon M Hirshon
- Department of Emergency Medicine, University of Maryland, School of Medicine, Baltimore, MD, USA
- Department of Epidemiology and Public Health, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Mohamed El-Shinawi
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Galala University, Galala City, Suez, Egypt
| | - Moustafa El-Hussaini
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Maged El-Setouhy
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Department of Family and Community Medicine, Faculty of Medince, Jazan University, Jazan, Kingdom of Saudi Arabia
| |
Collapse
|
4
|
Bodiga VL, Vemuri PK, Kudle MR, Bodiga S. Ellagic Acid from Terminalia arjuna Fruits Protects Against Chromium and Cobalt Toxicity in Primary Human Lymphocytes. Biol Trace Elem Res 2022; 200:2698-2708. [PMID: 34432268 DOI: 10.1007/s12011-021-02900-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 08/21/2021] [Indexed: 12/28/2022]
Abstract
Increased accumulation of heavy metal ions such as Cr6+ and Co2+ due to release from prostheses and metallic implants has been reported. These metal ions have been shown to affect both resting and activated lymphocytes. Natural remedies towards mitigating the cytotoxic effects of metal ions are clearly warranted. Polyphenolic compounds which are part of hydrolysable tannins from natural plant sources are considered effective in cheating heavy metal ions in a biological system. We have isolated and characterized a polyphenolic compound (ellagic acid) from Terminalia arjuna fruits that has been tested for its ability to attenuate the metal ion toxicity in primary human lymphocytes in culture. Cr6+ and Co2+ (100 μM) decreased lymphocyte viability and proliferation and increased apoptosis of resting as well as CD3 and/or CD28-stimulated lymphocytes. Metal ions markedly diminished the cytokine (interleukin-2 and interferon-γ) secretion from activated lymphocytes. Pretreatment with ellagic acid at 25, 50, and 100 μM concentrations effectively improved viability and proliferative responses of both resting and activated lymphocytes, while attenuating the apoptotic index. Ellagic acid also tended to normalize the cytokine secretion from the activated lymphocytes even in the presence of metal ions, suggesting broad effects on the adaptive immune system.
Collapse
Affiliation(s)
- Vijaya Lakshmi Bodiga
- Department of Biochemistry and Molecular Biology, Institute of Genetics & Hospital for Genetic Diseases, Osmania University, Begumpet, Hyderabad, Telangana, India
| | - Praveen Kumar Vemuri
- Department of Biotechnology, Koneru Lakshmaiah University, Green Fields, Vaddeswaram, Guntur, Andhra Pradesh, India
| | - Madhukar Rao Kudle
- Department of Biochemistry, Kakatiya University, Warangal, Telangana, India
| | - Sreedhar Bodiga
- Laboratory of Biochemistry, Department of Basic Sciences, Forest College and Research Institute Hyderabad, Siddipet District Telangana, Mulugu, India.
| |
Collapse
|
5
|
Kong K, Zhao C, Chang Y, Qiao H, Hu Y, Li H, Zhang J. Use of Customized 3D-Printed Titanium Augment With Tantalum Trabecular Cup for Large Acetabular Bone Defects in Revision Total Hip Arthroplasty: A Midterm Follow-Up Study. Front Bioeng Biotechnol 2022; 10:900905. [PMID: 35721851 PMCID: PMC9198309 DOI: 10.3389/fbioe.2022.900905] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/09/2022] [Indexed: 12/27/2022] Open
Abstract
Aims: In revision total hip arthroplasty (THA), large acetabular bone defects pose challenges for surgeons. Recently, wide application of trabecular tantalum, which has outstanding biocompatibility and mechanical properties, and the development of three-dimensional (3D) printing have led to the introduction of new schemes for acetabular reconstruction. However, few studies have focused on the treatment of bone defects with customized 3D-printed titanium augments combined with tantalum trabecular cup. Thus, we aimed to evaluate the effect of this therapy in patients who underwent revision THAs. Patients and Methods: We included 23 patients with Paprosky type III acetabular bone defects who underwent revision THA between January 2013 and June 2019. The preoperative hip rotation center and functional score were compared with those at 2–7 years (average 4.7 years) postoperatively to evaluate the midterm prognosis of our treatment choice. Results: Postoperatively, the rotation centres of all hips were comparable with those of the contralateral hips. Hip function improved with average Harris Hip Score improved from 33.5 (22.7–40.2) to 86.1 (73.5–95.6) and average Oxford Hip Score improved from 8.3 (0–14) to 38.8 (35–48) during follow-up. One dislocation, which occurred due to extreme hip flexion within 6 weeks, was treated with closed reduction, and no recurrent dislocation occurred. No nerve injury, infection, aseptic loosening, or osteolysis were observed and no re-revision was performed in any patient. Conclusion: Satisfactory midterm outcomes were obtained with 3D-printed titanium augment combined with tantalum cup for the treatment of acetabular defects in revision THA. Changes in the Harris Hip Score and Oxford Hip Score suggested a significant improvement in hip function.
Collapse
Affiliation(s)
| | | | | | | | | | - Huiwu Li
- *Correspondence: Huiwu Li, ; Jingwei Zhang,
| | | |
Collapse
|
6
|
Kovač V, Bergant M, Ščančar J, Primožič J, Jamnik P, Poljšak B. Causation of Oxidative Stress and Defense Response of a Yeast Cell Model after Treatment with Orthodontic Alloys Consisting of Metal Ions. Antioxidants (Basel) 2021; 11:antiox11010063. [PMID: 35052565 PMCID: PMC8772795 DOI: 10.3390/antiox11010063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/17/2021] [Accepted: 12/23/2021] [Indexed: 11/16/2022] Open
Abstract
Misaligned teeth have a tremendous impact on oral and dental health, and the most efficient method of correcting the problem is orthodontic treatment with orthodontic appliances. The study was conducted to investigate the metal composition of selected orthodontic alloys, the release of metal ions, and the oxidative consequences that the metal ions may cause in the cell. Different sets of archwires, stainless steel brackets, and molar bands were incubated in artificial saliva for 90 days. The composition of each orthodontic material and quantification of the concentration of metal ions released were evaluated. Metal ion mixtures were prepared to determine the occurrence of oxidative stress, antioxidant enzyme defense system, and oxidative damage to proteins. The beta titanium alloy released the fewest metal ions and did not cause oxidative stress or protein damage. The metal ions from stainless steel and the cobalt-chromium alloy can cause oxidative stress and protein damage only at high concentrations. All metal ions from orthodontic alloys alter the activity of antioxidant enzymes in some way. The determined amounts of metal ions released from orthodontic appliances in a simulated oral environment are still below the maximum tolerated dose, and the concentrations of released metal ions are not capable of inducing oxidative stress, although some changes in antioxidant enzyme activity were observed at these concentrations.
Collapse
Affiliation(s)
- Vito Kovač
- Faculty of Health Sciences, University of Ljubljana, Zdravstvena pot 5, 1000 Ljubljana, Slovenia;
| | - Matic Bergant
- Department of Environmental Sciences, Jozef Stefan Institute, Jamova 39, 1000 Ljubljana, Slovenia; (M.B.); (J.Š.)
| | - Janez Ščančar
- Department of Environmental Sciences, Jozef Stefan Institute, Jamova 39, 1000 Ljubljana, Slovenia; (M.B.); (J.Š.)
| | - Jasmina Primožič
- Department of Dental and Jaw Orthopedics, Medical Faculty, University of Ljubljana, Hrvatski trg 6, 1000 Ljubljana, Slovenia;
| | - Polona Jamnik
- Biotechnical Faculty, University of Ljubljana, Jamnikarjeva ulica 101, 1000 Ljubljana, Slovenia;
| | - Borut Poljšak
- Faculty of Health Sciences, University of Ljubljana, Zdravstvena pot 5, 1000 Ljubljana, Slovenia;
- Correspondence:
| |
Collapse
|
7
|
Manjunath V, Badhe RV, McCoy M, Rynne J, Bhatti A, Segu A, Oral E, Jacobs JJ, Chastain P, Bijukumar D, Mathew MT. The role of Vitamin E in hip implant-related corrosion and toxicity: Initial outcome. J Mech Behav Biomed Mater 2021; 123:104769. [PMID: 34412025 PMCID: PMC10559727 DOI: 10.1016/j.jmbbm.2021.104769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 07/27/2021] [Accepted: 08/07/2021] [Indexed: 10/20/2022]
Abstract
In orthopedic healthcare, Total Hip Replacement (THR) is a common and effective solution to hip-related bone and joint diseases/fracture; however, corrosion of the hip implant and the release of degradation metal ions/particles can lead to early implant failure and pose potential toxicity risk for the surrounding tissues. The main objective of this work was to investigate the potential role of Vitamin E to minimize corrosion-related concerns from CoCrMo hip implants. The study focused on two questions (i) Can Vitamin E inhibit CoCrMo corrosion? and (ii) Does Vitamin E moderate the toxicity associated with the CoCrMo implant particles? In the study (i) the electrochemical experiments (ASTM G61) with different concentrations of Vitamin E (1, 2, 3 mg/ml against the control) were performed using normal saline and simulated synovial fluid (Bovine calf serum-BCS, 30 g/L protein, pH 7.4) as electrolytes. The polished CoCrMo disc (Ra 50 nm) was the working electrode. The findings suggested that both Vitamin E-Saline (45 ± 0.9%) and Vitamin E-BCS (91 ± 3%) solutions protected against implant corrosion at a Vitamin E concentration of 3 mg/ml, but Vitamin E-BCS showed protection at all Vitamin E (1-3 mg/ml) concentration levels. These results suggested that the Vitamin E and the protein present in the BCS imparted additive effects towards the electrochemical inhibition. In the study (ii) the role of Vitamin E in cytotoxicity inhibition was studied using a mouse neuroblastoma cell line (N2a) for CoCrMo particles and Cr ions separately. The CoCrMo particles were generated from a custom-built hip simulator. The alamarBlue assay results suggested that Vitamin E provides significant protection (85% and 75% proliferation) to N2a cells against CoCrMo particles and Cr ions, respectively at 1 μg/ml concentration, as compared to the control group. However, the results obtained from ROS expression and DNA fiber staining suggest that Vitamin E is only effective against CoCrMo degradation particles and not against Cr ions. In summary, the findings show that Vitamin E can minimize the corrosion processes and play a role in minimizing the potential toxicity associated with implants.
Collapse
Affiliation(s)
- Vikas Manjunath
- Department of Biomedical Sciences, University of Illinois College of Medicine at Rockford, Rockford, IL, USA
| | - Ravindra V Badhe
- Department of Biomedical Sciences, University of Illinois College of Medicine at Rockford, Rockford, IL, USA
| | - Maureen McCoy
- Department of Biochemistry, University of Illinois, Urbana-Champaign, IL, USA
| | - Josiah Rynne
- Department of Mechanical Science and Engineering, University of Illinois, Urbana-Champaign, IL, USA
| | - Aisha Bhatti
- Department of Biomedical Sciences, University of Illinois College of Medicine at Rockford, Rockford, IL, USA
| | - Abhijith Segu
- Department of Biomedical Sciences, University of Illinois College of Medicine at Rockford, Rockford, IL, USA
| | - Ebru Oral
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Joshua J Jacobs
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Paul Chastain
- Department of Biomedical Sciences, University of Illinois College of Medicine at Rockford, Rockford, IL, USA
| | - Divya Bijukumar
- Department of Biomedical Sciences, University of Illinois College of Medicine at Rockford, Rockford, IL, USA
| | - Mathew T Mathew
- Department of Biomedical Sciences, University of Illinois College of Medicine at Rockford, Rockford, IL, USA.
| |
Collapse
|
8
|
The Expression Levels of Toll-like Receptors after Metallic Particle and Ion Exposition in the Synovium of a Murine Model. J Clin Med 2021; 10:jcm10163489. [PMID: 34441785 PMCID: PMC8396889 DOI: 10.3390/jcm10163489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/21/2021] [Accepted: 08/02/2021] [Indexed: 11/16/2022] Open
Abstract
To date, the exact role of specific Toll-like receptors (TLRs) in regulating immune reactivity to metallic byproducts of orthopedic implants has not been fully clarified. In light of the situation, our objective in this investigation was to assess the expression levels of surface TLRs after metallic particle and ion exposure in an established animal model. Ten female BALB/c mice in each group received intra-articular injections of phosphate buffer (PBS) (control), metallic particles (MP), and metallic ions (MI), respectively. Seven days later, immunohistochemical staining was undertaken in the synovial layer of the murine knee joints using anti-TLR 1, 2, 4, 5, and 6 polyclonal antibodies. In addition to increased cellular infiltrates and a hyperplastic synovial membrane, the MP group showed significantly elevated TLR expression compared to the control group and had higher TLR 1-, 4-, and 6-positive cells than the MI group (p < 0.0167). TLR 4- and TLR 6-positive cells were significantly augmented for the MI group compared to the control group (p < 0.0167). Additionally, greenish corrosion particles found in the necrotic tissue suggested that metallic particles might release a certain level of locally toxic metallic ions in vivo.
Collapse
|
9
|
Larsen BM, Borgwardt A, Ribel-Madsen S, Zerahn B. False profile view is independently associated with serum metal levels in patients with metal-on-metal hip arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:1029-1036. [PMID: 33244659 DOI: 10.1007/s00590-020-02839-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/16/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Elevated levels of serum metal ions can be found in some patients with metal-on-metal (MoM) hip replacements. This study seeks to identify whether there is a significant association between the contact patch to rim distance (CPRD) and the anterior center edge angle (ACEA), respectively, and serum cobalt (Co) and chromium (Cr) levels in patients treated with unilateral MoM hip replacements by using standing anteroposterior and false profile view radiographs. METHODS This is a retrospective analysis on 53 patients with either unilateral ReCap or M2a-Magnum MoM hip replacements operated in 2006 or 2007. Univariate linear regression and multivariable linear regression (MLR) analyses were performed using the CPRD and ACEA along with risk factors for elevated serum levels of Co and Cr previously suggested in the literature as explanatory variables. Serum Co and Cr were measured using inductively coupled plasma mass spectrometry. RESULTS The MLR model showed that the same three variables (gender, CPRD and ACEA) were significantly associated with serum levels of both Co and Cr explaining approximately half of the variation. A univariate analysis showed a polynomial association between both anteversion angle and the ACEA with serum levels of Co and Cr. The vertex of the polynomial function was located at approximately 20° and 40°, respectively. CONCLUSION Gender, CPRD and ACEA are independently associated with serum levels of Co and Cr. Both ACEA and anteversion angles have optimae associated with low serum metal levels which may be useful for post-surgery evaluation of cup positioning.
Collapse
Affiliation(s)
- Bo Madvig Larsen
- Department of Orthopaedic Surgery, Bispebjerg and Frederiksberg University Hospital, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark.
| | - Arne Borgwardt
- Department of Orthopaedic Surgery, Bispebjerg and Frederiksberg University Hospital, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark
| | - Søren Ribel-Madsen
- Department of Orthopaedic Surgery, Bispebjerg and Frederiksberg University Hospital, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark
| | - Bo Zerahn
- Department of Clinical Physiology and Nuclear Medicine, Herlev University Hospital, Borgmester Ib Juuls Vej 1, Herlev, 2730, Denmark
| |
Collapse
|
10
|
Tarpada SP, Loloi J, Schwechter EM. A Case of Titanium Pseudotumor and Systemic Toxicity After Total Hip Arthroplasty Polyethylene Failure. Arthroplast Today 2020; 6:710-715. [PMID: 32923555 PMCID: PMC7475049 DOI: 10.1016/j.artd.2020.07.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/26/2020] [Accepted: 07/21/2020] [Indexed: 12/28/2022] Open
Abstract
We describe the case of a 57-year-old female who underwent bilateral ceramic-on-polyethylene total hip arthroplasties performed in 2015. She presented to us in 2018 with headaches, fatigue, and right hip pain 5 months after an atraumatic right polyethylene liner failure for which she did not seek treatment. She was found to have imaging consistent with an adverse local tissue reaction and massive pseudotumor formation. During revision surgery, fracture of the acetabular liner was noted, with ceramic head wear through the titanium cup. In the months after her debridement and prosthesis revision, the patient continued to complain of systemic symptoms including weakness, fatigue, headaches, and vision problems. Serum titanium levels were found to be 100 times higher than normal. This case serves as a rarely reported example of titanium toxicity and titanium pseudotumor formation in the setting of polyethylene failure.
Collapse
Affiliation(s)
- Sandip P Tarpada
- Department of Orthopaedic Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Jeremy Loloi
- Department of Orthopaedic Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Evan M Schwechter
- Department of Orthopaedic Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| |
Collapse
|
11
|
Vendittoli PA, Massé V, Kiss MO, Lusignan D, Lavigne M. Modular junction may be more problematic than bearing wear in metal-on-metal total hip arthroplasty. Hip Int 2019; 29:262-269. [PMID: 30378457 DOI: 10.1177/1120700018808696] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION In total hip arthroplasty (THA), local adverse reaction to metal debris (ARMD) may be caused by abnormal metal ion release from a metal-on-metal (MoM) bearing, or by wear and corrosion of the implant's modular junction. The aim of this study was to compare ion levels and rate of ARMD between patients sharing the same MoM bearing but 1 group having monoblock stems versus another having modular stems. MATERIALS AND METHODS Whole blood cobalt (Co) and chromium (Cr) ion concentrations, ARMD rate, revision rate, and function measured by UCLA and WOMAC scores were compared between groups. RESULTS ARMD rate was significantly higher in the modular group (46%) compared with the monoblock group (16%, p = 0.031). Revision for ARMD was performed at 52.8 ± 8.1 months in the modular group versus 98.2 ± 15.5 months after primary THA in the monoblock group. ARMD originated from wear and corrosion of the junction between stem and femoral head adapter sleeve in all monoblock cases, and the junction between stem and modular neck in all the modular ones. Cr and Co ions levels were significantly higher in the modular stem group ( p < 0.001 for both). CONCLUSIONS Although both groups had MoM bearings, corrosion at stem/neck or neck/head junctions combining dissimilar metal (Ti and Cr-Co) was seen as the source of excess metal ions release leading to ARMD. Poor performance of the modular junction may be more deleterious than wear of the bearing. To avoid such complications, THA femoral stem modular junctions should be eliminated (return to a full monoblock implant) or have improved junction design.
Collapse
Affiliation(s)
- Pascal-André Vendittoli
- Department of Surgery, University of Montreal, Hospital Maisonneuve-Rosemont, Montreal, Canada
| | - Vincent Massé
- Department of Surgery, University of Montreal, Hospital Maisonneuve-Rosemont, Montreal, Canada
| | - Marc-Olivier Kiss
- Department of Surgery, University of Montreal, Hospital Maisonneuve-Rosemont, Montreal, Canada
| | - Daniel Lusignan
- Department of Surgery, University of Montreal, Hospital Maisonneuve-Rosemont, Montreal, Canada
| | - Martin Lavigne
- Department of Surgery, University of Montreal, Hospital Maisonneuve-Rosemont, Montreal, Canada
| |
Collapse
|
12
|
Drynda A, Drynda S, Kekow J, Lohmann CH, Bertrand J. Differential Effect of Cobalt and Chromium Ions as Well as CoCr Particles on the Expression of Osteogenic Markers and Osteoblast Function. Int J Mol Sci 2018; 19:ijms19103034. [PMID: 30301134 PMCID: PMC6213485 DOI: 10.3390/ijms19103034] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 09/30/2018] [Accepted: 10/01/2018] [Indexed: 01/18/2023] Open
Abstract
The balance of bone formation and resorption is the result of a regulated crosstalk between osteoblasts, osteoclasts, and osteocytes. Inflammation, mechanical load, and external stimuli modulate this system. Exposure of bone cells to metal ions or wear particles are thought to cause osteolysis via activation of osteoclasts and inhibition of osteoblast activity. Co2+ ions have been shown to impair osteoblast function and the expression of the three transforming growth factor (TGF)-β isoforms. The current study was performed to analyze how Co2+ and Cr3+ influence the expression, proliferation, and migration profile of osteoblast-like cells. The influence of Co2+, Cr3+, and CoCr particles on gene expression was analyzed using an osteogenesis PCR Array. The expression of different members of the TGF-β signaling cascade were down-regulated by Co2+, as well as several TGF-β regulated collagens, however, Cr3+ had no effect. CoCr particles partially affected similar genes as the Co2+treatment. Total collagen production of Co2+ treated osteoblasts was reduced, which can be explained by the reduced expression levels of various collagens. While proliferation of MG63 cells appears unaffected by Co2+, the migration capacity was impaired. Our data may improve the knowledge of changes in gene expression patterns, and the proliferation and migration effects caused by artificial materials.
Collapse
Affiliation(s)
- Andreas Drynda
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Leipziger Straße 44, D-39120 Magdeburg, Germany.
| | - Susanne Drynda
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Leipziger Straße 44, D-39120 Magdeburg, Germany.
- Clinic for Rheumatology, Otto-von-Guericke University, Leipziger Straße 44, D-39120 Magdeburg, Germany.
| | - Jörn Kekow
- Clinic for Rheumatology, Otto-von-Guericke University, Leipziger Straße 44, D-39120 Magdeburg, Germany.
| | - Christoph Hubertus Lohmann
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Leipziger Straße 44, D-39120 Magdeburg, Germany.
| | - Jessica Bertrand
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Leipziger Straße 44, D-39120 Magdeburg, Germany.
| |
Collapse
|
13
|
Drynda S, Drynda A, Feuerstein B, Kekow J, Lohmann CH, Bertrand J. The effects of cobalt and chromium ions on transforming growth factor-beta patterns and mineralization in human osteoblast-like MG63 and SaOs-2 cells. J Biomed Mater Res A 2018; 106:2105-2115. [DOI: 10.1002/jbm.a.36409] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/11/2018] [Accepted: 03/15/2018] [Indexed: 01/04/2023]
Affiliation(s)
- Susanne Drynda
- Department of Orthopaedic Surgery; Otto-von-Guericke University; Magdeburg Germany
- Clinic for Rheumatology, Otto-von-Guericke University; Magdeburg Germany
| | - Andreas Drynda
- Department of Orthopaedic Surgery; Otto-von-Guericke University; Magdeburg Germany
| | - Bernd Feuerstein
- Department of Mechanical Engineering; Magdeburg-Stendal University of Applied Sciences; Magdeburg Germany
| | - Jörn Kekow
- Clinic for Rheumatology, Otto-von-Guericke University; Magdeburg Germany
| | - Christoph H. Lohmann
- Department of Orthopaedic Surgery; Otto-von-Guericke University; Magdeburg Germany
| | - Jessica Bertrand
- Department of Orthopaedic Surgery; Otto-von-Guericke University; Magdeburg Germany
| |
Collapse
|
14
|
Bijukumar DR, Segu A, Souza JCM, Li X, Barba M, Mercuri LG, J Jacobs J, Mathew MT. Systemic and local toxicity of metal debris released from hip prostheses: A review of experimental approaches. NANOMEDICINE : NANOTECHNOLOGY, BIOLOGY, AND MEDICINE 2018; 14:951-963. [PMID: 29339190 PMCID: PMC6017990 DOI: 10.1016/j.nano.2018.01.001] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 12/22/2017] [Accepted: 01/02/2018] [Indexed: 12/12/2022]
Abstract
Despite the technological improvements in orthopedic joint replacement implants, wear and corrosion products associated with the metal components of these implants may result in adverse local tissue and perhaps systemic reactions and toxicities. The current review encompasses a literature review of the local and systemic toxicity studies concerning the effect of CoCrMo wear debris released from wear and corrosion of orthopedic implants and prostheses. Release of metallic debris is mainly in the form of micro- and nano-particles, ions of different valences, and oxides composed of Co and Cr. Though these substances alter human biology, their direct effects of these substances on specific tissue types remain poorly understood. This may partially be the consequence of the multivariate research methodologies employed, leading to inconsistent reports. This review proposes the importance of developing new and more appropriate in-vitro methodologies to study the cellular responses and toxicity mediated by joint replacement wear debris in-vivo.
Collapse
Affiliation(s)
- Divya Rani Bijukumar
- Regenerative Medicine and Disability Research Lab, Department of Biomedical Sciences, University of Illinois College of Medicine at Rockford, IL, USA
| | - Abhijith Segu
- Regenerative Medicine and Disability Research Lab, Department of Biomedical Sciences, University of Illinois College of Medicine at Rockford, IL, USA
| | - Júlio C M Souza
- Center for MicroElectromechanical Systems (CMEMS-UMINHO), University of Minho, Guimaraes, Portugal
| | - XueJun Li
- Regenerative Medicine and Disability Research Lab, Department of Biomedical Sciences, University of Illinois College of Medicine at Rockford, IL, USA
| | - Mark Barba
- Regenerative Medicine and Disability Research Lab, Department of Biomedical Sciences, University of Illinois College of Medicine at Rockford, IL, USA; OrthoIllinois, Rockford, IL, USA
| | - Louis G Mercuri
- Department of Orthopedics, Rush University Medical Center, Chicago, IL, USA
| | - Joshua J Jacobs
- Department of Orthopedics, Rush University Medical Center, Chicago, IL, USA
| | - Mathew Thoppil Mathew
- Regenerative Medicine and Disability Research Lab, Department of Biomedical Sciences, University of Illinois College of Medicine at Rockford, IL, USA; Department of Orthopedics, Rush University Medical Center, Chicago, IL, USA; Department of Bioengineering, University of Illinois at Chicago, IL, USA.
| |
Collapse
|
15
|
Ho JH, Leikin JB, Dargan PI, Archer JRH, Wood DM, Brent J. Metal-on-Metal Hip Joint Prostheses: a Retrospective Case Series Investigating the Association of Systemic Toxicity with Serum Cobalt and Chromium Concentrations. J Med Toxicol 2017; 13:321-328. [PMID: 28900863 PMCID: PMC5711759 DOI: 10.1007/s13181-017-0629-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/09/2017] [Accepted: 08/17/2017] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION There have been concerns about prosthesis failure and the potential for systemic toxicity due to release of cobalt and chromium from metal-on-metal hip joint prostheses (MoM-HP). There is conflicting evidence on whether there is a correlation between higher cobalt and chromium concentrations and systemic toxicity. METHODS We undertook a retrospective review of consecutive patients with MoM-HP referred for outpatient review in toxicology clinics in London, UK, and in the USA recorded in the Toxicology Investigators Consortium (ToxIC) Registry from June 2011 to June 2015. RESULTS Thirty-one cases were identified; the median (IQR) serum cobalt concentration was 10.0 (3.8-32.8) mcg/L, and the median (IQR) serum chromium concentration was 6.9 (3.7-18.7) mcg/L. Twenty-three (74.2%) had symptoms, most commonly lethargy, hearing loss, and tinnitus. The odds ratios of symptomatic/asymptomatic patients for metal ion concentrations above/below 7 mcg/L were 1.87 (95% CI 0.37-9.57, p = 0.45) and 0.60 (95% CI 0.10-3.50, p = 0.57) for cobalt and chromium, respectively. Two (6.5%) patients with systemic cobalt toxicity had median (IQR) serum cobalt concentrations significantly higher than those without systemic features (630.4 [397.6-863.2] mcg/L versus 9.8 [2.9-16.4] mcg/L; p = 0.017). However, overall, there were no differences between cobalt (p = 0.38) or chromium (p = 0.92) concentrations between symptomatic and asymptomatic patients and no clinical features or investigation results correlated with cobalt or chromium concentration. CONCLUSION Two (6.5%) of 31 individuals referred for assessment of MoM-HP were diagnosed with systemic cobalt toxicity. However, despite a high prevalence of reported symptoms, neither symptoms nor investigation results correlated with serum cobalt or chromium concentrations.
Collapse
Affiliation(s)
- James H Ho
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, Westminster Bridge Road, London, SE1 7EH, UK
| | - Jerrold B Leikin
- Medical Toxicology, Glenbrook Hospital, NorthShore University Health System-OMEGA, Glenview, IL, USA
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Paul I Dargan
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, Westminster Bridge Road, London, SE1 7EH, UK.
- Faculty of Life Sciences and Medicine, King's College London, London, UK.
| | - John R H Archer
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, Westminster Bridge Road, London, SE1 7EH, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - David M Wood
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, Westminster Bridge Road, London, SE1 7EH, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Jeffrey Brent
- School of Medicine, University of Colorado, Aurora, CO, USA
| |
Collapse
|
16
|
Leyssens L, Vinck B, Van Der Straeten C, Wuyts F, Maes L. Cobalt toxicity in humans-A review of the potential sources and systemic health effects. Toxicology 2017; 387:43-56. [PMID: 28572025 DOI: 10.1016/j.tox.2017.05.015] [Citation(s) in RCA: 392] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/17/2017] [Accepted: 05/24/2017] [Indexed: 12/21/2022]
Abstract
Cobalt (Co) and its compounds are widely distributed in nature and are part of numerous anthropogenic activities. Although cobalt has a biologically necessary role as metal constituent of vitamin B12, excessive exposure has been shown to induce various adverse health effects. This review provides an extended overview of the possible Co sources and related intake routes, the detection and quantification methods for Co intake and the interpretation thereof, and the reported health effects. The Co sources were allocated to four exposure settings: occupational, environmental, dietary and medical exposure. Oral intake of Co supplements and internal exposure through metal-on-metal (MoM) hip implants deliver the highest systemic Co concentrations. The systemic health effects are characterized by a complex clinical syndrome, mainly including neurological (e.g. hearing and visual impairment), cardiovascular and endocrine deficits. Recently, a biokinetic model has been proposed to characterize the dose-response relationship and effects of chronic exposure. According to the model, health effects are unlikely to occur at blood Co concentrations under 300μg/l (100μg/l respecting a safety factor of 3) in healthy individuals, hematological and endocrine dysfunctions are the primary health endpoints, and chronic exposure to acceptable doses is not expected to pose considerable health hazards. However, toxic reactions at lower doses have been described in several cases of malfunctioning MoM hip implants, which may be explained by certain underlying pathologies that increase the individual susceptibility for Co-induced systemic toxicity. This may be associated with a decrease in Co bound to serum proteins and an increase in free ionic Co2+. As the latter is believed to be the primary toxic form, monitoring of the free fraction of Co2+ might be advisable for future risk assessment. Furthermore, future research should focus on longitudinal studies in the clinical setting of MoM hip implant patients to further elucidate the dose-response discrepancies.
Collapse
Affiliation(s)
- Laura Leyssens
- Faculty of Medicine and Health Sciences, University of Ghent (Belgium), Department of Speech, Language and Hearing Sciences, University Hospital Ghent, policlinic 1 floor 2, De Pintelaan 185, 9000 Ghent, Belgium.
| | - Bart Vinck
- Faculty of Medicine and Health Sciences, University of Ghent (Belgium), Department of Speech, Language and Hearing Sciences, University Hospital Ghent, policlinic 1 floor 2, De Pintelaan 185, 9000 Ghent, Belgium; Faculty of Humanities, University of Pretoria (South Africa), Department of Speech-Language Pathology and Audiology, Aula Theatre,University Road, Pretoria, 0001, South Africa.
| | - Catherine Van Der Straeten
- Faculty of Medicine, Imperial College London, Department of Surgery & Cancer, Musculoskeletal Sciences and Technology, Imperial College London, Charing Cross Campus,7L21 Lab Block, London SW7 2AZ, UK; Faculty of Medicine and Health Sciences, University of Ghent (Belgium), De Pintelaan 185, 9000 Ghent, Belgium.
| | - Floris Wuyts
- Antwerp University Research center for Equilibrium and Aerospace (AUREA), Department of Otorhinolaryngology, University Hospital Antwerp, Campus Groenenborger, Groenenborgerlaan 171, 2020 Antwerp, Belgium; Department of Biomedical Physics, University of Antwerp (Belgium), Campus Groenenborger, Groenenborgerlaan 171, 2020 Antwerp, Belgium.
| | - Leen Maes
- Faculty of Medicine and Health Sciences, University of Ghent (Belgium), Department of Speech, Language and Hearing Sciences, University Hospital Ghent, policlinic 1 floor 2, De Pintelaan 185, 9000 Ghent, Belgium; Clinical audiology department, University Hospital Ghent, De Pintelaan 185, 9000 Ghent, Belgium.
| |
Collapse
|
17
|
Xu D, Chen H, Lin Q, Li Z, Yang T, Yuan Z. Selective and sensitive colorimetric determination of cobalt ions using Ag–Au bimetallic nanoparticles. RSC Adv 2017. [DOI: 10.1039/c7ra00900c] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Selective and sensitive colorimetric detection of Co2+based on the aggregation of Ag–Au BNPs is due to the formation of positively charged (en)2CoS2O3+on the negative nanoparticle surface.
Collapse
Affiliation(s)
- Dong Xu
- National Engineering Laboratory for Rice and By-products Further Processing
- Central South University of Forestry & Technology
- Changsha 410004
- China
| | - Hong Chen
- National Engineering Laboratory for Rice and By-products Further Processing
- Central South University of Forestry & Technology
- Changsha 410004
- China
| | - Qinlu Lin
- National Engineering Laboratory for Rice and By-products Further Processing
- Central South University of Forestry & Technology
- Changsha 410004
- China
| | - Ziwei Li
- National Engineering Laboratory for Rice and By-products Further Processing
- Central South University of Forestry & Technology
- Changsha 410004
- China
| | - Tao Yang
- National Engineering Laboratory for Rice and By-products Further Processing
- Central South University of Forestry & Technology
- Changsha 410004
- China
| | - Zhiqin Yuan
- State Key Laboratory of Chemical Resource Engineering
- Beijing University of Chemical Technology
- Beijing 100029
- China
| |
Collapse
|
18
|
Abstract
Cobalt can cause a distinctive, rapidly progressive and reversible depression of cardiac systolic function, which is readily distinguished from other causes of cardiomyopathy. Patients present with the subacute onset of severe heart failure, which is accompanied by hypotension and cyanosis, pericardial effusion, low voltage on the electrocardiogram, marked elevation of serum enzymes, and lactic acidosis. They typically have a history of lethargy, anorexia, and weight loss in the months preceding the illness and exhibit other evidence of cobalt’s effects on the body (eg, polycythemia and goiter). The course of cobalt-related cardiomyopathy may be progressive and fatal, but those who survive and cease exposure generally demonstrate complete resolution of symptoms and recovery of cardiac function. Patients presenting with rapid onset of cardiomyopathy, who also exhibit polycythemia, pericardial effusion, or goiter should be evaluated for cobalt exposure. Exposure can be confirmed by the measurement of cobalt in the serum, but serum levels of the ion are not reliably predictive of clinical cardiotoxicity. The clinical emergence of cobalt cardiomyopathy seems to require the coexistence of one or more cofactors, particularly a low-protein diet, thiamine deficiency, alcoholism, and hypothyroidism. As the medicinal use of cobalt has waned and measures to reduce industrial exposure have been implemented, subacute cobalt-related cardiomyopathy had become rare. However, reports describing classical features of the disease have recently surged among patients with a malfunctioning cobalt-alloy hip prosthesis.
Collapse
Affiliation(s)
- Milton Packer
- From the Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX
| |
Collapse
|
19
|
Kwon YM, Khormaee S, Liow MHL, Tsai TY, Freiberg AA, Rubash HE. Asymptomatic Pseudotumors in Patients with Taper Corrosion of a Dual-Taper Modular Femoral Stem: MARS-MRI and Metal Ion Study. J Bone Joint Surg Am 2016; 98:1735-1740. [PMID: 27869625 DOI: 10.2106/jbjs.15.01325] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Modularity in total hip arthroplasty facilitates intraoperative restoration of patient anatomy. Although dual-taper modular total hip arthroplasty offers potential advantages for optimizing the hip center of rotation, it has been associated with modular taper corrosion. This corrosion has led to adverse local tissue reactions (pseudotumors) at the neck-stem junction and elevated metal-ion levels. However, the occurrence of taper-corrosion-related pseudotumors in patients who remain asymptomatic following total hip arthroplasty with a dual-taper modular femoral stem remains largely unknown. The aims of this study were (1) to determine the prevalence of asymptomatic pseudotumors by utilizing metal artifact reduction sequence magnetic resonance imaging (MARS-MRI) and (2) compare serum metal-ion levels between symptomatic and asymptomatic patients with a dual-taper modular stem total hip replacement. METHODS We performed a retrospective cross-sectional study of 97 consecutive patients who had been treated with a dual-taper modular femoral stem total hip arthroplasty. Eighty-three patients were stratified into symptomatic and asymptomatic groups and evaluated with MARS-MRI, measurement of serum metal-ion levels, and the University of California at Los Angeles (UCLA) functional hip score. RESULTS The prevalence of pseudotumors as determined with MARS-MRI was 15% in our asymptomatic patients and 36% in the overall cohort. The median serum cobalt level and cobalt/chromium ratio were significantly higher in patients with a pseudotumor than in those without a pseudotumor (8.0 versus 2.0 μg/L [p = 0.004] and 10.3 versus 2.4 μg/L [p = 0.012], respectively). However, there was no significant difference in the serum cobalt level or cobalt/chromium ratio between symptomatic patients with a pseudotumor and asymptomatic patients with a pseudotumor (7.6 versus 6.2 μg/L [p = 0.37] and 8.3 versus 10.6 μg/L [p = 0.46], respectively). The UCLA scores of asymptomatic patients with a pseudotumor were similar to those of patients without a pseudotumor (6.7 versus 6.6). CONCLUSIONS The prevalence of asymptomatic taper-corrosion-related pseudotumors on MARS-MRI in this study demonstrated that the absence of symptoms does not exclude the presence of adverse local tissue reactions. Elevated cobalt levels and cobalt/chromium ratios were associated with the presence of pseudotumors in asymptomatic and symptomatic patients. Cross-sectional imaging such as MARS-MRI is indicated for patients with elevated metal-ion levels. A longitudinal study is required to determine whether asymptomatic patients with taper-corrosion-related pseudotumors will develop symptoms with time. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Young-Min Kwon
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sariah Khormaee
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ming Han Lincoln Liow
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tsung-Yuan Tsai
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew A Freiberg
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Harry E Rubash
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
20
|
Liu YK, Deng XX, Yang HL. Cytotoxicity and genotoxicity in liver cells induced by cobalt nanoparticles and ions. Bone Joint Res 2016; 5:461-469. [PMID: 27754833 PMCID: PMC5075796 DOI: 10.1302/2046-3758.510.bjr-2016-0016.r1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 07/04/2016] [Indexed: 12/12/2022] Open
Abstract
Objectives The cytotoxicity induced by cobalt ions (Co2+) and cobalt nanoparticles (Co-NPs) which released following the insertion of a total hip prosthesis, has been reported. However, little is known about the underlying mechanisms. In this study, we investigate the toxic effect of Co2+ and Co-NPs on liver cells, and explain further the potential mechanisms. Methods Co-NPs were characterised for size, shape, elemental analysis, and hydrodynamic diameter, and were assessed by Transmission Electron Microscope, Scanning Electron Microscope, Energy Dispersive X-ray Spectroscopy and Dynamic Light Scattering. BRL-3A cells were used in this study. Cytotoxicity was evaluated by MTT and lactate dehydrogenase release assay. In order to clarify the potential mechanisms, reactive oxygen species, Bax/Bcl-2 mRNA expression, IL-8 mRNA expression and DNA damage were assessed on BRL-3A cells after Co2+ or Co-NPs treatment. Results Results showed cytotoxic effects of Co2+ and Co-NPs were dependent upon time and dosage, and the cytotoxicity of Co-NPs was greater than that of Co2+. In addition, Co-NPs elicited a significant (p < 0.05) reduction in cell viability with a concomitant increase in lactic dehydrogenase release, reactive oxygen species generation, IL-8 mRNA expression, Bax/Bcl-2 mRNA expression and DNA damage after 24 hours of exposure. Conclusion Co-NPs induced greater cytotoxicity and genotoxicity in BRL-3A cells than Co2+. Cell membrane damage, oxidative stress, immune inflammation and DNA damage may play an important role in the effects of Co-NPs on liver cells. Cite this article: Y. K. Liu, X. X. Deng, H.L. Yang. Cytotoxicity and genotoxicity in liver cells induced by cobalt nanoparticles and ions. Bone Joint Res 2016;5:461–469. DOI: 10.1302/2046-3758.510.BJR-2016-0016.R1.
Collapse
Affiliation(s)
- Y K Liu
- Department of Orthopaedics, The Affiliated Hospital to Soochow University, Jiangsu, China
| | - X X Deng
- Department of Orthopaedics, The Affiliated Hospital to Soochow University, Jiangsu, China
| | - H L Yang
- The Affiliated Hospital to Nantong University, Jiangsu, China
| |
Collapse
|
21
|
Abstract
The placement of a hip prosthesis is one of the most common orthopedic surgical procedures. Some implants contain metal and are therefore capable of releasing metal particles like cobalt in patients who wear metal prostheses. Cobalt can be responsible of local toxicity (including metallosis, hypersensitivity reaction, and benign tumor) or systemic toxicity (including cardiomyopathy, polycythemia, hypothyroidism, and neurological disorders). To monitor potential toxicity of metal hip prostheses, an annual monitoring of patients implanted is recommended and includes clinical examination, radiological examination and blood cobalt determination. The cobalt concentration in blood allows to estimate the risk of toxicity and to evaluate the performance of the implant. The currently recommended threshold value is equal to 7 µg of cobalt per liter of blood. Our study, conducted on 251 patients over a period of 4 years, has shown that the cobalt concentration average was 2.51 µg/l in blood, with 51 patients having a cobaltemia higher than the threshold of 7 µg/l.
Collapse
Affiliation(s)
- Virginie Mistretta
- Service de toxicologie clinique, médico-légale, de l'environnement et en entreprise, CHU Sart-Tilman, 1 avenue de l'Hôpital, 4000 Liège, Belgique
| | - William Kurth
- Service de chirurgie de l'appareil locomoteur, CHU Sart-Tilman, 1 avenue de l'Hôpital, 4000 Liège, Belgique
| | - Corinne Charlier
- Service de toxicologie clinique, médico-légale, de l'environnement et en entreprise, CHU Sart-Tilman, 1 avenue de l'Hôpital, 4000 Liège, Belgique
| |
Collapse
|
22
|
Drynda A, Ren Q, Buchhorn GH, Lohmann CH. The induction of CXCR4 expression in human osteoblast-like cells (MG63) by CoCr particles is regulated by the PLC-DAG-PKC pathway. J Biomed Mater Res B Appl Biomater 2016; 105:2326-2332. [PMID: 27504737 DOI: 10.1002/jbm.b.33770] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 06/13/2016] [Accepted: 07/26/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND Osteolysis which leads to aseptic loosening of implants is a fundamental problem in joint replacement surgery (arthroplasty) and the leading cause for implant failure and revision surgery. Metal (CoCr) particles separated from implants by wear cause osteolysis and the failure of orthopedic implants, but the molecular mechanism is not clear. The chemokine receptor CXCR4 has been shown to play a pivotal role in periprosthetic osteolysis. The aim of this study was to determine which signal transduction pathway (PLC-DAG-PKC or MAPK/ERK) induces CXCR4 expression in osteoblast-like cells (MG63) cells. METHODS MG63 and Jurkat cells were stimulated with different amounts of particles (107 , 106 , and 105 ) for different time periods (30 min to 24 h), in the presence and absence of specific inhibitors (chelerythrine for the PLC-DAG-PKC pathway and PD98059 for the MAPK/ERK pathway). The expression of CXCR4-specific mRNA was determined by real-time polymerase chain reaction (PCR), and the PKC activity was measured by Western Blot using an antibody specific for PKC-related phosphorylation. RESULTS Real-time PCR data showed that CXCR4 mRNA expression in MG63 cells induced by CoCr particles was significantly diminished by the PKC-specific inhibitor chelerythrine. This effect was not observed with the MAPK/ERK inhibitor PD98059. The involvement of PKC was also confirmed by an intensified phosphorylation pattern after stimulation with CoCr particles. In Jurkat cells, none of the inhibitors exhibited any effect. CONCLUSION The induction of CXCR4-specific mRNA expression in MG63 cells after stimulation with CoCr particles is regulated by the PLC-DAG-PKC pathway and not by the MAPK/ERK pathway. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 2326-2332, 2017.
Collapse
Affiliation(s)
- Andreas Drynda
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Qiang Ren
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | | | - Christoph H Lohmann
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany
| |
Collapse
|
23
|
Zywiel MG, Cherian JJ, Banerjee S, Cheung AC, Wong F, Butany J, Gilbert C, Overgaard C, Syed K, Jacobs JJ, Mont MA. Systemic cobalt toxicity from total hip arthroplasties. Bone Joint J 2016; 98-B:14-20. [PMID: 26733510 DOI: 10.1302/0301-620x.98b1.36712] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
As adverse events related to metal on metal hip arthroplasty have been better understood, there has been increased interest in toxicity related to the high circulating levels of cobalt ions. However, distinguishing true toxicity from benign elevations in cobalt levels can be challenging. The purpose of this review is to examine the use of cobalt alloys in total hip arthroplasty, to review the methods of measuring circulating cobalt levels, to define a level of cobalt which is considered pathological and to review the pathophysiology, risk factors and treatment of cobalt toxicity. To the best of our knowledge, there are 18 published cases where cobalt metal ion toxicity has been attributed to the use of cobalt-chromium alloys in hip arthroplasty. Of these cases, the great majority reported systemic toxic reactions at serum cobalt levels more than 100 μg/L. This review highlights some of the clinical features of cobalt toxicity, with the goal that early awareness may decrease the risk factors for the development of cobalt toxicity and/or reduce its severity. Take home message: Severe adverse events can arise from the release of cobalt from metal-on-metal arthroplasties, and as such, orthopaedic surgeons should not only be aware of the presenting problems, but also have the knowledge to treat appropriately. Cite this article: Bone Joint J 2016;98-B:14–20.
Collapse
Affiliation(s)
- M. G. Zywiel
- University of Toronto, 100
College Street Room 302, Toronto, Ontario, M5G
1L5, Canada
| | - J. J. Cherian
- Philadelphia College of Osteopathic Medicine, 4190
City Line Ave, Philadelphia, PA
19131, USA
| | - S. Banerjee
- Sinai Hospital of Baltimore, 2401
West Belvedere Avenue, Baltimore, MD 21215, USA
| | - A. C. Cheung
- University of Toronto, 200
Elizabeth Street, Toronto, Ontario, M5G
2C4, Canada
| | - F. Wong
- University of Toronto, 200
Elizabeth Street, Toronto, Ontario, M5G
2C4, Canada
| | - J. Butany
- University of Toronto, 200
Elizabeth Street, Toronto, Ontario, M5G
2C4, Canada
| | - C. Gilbert
- University of Toronto, 200
Elizabeth Street, Toronto, Ontario, M5G
2C4, Canada
| | - C. Overgaard
- University of Toronto, 200
Elizabeth Street, Toronto, Ontario, M5G
2C4, Canada
| | - K. Syed
- University of Toronto, 100
College Street Room 302, Toronto, Ontario, M5G
1L5, Canada
| | - J. J. Jacobs
- Rush
University, 1611 W. Harrison St., Suite
400, Chicago, IL, 60612, USA
| | - M. A. Mont
- Sinai Hospital of Baltimore, 2401
West Belvedere Avenue, Baltimore, MD 21215, USA
| |
Collapse
|
24
|
Prevalence of Pseudotumor in Patients After Metal-On-Metal Hip Arthroplasty Evaluated with Metal Ion Analysis and MARS-MRI. J Arthroplasty 2016; 31:260-3. [PMID: 26253484 DOI: 10.1016/j.arth.2015.07.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 06/29/2015] [Accepted: 07/07/2015] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study is to quantify the prevalence of pseudotumors in patients with well-functioning and painful metal-on-metal total hip arthroplasty, to characterize the pseudotumor with the use of MARS-MRI, and to assess the relationship between pseudotumors and metal ions. We retrospectively reviewed 102 single surgeon patients. The results showed that 68.6% developed pseudotumor with 60.9% of the asymptomatic group developing pseudotumor. The symptomatic group had a higher proportion of patients with elevated serum cobalt levels (P=0.035). There was no difference found with elevated metal ions and prevalence of pseudotumor, but elevated cobalt levels were associated with larger pseudotumor size (P=0.001). The available evidence indicated that most patients that develop pseudotumors are asymptomatic, and that elevated serum cobalt levels may be associated with symptoms and pseudotumor size.
Collapse
|
25
|
De Pasquale D, Stea S, Squarzoni S, Bordini B, Amabile M, Catalani S, Apostoli P, Toni A. Metal-on-metal hip prostheses: correlation between debris in the synovial fluid and levels of cobalt and chromium ions in the bloodstream. INTERNATIONAL ORTHOPAEDICS 2015; 38:469-75. [PMID: 24122048 DOI: 10.1007/s00264-013-2137-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 09/19/2013] [Indexed: 12/12/2022]
Abstract
PURPOSE Hip prostheses with metal-on-metal (MoM) coupling can release cobalt-chromium particles and ions. The aim of this work is to verify the correlation between particles in the synovial fluid and circulating ions. METHODS Forty patients were enrolled; particles from synovial fluid were analysed by SEM–EDX (Scanning Electron Microscopy-Energy Dispersion X-rays analysis) and levels of circulating Co and Cr were assayed by ICP-MS (inductively-coupled plasma mass spectrometry). RESULTS In 16 cases we did not find any particles in the synovial fluid and the Co level in whole blood was 0.05–4.42 ppb; in seven with few particles the blood level was 2.2–15.6 ppb; in six cases with several particles the level was 5.0–54.3 ppb; finally, in 11 cases we isolated not only Co-Cr particles, but also Cr particles with low or absent Co and in these patients the circulating level of Co was 23.8–109.6 ppb. Co in serumand Cr level both whole blood and serum have shown a similar trend to Co; the correlation between all these values and the corresponding particles is statistically significant in all cases. CONCLUSION Co and Cr both in serum and whole blood represents a systemic representation of the particle release at local level and can therefore be used to confirm a diagnosis and monitor the wear process of MoM articular prostheses.
Collapse
|
26
|
Bisseling P, Smolders JMH, Hol A, van Susante JLC. Metal ion levels and functional results following resurfacing hip arthroplasty versus conventional small-diameter metal-on-metal total hip arthroplasty; a 3 to 5year follow-up of a randomized controlled trial. J Arthroplasty 2015; 30:61-7. [PMID: 25172584 DOI: 10.1016/j.arth.2014.07.036] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 07/31/2014] [Accepted: 07/31/2014] [Indexed: 02/01/2023] Open
Abstract
We present an update of a randomized controlled trial on 71 patients (<65 years) who received either a resurfacing hip arthroplasty (RHA) (n=38) or cementless 28-mm metal-on-metal (MoM) total hip arthroplasty (THA) (n=33). Metal ion levels and functional outcome scores were analyzed with a mean follow-up of 58 months (SD 8.1). No clear shifts in relatively good outcome was encountered between RHA and THA. Metal ion levels appear to equalize between groups after 3 years. Median cobalt and chromium remained below 1.3 μg/L throughout follow-up in both groups. Six revisions were performed, of which three for pseudotumor formation (one THA, two RHA). In conclusion there were no clinical differences between the two groups and metal ion levels were lower than other series remained low, however, pseudotumor formation was not eliminated.
Collapse
Affiliation(s)
- Pepijn Bisseling
- Department of Orthopaedics, Rijnstate Hospital, Arnhem, The Netherlands
| | - José M H Smolders
- Department of Orthopaedics, Rijnstate Hospital, Arnhem, The Netherlands
| | - Annemiek Hol
- Department of Orthopaedics, Rijnstate Hospital, Arnhem, The Netherlands
| | | |
Collapse
|
27
|
Abstract
Metal-on-metal resurfacing of the hip (MoMHR) has enjoyed a resurgence in the last decade, but is now again in question as a routine option for osteoarthritis of the hip. Proponents of hip resurfacing suggest that its survival is superior to that of conventional hip replacement (THR), and that hip resurfacing is less invasive, is easier to revise than THR, and provides superior functional outcomes. Our argument serves to illustrate that none of these proposed advantages have been realised and new and unanticipated serious complications, such as pseudotumors, have been associated with the procedure. As such, we feel that the routine use of MoMHR is not justified. Cite this article: Bone Joint J 2014;96-B(11 Suppl A):17–21.
Collapse
Affiliation(s)
- M. J. Dunbar
- Halifax Infirmary Hospital, 1796
Summer Street, Halifax, B3H
3A7, Canada
| | - V. Prasad
- Halifax Infirmary Hospital, 1796
Summer Street, Halifax, B3H
3A7, Canada
| | - B. Weerts
- Halifax Infirmary Hospital, 1796
Summer Street, Halifax, B3H
3A7, Canada
| | - G. Richardson
- Halifax Infirmary Hospital, 1796
Summer Street, Halifax, B3H
3A7, Canada
| |
Collapse
|
28
|
Tai SM, Millard N, Munir S, Jenabzadeh AR, Walter LR, Walter WL. Two-year serum metal ion levels in minimally invasive total conservative hip resurfacing: preliminary results of a prospective study. ANZ J Surg 2014; 85:164-8. [PMID: 25288230 DOI: 10.1111/ans.12868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Metal-on-metal (MoM) hip resurfacings have been associated with the potential development of metallic debris and its associated pathology. Serum cobalt and chromium levels are a reliable surrogate marker of wear rates in MoM bearings. The aim of the study was to examine the trend in serum metal ion levels in the initial 2-year post-operative period following implantation of the minimally invasive total conservative hip MoM hip resurfacing and to determine whether head size, acetabular component orientation, clinical outcome scores or post-operative range of movement would affect these levels. METHODS In this prospective cohort study, serum cobalt and chromium ion levels were measured pre- and post-operatively in 25 patients who underwent minimally invasive total conservative hip MoM hip resurfacing. The results were correlated with acetabular component orientation, head size, outcome scores and post-operative range of movement. RESULTS The mean serum cobalt and chromium levels at 2 years were 1.2 ppb (0.4-4.4 ppb) and 2.1 ppb (0.7-5.7 ppb). The mean cup inclination was 43° (30°-60°) and anteversion was 18° (1°-47°). There was no clear relationship between serum ions and acetabular component orientation, outcome scores or range of movement. Patients with a head size ≤52 mm had significantly higher metal ion levels (cobalt P = 0.02, chromium P = 0.045). CONCLUSION Our preliminary results show all patients had cobalt and chromium levels below those indicating a high-risk implant, suggesting successful early outcome from minimally invasive total conservative hip resurfacing surgery.
Collapse
Affiliation(s)
- Stephen M Tai
- Mater Clinic, Specialist Orthopaedic Group, Sydney, New South Wales, Australia
| | | | | | | | | | | |
Collapse
|
29
|
Nicolli A, Bisinella G, Padovani G, Vitella A, Chiara F, Trevisan A. Predictivity and fate of metal ion release from metal-on-metal total hip prostheses. J Arthroplasty 2014; 29:1763-7. [PMID: 24890993 DOI: 10.1016/j.arth.2014.04.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 04/17/2014] [Accepted: 04/29/2014] [Indexed: 02/01/2023] Open
Abstract
Blood metal ion levels in 72 patients with large head metal-on-metal hip arthroplasty were studied to determine the correlation between the values measured in whole blood and urine. Urinary cobalt and chromium levels of 30μg and 21μg, respectively, adjusted to creatinine were found to correspond to the 7μg/l cut-off value that has been accepted in whole blood. Cobalt and chromium levels in whole blood and urine both significantly correlated with increased acetabular component inclination angle over 50 degrees and pain scores. There was no correlation with socket anteversion angle or femoral head diameter. The data support the use of urinary measurement of metal ions adjusted to creatinine to monitor patients with large head metal-on-metal total hip arthroplasty.
Collapse
Affiliation(s)
- Annamaria Nicolli
- Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Via Giustiniani 2, I-35128 Padova, Italy
| | - Gianluca Bisinella
- Division of Orthopaedics and Trauma, Hospital of Este (Padova), Via San Fermo 10, I-35042 Este (Padova), Italy
| | - Giovanni Padovani
- Division of Orthopaedics and Trauma, Hospital of Este (Padova), Via San Fermo 10, I-35042 Este (Padova), Italy
| | - Antonio Vitella
- Division of Orthopaedics and Trauma, Hospital of Este (Padova), Via San Fermo 10, I-35042 Este (Padova), Italy
| | - Federica Chiara
- Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Via Giustiniani 2, I-35128 Padova, Italy
| | - Andrea Trevisan
- Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Via Giustiniani 2, I-35128 Padova, Italy.
| |
Collapse
|
30
|
Five year results of the first US FDA-approved hip resurfacing device. J Arthroplasty 2014; 29:1571-5. [PMID: 24780203 DOI: 10.1016/j.arth.2014.03.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 03/17/2014] [Accepted: 03/24/2014] [Indexed: 02/01/2023] Open
Abstract
A prospective, multi-center postmarket approval study has been ongoing since May 2006 to assess safety and efficacy of the first US FDA approved hip resurfacing implant. 265 patients have been enrolled at five study sites. The average age of the patients is 51.3 years. There have been 7 revisions (2.4%) in the cohort to date. K-M survival curves for the cohort are 97.6% at 5 years. There is a trend toward a gender difference in implant survivorship, with 98.6% of men and 94.7% of women free from revision. Metal ion analysis revealed median cobalt and chromium levels of 1.5 ppb and 1.7 ppb at 1 year. In this prospective US study, the Birmingham Hip Resurfacing implant is demonstrating results comparable to those in the literature.
Collapse
|
31
|
Mauerer A, Lange B, Welsch GH, Heidenau F, Adler W, Forst R, Richter RH. Release of Cu2+ from a copper-filled TiO2 coating in a rabbit model for total knee arthroplasty. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2014; 25:813-821. [PMID: 24343105 DOI: 10.1007/s10856-013-5116-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Accepted: 11/29/2013] [Indexed: 06/03/2023]
Abstract
The aim of this study was the investigation of a copper-filled TiO2 coating, that in vitro showed good antibacterial properties combined with good tissue tolerance in an animal model. To better understand the antibacterial mechanism of the bioactive coating the release of copper (Cu) ions over time was monitored to be able to detect possible threats as well as possible fields of application. 30 New Zealand White rabbits were divided into two groups with 15 animals per group. In group 1 (control group) Ti6Al4 V bolts were implanted into the distal femur, in group 2 the Ti6Al4 V bolts were coated with four TiO2-coatings with integrated Cu(2+)-ions (4 × Cu-TiO2). Blood tests were performed weekly until the animals were sacrificed 4 weeks postoperative. The maximum peak of Cu and ceruloplasmin concentration could be seen in both groups one week postoperative, whereas the Cu values in group II were significantly higher. The Cu concentration in both groups approximated the initial basic values 4 weeks postoperative. The 4 × Cu-TiO2 coating tested in our rabbit model for total knee arthroplasty is an active coating that releases potentially antibacterial Cu(2+) for 4 weeks with a peak 1 week postoperative. The bioactive coating could be a promising approach for a use in the field of implant related infection, orthopaedic revision and tumor surgery in the future.
Collapse
Affiliation(s)
- Andreas Mauerer
- Department of Orthopaedic Trauma Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054, Erlangen, Germany,
| | | | | | | | | | | | | |
Collapse
|
32
|
Abstract
Systemic contact dermatitis (SCD) refers to a skin condition where an individual who is cutaneously sensitized to an allergen will subsequently react to that same allergen or a cross-reacting allergen via the systemic route. It occurs to allergens including metals, medications, and foods. There has been recent interest in metal allergy as it relates to the implantation of devices such as orthopedic, dental, cardiac, and gynecologic implants. This review will briefly address all causes of systemic contact dermatitis with a special and expanded focus on metal implant allergy. We present literature on SCD to various metal biomedical devices, patch testing for diagnosis of metal allergy pre and post implantation and treatment.
Collapse
|
33
|
Le Duff MJ, Johnson AJ, Wassef AJ, Amstutz HC. Does femoral neck to cup impingement affect metal ion levels in hip resurfacing? Clin Orthop Relat Res 2014; 472:489-96. [PMID: 23690156 PMCID: PMC3890152 DOI: 10.1007/s11999-013-3074-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Impingement of the femoral neck with the acetabular component after metal-on-metal hip resurfacing arthroplasty (HRA) is a possible cause of edge loading and accelerated bearing wear. No attempt has been made to correlate radiographic impingement signs and blood metal ion levels. QUESTIONS/PURPOSES We (1) compared serum cobalt (CoS) and chromium (CrS) concentrations between patients with and without radiographic impingement signs treated with unilateral HRA, (2) determined whether divot depth on the femoral neck correlated with CoS and CrS, and (3) assessed the predictive value of radiographic impingement signs for high levels of CoS and CrS. METHODS A retrospective radiographic review of 141 patients with CoS and CrS analyses yielded 21 patients with and 120 without radiographic impingement signs (controls). Radiographic measurements included divot depth and orientation of the acetabular component to compute the contact patch to rim distance, a measure of functional head coverage. We defined a patient as having radiographic impingement signs if a remodeling of the femoral neck cortex showed a depression matching the predicted path of an impinging acetabular component. CoS and CrS were analyzed by inductively coupled plasma mass spectrometry and the radiographs were taken within 12 months of the last blood draw. RESULTS Median CoS and CrS were greater in the impingement group than in controls in patients with less than 10-mm contact patch to rim distances. Divot depth did not correlate with CoS or CrS. In predicting elevated ion levels (≥ 7 μg/L), the presence of a radiographic impingement sign showed a sensitivity of 50% for CoS and 33% for CrS and a specificity of 87% for both CoS and CrS. CONCLUSIONS Radiographic impingement signs influenced CoS and CrS only when the functional head coverage was insufficient due to poor socket positioning. Radiographic impingement signs alone were not a good predictor of elevated metal ion levels.
Collapse
Affiliation(s)
- Michel J. Le Duff
- Joint Replacement Institute, St Vincent Medical Center, 2200 West Third Street, Suite 400, Los Angeles, CA 90057 USA
| | - Alicia J. Johnson
- Joint Replacement Institute, St Vincent Medical Center, 2200 West Third Street, Suite 400, Los Angeles, CA 90057 USA
| | - Andrew J. Wassef
- Joint Replacement Institute, St Vincent Medical Center, 2200 West Third Street, Suite 400, Los Angeles, CA 90057 USA
| | - Harlan C. Amstutz
- Joint Replacement Institute, St Vincent Medical Center, 2200 West Third Street, Suite 400, Los Angeles, CA 90057 USA
| |
Collapse
|
34
|
Wear analysis of 39 conserve plus metal-on-metal hip resurfacing retrievals. J Arthroplasty 2014; 29:410-5. [PMID: 23845764 DOI: 10.1016/j.arth.2013.05.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 03/07/2013] [Accepted: 05/30/2013] [Indexed: 02/01/2023] Open
Abstract
There have been increasing concerns regarding adverse local tissue reactions (ALTR) following metal-on-metal (MOM) hip arthroplasties. This study examined wear rates in retrievals of one design of MOM resurfacing arthroplasty, and assessed the differences in wear between those with and without ALTR. Wear measurements were made on 39 MOM resurfacing components (30 femoral, 9 acetabular) which were at least 2years in vivo. Seven hips (6 patients; 4 acetabular components, 7 femoral components) were identified to have ALTR. Acetabular component abduction and anteversion angles were determined using EBRA, and the contact-patch-to-rim (CPR) distance was calculated. The ALTR group had higher linear femoral and acetabular wear rates, acetabular anteversion and abduction angles, lower CPR, and longer time to revision. Given the increased risk for ALTR associated with acetabular component malpositioning, patients with malpositioned acetabular components may require closer clinical follow-up and monitoring.
Collapse
|
35
|
Smith J, Lee D, Bali K, Railton P, Kinniburgh D, Faris P, Marshall D, Burkart B, Powell J. Does bearing size influence metal ion levels in large-head metal-on-metal total hip arthroplasty? A comparison of three total hip systems. J Orthop Surg Res 2014; 9:3. [PMID: 24472283 PMCID: PMC3916311 DOI: 10.1186/1749-799x-9-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 01/21/2014] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The purpose of the study was twofold: first, to determine whether there is a statistically significant difference in the metal ion levels among three different large-head metal-on-metal (MOM) total hip systems. The second objective was to assess whether position of the implanted prostheses, patient demographics or factors such as activity levels influence overall blood metal ion levels and whether there is a difference in the functional outcomes between the systems. METHODS In a cross-sectional cohort study, three different metal-on-metal total hip systems were assessed: two monoblock heads, the Durom socket (Zimmer, Warsaw, IN, USA) and the Birmingham socket (Smith and Nephew, Memphis, TN, USA), and one modular metal-on-metal total hip system (Pinnacle, Depuy Orthopedics, Warsaw, IN, USA). Fifty-four patients were recruited, with a mean age of 59.7 years and a mean follow-up time of 41 months (12 to 60). Patients were evaluated clinically, radiologically and biochemically. Statistical analysis was performed on all collected data to assess any differences between the three groups in terms of overall blood metal ion levels and also to identify whether there was any other factor within the group demographics and outcomes that could influence the mean levels of Co and Cr. RESULTS Although the functional outcome scores were similar in all three groups, the blood metal ion levels in the larger monoblock large heads (Durom, Birmingham sockets) were significantly raised compared with those of the Pinnacle group. In addition, the metal ion levels were not found to have a statistically significant relationship to the anteversion or abduction angles as measured on the radiographs. CONCLUSIONS When considering a MOM THR, the use of a monoblock large-head system leads to higher elevations in whole blood metal ions and offers no advantage over a smaller head modular system.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - James Powell
- Orthopaedic Trauma and Lower Extremity Reconstruction, University of Calgary, #0444 3134 Hospital Drive NW Calgary AB T2N 5A1, Canada.
| |
Collapse
|
36
|
Moroni A, Cadossi M, Bellenghi C, Romagnoli M, Bevoni R, Giannini S. Resurrection of hip resurfacing: what is the evidence? Expert Rev Med Devices 2014; 3:755-62. [PMID: 17280540 DOI: 10.1586/17434440.3.6.755] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Total hip resurfacing has long been conceptually attractive to both surgeons and patients. However, historically it has been plagued by limited durability and marked acetabular bone loss. The recent development of wear-resistant bearings, such as metal-on-metal, has led to renewed interest in hip resurfacing in the orthopedic community. Several resurfacing implants have been designed and positive results, particularly in young patients, have been reported. Although comparative studies of hip resurfacing and standard total hip replacement are still lacking, we believe that there is now evidence to demonstrate that this surgical concept deserves consideration, particularly when treating young patients with hip diseases.
Collapse
Affiliation(s)
- Antonio Moroni
- Bologna University, Rizzoli Orthopaedic Institute, Bologna, Istituti Ortopedici Rizzoli, Via G C Pupilli 1, 40136 Bologna, Italy.
| | | | | | | | | | | |
Collapse
|
37
|
Paustenbach DJ, Galbraith DA, Finley BL. Interpreting cobalt blood concentrations in hip implant patients. Clin Toxicol (Phila) 2013; 52:98-112. [DOI: 10.3109/15563650.2013.857024] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
38
|
Bestic JM, Berquist TH. Current concepts in hip arthroplasty imaging: metal-on-metal prostheses, their complications, and imaging strategies. Semin Roentgenol 2013; 48:178-86. [PMID: 23452465 DOI: 10.1053/j.ro.2012.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Joseph M Bestic
- Department of Radiology, Mayo Clinic, Jacksonville, FL 32224-3899, USA.
| | | |
Collapse
|
39
|
Sansone V, Pagani D, Melato M. The effects on bone cells of metal ions released from orthopaedic implants. A review. ACTA ACUST UNITED AC 2013; 10:34-40. [PMID: 23858309 DOI: 10.11138/ccmbm/2013.10.1.034] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The increasing use of orthopedic implants and, in particular, of hip and knee joint replacements for young and active patients, has stimulated interest and concern regarding the chronic, long-term effects of the materials used. This review focuses on the current knowledge of the adverse biologic reactions to metal particles released from orthopaedic implants in vivo and in vitro. More specifically, the purpose of this article is to provide an overview of the current literature about the adverse effects of metal particles on bone cells and peri-implant bone.
Collapse
Affiliation(s)
- Valerio Sansone
- Orthopaedic Department, University of Milan, "Istituto Ortopedico Galeazzi" IRCCS, Milano, Italy
| | | | | |
Collapse
|
40
|
Prentice JR, Clark MJ, Hoggard N, Morton AC, Tooth C, Paley MN, Stockley I, Hadjivassiliou M, Wilkinson JM. Metal-on-metal hip prostheses and systemic health: a cross-sectional association study 8 years after implantation. PLoS One 2013; 8:e66186. [PMID: 23762480 PMCID: PMC3677913 DOI: 10.1371/journal.pone.0066186] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 05/02/2013] [Indexed: 12/19/2022] Open
Abstract
There is public concern over the long term systemic health effects of metal released from hip replacement prostheses that use large-diameter metal-on-metal bearings. However, to date there has been no systematic study to determine which organs may be at risk, or the magnitude of any effect. We undertook a detailed cross-sectional health screen at a mean of 8 years after surgery in 35 asymptomatic patients who had previously received a metal-on-metal hip resurfacing (MoMHR) versus 35 individually age and sex matched asymptomatic patients who had received a conventional hip replacement. Total body bone mineral density was 5% higher (mean difference 0.05 g/cm2, P = 0.02) and bone turnover was 14% lower (TRAP 5b, mean difference −0.56IU/L, P = 0.006; osteocalcin, mean difference −3.08 ng/mL, P = 0.03) in the hip resurfacing versus conventional hip replacement group. Cardiac ejection fraction was 7% lower (mean absolute difference −5%, P = 0.04) and left ventricular end-diastolic diameter was 6% larger (mean difference 2.7 mm, P = 0.007) in the hip resurfacing group versus those patients who received a conventional hip replacement. The urinary fractional excretion of metal was low (cobalt 5%, chromium 1.5%) in patients with MoMHR, but creatinine clearance was normal. Diuretic prescription was associated with a 40% increase in the fractional excretion of chromium (mean difference 0.5%, P = 0.03). There was no evidence of difference in neuropsychological, renal tubular, hepatic or endocrine function between groups (P>0.05). Our findings of differences in bone and cardiac function between patient groups suggest that chronic exposure to low elevated metal concentrations in patients with well-functioning MoMHR prostheses may have systemic effects. Long-term epidemiological studies in patients with well-functioning metal on metal hip prostheses should include musculoskeletal and cardiac endpoints to quantitate the risk of clinical disease.
Collapse
Affiliation(s)
- Jennifer R. Prentice
- Department of Human Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Matthew J. Clark
- Department of Human Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Nigel Hoggard
- Department of Human Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Allison C. Morton
- Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Claire Tooth
- Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Martyn N. Paley
- Department of Human Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Ian Stockley
- Department of Orthopaedics, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Marios Hadjivassiliou
- Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - J. Mark Wilkinson
- Department of Human Metabolism, University of Sheffield, Sheffield, United Kingdom
- Department of Orthopaedics, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
- * E-mail:
| |
Collapse
|
41
|
Jantzen C, Jørgensen HL, Duus BR, Sporring SL, Lauritzen JB. Chromium and cobalt ion concentrations in blood and serum following various types of metal-on-metal hip arthroplasties: a literature overview. Acta Orthop 2013; 84:229-36. [PMID: 23594249 PMCID: PMC3715816 DOI: 10.3109/17453674.2013.792034] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Widely different metal ion concentrations in blood and serum have been reported with metal-on-metal (MoM) implants. We reviewed the literature on blood and serum ion concentrations of chromium (Cr) and cobalt (Co) following various MoM hip arthroplasties. METHODS Studies were searched for in the Medline database, Embase, and the Cochrane Database of Systematic Reviews. Highest mean or median ion concentrations of Cr and Co after a minimum of 1 year of follow-up were extracted and grouped according to sample- and articulation type, and average values were calculated. RESULTS 43 studies were included and 16 different MoM implants were identified. For the different types of bearings, average ion concentrations and range were calculated from the mean or median ion concentration. The average Cr concentration ranged between 0.5 and 2.5 μg/L in blood and between 0.8 and 5.1 μg/L in serum. For Co, the range was 0.7-3.4 μg/L in blood and 0.3-7.5 μg/L in serum. INTERPRETATION When the average blood ion concentrations calculated for the different implants, together with the concentrations measured in the individual studies, were compared with the upper acceptable limit for Cr and Co in blood, no clear pattern was recognized. Furthermore, we were unable to detect any clear difference in ion concentrations between different types of implants (THA and resurfacing).
Collapse
Affiliation(s)
| | - Henrik L Jørgensen
- Clinical Biochemistry, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | | | | |
Collapse
|
42
|
Abstract
We present our experience of contemporary cementless total hip arthroplasty (THA) conducted at a single institution to treat advanced avascular necrosis (AVN) in renal transplant patients. Between October 1997 and October 2008, 45 consecutive primary cementless THAs were performed in 30 patients with advanced AVN after renal transplantation. There were 18 males (27 hips) and 12 females (18 hips) (patient group) with an overall mean age 44 years (22 to 68). The clinical and radiographic results were compared with those of 96 sex and age-matched osteonecrotic hips in 72 patients that had not undergone organ transplantation or long-term steroid therapy (the control group). Patients were evaluated at surgery and at a mean of 7.2 years (2 to 13 years) postoperatively. The mean Harris hip score of patients improved from 48 points preoperatively to 94 points at last follow-up (p<0.05). Three hips in the patient group had massive osteolysis with polyethylene wear requiring revision surgery. One hip in the patient group underwent revision surgery because of recurrent dislocation at 11 years postoperatively. No intergroup differences in overall rates of complications or revisions were observed. However, transplant patients had a significantly higher rate of ectopic ossification. Despite diffuse osteopenia and chronic immunosuppression in renal transplant patients with osteonecrotic hips, cementless THA showed durable implant fixation to bone and no increased risk of complications.
Collapse
|
43
|
Paustenbach DJ, Tvermoes BE, Unice KM, Finley BL, Kerger BD. A review of the health hazards posed by cobalt. Crit Rev Toxicol 2013; 43:316-62. [DOI: 10.3109/10408444.2013.779633] [Citation(s) in RCA: 138] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
44
|
Yoon JP, Le Duff MJ, Johnson AJ, Takamura KM, Ebramzadeh E, Amstutz HC. Contact patch to rim distance predicts metal ion levels in hip resurfacing. Clin Orthop Relat Res 2013. [PMID: 23184671 PMCID: PMC3613526 DOI: 10.1007/s11999-012-2711-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Component design, size, acetabular orientation, patient gender, and activity level have been suggested as factors leading to elevated metal ion concentrations after-on-metal hip resurfacing arthroplasty (MMHRA). The calculation of the contact patch to rim (CPR) distance integrates component size, design, and acetabular orientation and may be a good predictor of elevated metal ion levels. QUESTIONS/PURPOSES We evaluated the effects and the predictive value of the CPR distance on serum cobalt (CoS) and chromium (CrS) ion levels. METHODS We retrospectively studied 182 patients with Conserve Plus MMHRAs at a minimum of 12 months after surgery (median, 57 months; range, 12-165 months). CoS and CrS levels were analyzed using inductively-coupled plasma mass spectrometry. Multiple logistic regression was performed to determine which if any of the factors related to serum ion levels. RESULTS Patients with CPR distances of 10 mm or less had a 37-fold increased risk of having elevated CoS of 7 μg/L or higher. Similarly, these patients had an 11-fold increased risk of having elevated CrS of 7 μg/L or higher. Sex and University of California Los Angeles activity scores did not influence the postoperative CoS and CrS levels. The negative predictive value for CPR distance less than 10 mm was 99.3% for CoS greater than 7 μg/L and 98.0% for CrS greater than 7 μg/L. CONCLUSIONS Our observations suggest the CPR distance would be a useful indicator to determine which patients are at risk for elevated ion levels. Patients with CPR distances greater than 10 mm need not be monitored unless they become symptomatic.
Collapse
Affiliation(s)
- James P. Yoon
- Joint Replacement Institute at St. Vincent Medical Center, 2200 West Third Street, Suite 400, Los Angeles, CA 90057 USA
| | - Michel J. Le Duff
- Joint Replacement Institute at St. Vincent Medical Center, 2200 West Third Street, Suite 400, Los Angeles, CA 90057 USA
| | - Alicia J. Johnson
- Joint Replacement Institute at St. Vincent Medical Center, 2200 West Third Street, Suite 400, Los Angeles, CA 90057 USA
| | - Karren M. Takamura
- Joint Replacement Institute at St. Vincent Medical Center, 2200 West Third Street, Suite 400, Los Angeles, CA 90057 USA
| | - Edward Ebramzadeh
- J. Vernon Luck Sr. MD, Orthopaedic Research Center, Orthopaedic Hospital at UCLA, Los Angeles, CA USA
| | - Harlan C. Amstutz
- Joint Replacement Institute at St. Vincent Medical Center, 2200 West Third Street, Suite 400, Los Angeles, CA 90057 USA
| |
Collapse
|
45
|
Amstutz HC, Campbell PA, Dorey FJ, Johnson AJ, Skipor AK, Jacobs JJ. Do ion concentrations after metal-on-metal hip resurfacing increase over time? A prospective study. J Arthroplasty 2013; 28:695-700. [PMID: 23123040 DOI: 10.1016/j.arth.2012.07.040] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 06/28/2012] [Accepted: 07/27/2012] [Indexed: 02/01/2023] Open
Abstract
Thirteen male and five female patients received a Conserve Plus hip resurfacing and prospectively provided blood samples to measure cobalt and chromium levels for up to 11 years. Trends in metal levels over time in unilateral and bilateral patients were studied. A multi-variate regression model was used to account for potential covariates. For unilaterals over all time intervals, the median Serum Cobalt level (CoS) was 1.06 μg/L, while the median Serum Chromium level (CrS) was 1.58 μg/L. For bilaterals, the median post operative CoS was 2.80 μg/L, while the median CrS was 5.80 μg/L. Metal levels increased within the first year then decreased and stabilized. These results show that serum metal levels in well-functioning implants can be low and do not increase with time.
Collapse
Affiliation(s)
- Harlan C Amstutz
- Joint Replacement Institute, St. Vincent Medical Center, Los Angeles, CA 90057, USA
| | | | | | | | | | | |
Collapse
|
46
|
Campbell JR, Estey MP. Metal release from hip prostheses: cobalt and chromium toxicity and the role of the clinical laboratory. Clin Chem Lab Med 2013; 51:213-20. [DOI: 10.1515/cclm-2012-0492] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 08/31/2012] [Indexed: 11/15/2022]
|
47
|
Prospective study on serum metal levels in patients with metal-on-metal lumbar disc arthroplasty. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012. [PMID: 23179981 DOI: 10.1007/s00586-012-2581-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE Metal-on-metal total disc replacement is a recent alternative treatment for degenerative disc disease. Wear and corrosion of these implants can lead to local and systemic transport of metal debris. This prospective longitudinal study examined the serum chromium and cobalt levels in 24 patients with cobalt-chromium alloy metal-on-metal lumbar disc replacements. METHODS Serum was assayed for chromium (Cr) and cobalt (Co) using high-resolution inductively-coupled plasma-mass spectrometry. Detection limits were 0.015 ng/mL for Cr and 0.04 ng/mL for Co. RESULTS Median serum Co levels at pre-op, 3, 6, 12, 24, and 36-months post-op were 0.10, 1.03, 0.96, 0.98, 0.67, and 0.52 ng/mL, respectively. Median serum Cr levels were 0.06, 0.49, 0.65, 0.43, 0.52, and 0.50 ng/mL, respectively. CONCLUSION In general, these results indicated that serum Co and Cr levels are elevated at all postoperative time points and are of the same order of magnitude as those observed in well-functioning metal-on-metal surface replacements of the hip and in metal-on-metal total hip replacements at similar postoperative time points.
Collapse
|
48
|
Maurer-Ertl W, Friesenbichler J, Sadoghi P, Pechmann M, Trennheuser M, Leithner A. Metal ion levels in large-diameter total hip and resurfacing hip arthroplasty--preliminary results of a prospective five year study after two years of follow-up. BMC Musculoskelet Disord 2012; 13:56. [PMID: 22494794 PMCID: PMC3490776 DOI: 10.1186/1471-2474-13-56] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 03/27/2012] [Indexed: 01/15/2023] Open
Abstract
Background Metal-on-metal hip resurfacing is an alternative to metal-on-metal total hip arthroplasty, especially for young and physically active patients. However, wear which might be detected by increased serum ion levels is a matter of concern. Methods The aims of this preliminary study were to determine the raise of metal ion levels at 2-years follow-up in a prospective setting and to evaluate differences between patients with either resurfacing or total hip arthroplasty. Furthermore we investigated if the inclination of the acetabular component and the arc of cover would influence these findings. Therefore, 36 patients were followed prospectively. Results The results showed increments for Co and Cr in both implant groups. Patients treated with large-diameter total hip arthroplasty showed fourfold and threefold, respectively, higher levels for Co and Cr compared to the resurfacing group (Co: p < 0,001 and Cr: p = 0,005). Nevertheless, we observed no significant correlation between serum ion levels, inclination and arc of cover. Discussion In order to clarify the biologic effects of ion dissemination and to identify risks concerning long-term toxicity of metals, the exposure should be monitored carefully. Therefore, long-term studies have to be done to determine adverse effects of Co and Cr following metal-on-metal hip replacement.
Collapse
Affiliation(s)
- W Maurer-Ertl
- Department of Orthopaedic Surgery, Medical University of Graz, Graz, Austria
| | | | | | | | | | | |
Collapse
|
49
|
Kwon YM, Mellon SJ, Monk P, Murray DW, Gill HS. In vivo evaluation of edge-loading in metal-on-metal hip resurfacing patients with pseudotumours. Bone Joint Res 2012; 1:42-9. [PMID: 23610670 PMCID: PMC3626206 DOI: 10.1302/2046-3758.14.2000019] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 03/20/2012] [Indexed: 12/12/2022] Open
Abstract
Objectives Pseudotumours (abnormal peri-prosthetic soft-tissue reactions)
following metal-on-metal hip resurfacing arthroplasty (MoMHRA) have
been associated with elevated metal ion levels, suggesting that
excessive wear may occur due to edge-loading of these MoM implants.
This study aimed to quantify in vivo edge-loading
in MoMHRA patients with and without pseudotumours during functional
activities. Methods The duration and magnitude of edge-loading in vivo was
quantified during functional activities by combining the dynamic
hip joint segment contact force calculated from the three-dimensional
(3D) motion analysis system with the 3D reconstruction of orientation
of the acetabular component and each patient’s specific hip joint
centre, based on CT scans. Results Edge-loading in the hips with pseudotumours occurred with a four-fold
increase in duration and magnitude of force compared with the hips
without pseudotumours (p = 0.02). Conclusions The study provides the first in vivo evidence to support that
edge-loading is an important mechanism that leads to localised excessive
wear (edge-wear), with subsequent elevation of metal ion levels
in MoMHRA patients with pseudotumours.
Collapse
Affiliation(s)
- Y-M Kwon
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Suite 3B, Boston, Massachusetts 02114, USA
| | | | | | | | | |
Collapse
|
50
|
Liu YK, Xu H, Liu F, Tao R, Yin J. Effects of serum cobalt ion concentration on the liver, kidney and heart in mice. Orthop Surg 2012; 2:134-40. [PMID: 22009928 DOI: 10.1111/j.1757-7861.2010.00076.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To investigate the effects of serum cobalt ion concentration on the liver, kidney and heart in mice. METHODS Forty 4-week-old male ICR mice were randomly divided into four groups (n = 10 in each group) as follows: Group 1 (HD), high-dose cobalt chloride group (3.28 mg/kg/day); Group 2 (MD), medium-dose cobalt chloride group (1.64 mg/kg/day); Group 3 (LD), low-dose group cobalt chloride group (0.82 mg/kg/day); and Group 4 (NC), normal control group (vehicle). Cobalt chloride and normal saline were given by intraperitoneal injection once per day for 3 weeks. The body weights of the mice were recorded every 3 days to ensure the correct doses of cobalt chloride. Blood samples for testing were taken at day 4, week 1, week 2 and week 3. Serum cobalt ion concentrations were measured in all samples whereas other serum biochemical variables, including aspartate aminotransferase (AST), aspartate aminotransferase (ALT), blood urea nitrogen (BUN), creatinine (Cr), and creatine kinase (CK) were evaluated at week 1, 2 and 3. After killing the mice at week 3, the heart, liver and kidney were collected for pathological evaluation. RESULTS Serum cobalt ion concentration was different between the groups. High-dose cobalt chloride significantly increased AST, ALT and CK concentrations, the concentrations increasing in parallel with treatment duration. Pathological evaluation showed that high-dose cobalt chloride had toxic effects on the heart and liver; however no significant effect was apparent in the kidney. CONCLUSION High-dose cobalt ion concentration in serum has toxic effects on the heart and liver, but no significant effect on the kidney in mice.
Collapse
Affiliation(s)
- Ya-ke Liu
- Department of Orthopaedics, the Affiliated Hospital to Nantong University, Nantong, Jiangsu Province, China
| | | | | | | | | |
Collapse
|