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Hu X, Song J, Liao Z, Liu Y, Gao J, Menze B, Liu W. Morphological residual convolutional neural network (M-RCNN) for intelligent recognition of wear particles from artificial joints. FRICTION 2022; 10:560-572. [PMCID: PMC8372229 DOI: 10.1007/s40544-021-0516-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/18/2021] [Accepted: 03/30/2021] [Indexed: 06/28/2023]
Abstract
Finding the correct category of wear particles is important to understand the tribological behavior. However, manual identification is tedious and time-consuming. We here propose an automatic morphological residual convolutional neural network (M-RCNN), exploiting the residual knowledge and morphological priors between various particle types. We also employ data augmentation to prevent performance deterioration caused by the extremely imbalanced problem of class distribution. Experimental results indicate that our morphological priors are distinguishable and beneficial to largely boosting overall performance. M-RCNN demonstrates a much higher accuracy (0.940) than the deep residual network (0.845) and support vector machine (0.821). This work provides an effective solution for automatically identifying wear particles and can be a powerful tool to further analyze the failure mechanisms of artificial joints.
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Affiliation(s)
- Xiaobin Hu
- Department of Computer Science, Technical University of Munich, Garching, 85748 Germany
| | - Jian Song
- School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, 510006 China
| | - Zhenhua Liao
- Key Laboratory of Biomedical Materials and Implant Devices, Research Institute of Tsinghua University in Shenzhen, Shenzhen, 518057 China
| | - Yuhong Liu
- State Key Laboratory of Tribology, Tsinghua University, Beijing, 100084 China
| | - Jian Gao
- Mckelvey School of Engineering, Washington University in Saint Louis, St. Louis, MO 63130 USA
| | - Bjoern Menze
- Department of Computer Science, Technical University of Munich, Garching, 85748 Germany
| | - Weiqiang Liu
- Key Laboratory of Biomedical Materials and Implant Devices, Research Institute of Tsinghua University in Shenzhen, Shenzhen, 518057 China
- State Key Laboratory of Tribology, Tsinghua University, Beijing, 100084 China
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2
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Austin MS, Ashley BS, Bedard NA, Bezwada HP, Hannon CP, Fillingham YA, Kolwadkar YV, Rees HW, Grosso MJ, Zeegen EN. What is the Level of Evidence Substantiating Commercial Payers' Coverage Policies for Total Joint Arthroplasty? J Arthroplasty 2021; 36:2665-2673.e8. [PMID: 33867209 DOI: 10.1016/j.arth.2021.03.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/08/2021] [Accepted: 03/14/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The prevalence of total joint arthroplasty (TJA) in the United States has drawn the attention of health care stakeholders. The payers have also used a variety of strategies to regulate the medical necessity of these procedures. The purpose of this study was to examine the level of evidence of the coverage policies being used by commercial payers in the United States. METHODS The references of the coverage policies of four commercial insurance companies were reviewed for type of document, level of evidence, applicability to a TJA population, and success of nonoperative treatment in patients with severe degenerative joint disease. RESULTS 282 documents were reviewed. 45.8% were primary journal articles, 14.2% were level I or II, 41.2% were applicable to patients who were candidates for TJA, and 9.9% discussed the success of nonoperative treatment in patients who would be candidates for TJA. CONCLUSION Most of the references cited by commercial payers are of a lower level of scientific evidence and not applicable to patients considered to be candidates for TJA. This is relatively uniform across the reviewed payers. The dearth of high-quality literature cited by commercial payers reflects the lack of evidence and difficulty in conducting high level studies on the outcomes of nonoperative versus operative treatment for patients with severe, symptomatic osteoarthritis. Patients, surgeons, and payers would all benefit from such studies and we encourage professional societies to strive toward that end through multicenter collaboration.
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Affiliation(s)
- Matthew S Austin
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Blair S Ashley
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Nicholas A Bedard
- Department of Orthopaedic Surgery, University of Iowa Hospitals & Clinics, Iowa City, IA
| | | | - Charles P Hannon
- Department of Orthopaedic Surgery, The Mayo Clinic, Ochester, MN
| | - Yale A Fillingham
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Yogesh V Kolwadkar
- Department of Orthopaedic Surgery, VA Central California Health Care System, Fresno, CA
| | - Harold W Rees
- Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood, IL
| | - Matthew J Grosso
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA; Connecticut Joint Replacement Institute, Hartford, CT
| | - Erik N Zeegen
- Department of Orthopaedic Surgery, University of California Los Angeles, Santa Monica, CA
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Evidence based recommendations for reducing head-neck taper connection fretting corrosion in hip replacement prostheses. Hip Int 2017; 27:523-531. [PMID: 29027189 DOI: 10.5301/hipint.5000545] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION This systematic review seeks to summarise the published studies investigating prosthetic design, manufacture and surgical technique's effect on fretting corrosion at the head-neck taper connection, and provide clinical recommendations to reduce its occurrence. METHODS PubMed, MEDLINE and EMBASE electronic databases were searched using the terms taper, trunnion, cone and head-neck junction. Articles investigating prosthetic design, manufacture and surgical technique's effect on fretting corrosion were retrieved, reviewed and graded according to OCEBM levels of evidence and grades of recommendation. RESULTS The initial search yielded 1,224 unique articles, and 91 were included in the analysis. CONCLUSIONS There is fair evidence to recommend against the use of high offset femoral heads, larger diameter femoral heads, and to pay particular consideration to fretting corrosion's progression with time and risk with heavier or more active patients. Particular to metal-on-metal hip prostheses, there is fair evidence to recommend positioning the acetabular component to minimise edge loading. Particular to metal-on-polyethylene hip prostheses, there is fair evidence to recommend the use of ceramic femoral heads, against use of cast cobalt alloy femoral heads, and against use of low flexural rigidity femoral stems. Evidence related to taper connection design is largely conflicting or inconclusive. Head-neck taper connection fretting corrosion is a multifactorial problem. Strict adherence to the guidelines presented herein does not eliminate the risk. Prosthesis selection is critical, and well-controlled studies to identify each design parameter's relative contribution to head-neck taper connection fretting corrosion are required.
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Thorkildsen R, Reigstad O, Røkkum M. Chrome nitride coating reduces wear of small, spherical CrCoMo metal-on-metal articulations in a joint simulator. J Hand Surg Eur Vol 2017; 42:310-315. [PMID: 28196445 DOI: 10.1177/1753193416674161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Metal-on-metal articulations have fallen out of favour in larger joint replacements, but are still used in smaller joints. Coating the articulation has been suggested as one way of reducing wear. We compared a standard 6 mm CrCoMo articulation designed for the carpometacarpal joint of the thumb with a chromium nitride-coated version after 512,000 cycles in a joint simulator. A total of 6 articulations in each group were tested with a unidirectional load of 5 kg in Ringer's solution. We found a statistically significant reduction in weight loss, amount of metallic wear produced and volumetric wear for the chromium nitride-coated articulation. Our findings support the use of chromium nitride coating in order to minimize the amount of metallic wear produced.
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Affiliation(s)
- R Thorkildsen
- 1 Orthopaedic Department, University Hospital of Oslo, Oslo, Norway
| | - O Reigstad
- 1 Orthopaedic Department, University Hospital of Oslo, Oslo, Norway
| | - M Røkkum
- 1 Orthopaedic Department, University Hospital of Oslo, Oslo, Norway.,2 University of Oslo, Oslo, Norway
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Khan M, Kuiper JH, Sieniawska C, Richardson JB. Differences in concentration of metal debris in blood, serum, and plasma samples of patients with metal-on-metal hip resurfacing arthroplasty. J Orthop 2015; 13:450-454. [PMID: 27857480 DOI: 10.1016/j.jor.2015.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 10/04/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Cobalt and chromium are released from MOM hips and their precise nature (ions/particles) is not known. Their distribution in serum, plasma, and whole blood may help to determine their nature. METHODS We measured cobalt and chromium concentrations in plasma, serum, and whole blood samples of patients with resurfacing MOM hips. RESULTS We found that chromium concentration was highest in plasma, followed by serum and whole blood. Chromium and cobalt concentrations were higher in serum and plasma, compared to whole blood. CONCLUSION We, therefore, suggest that in future cobalt and chromium concentrations shall be reported using plasma samples.
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Affiliation(s)
- M Khan
- Institute of Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic and District Hospital, Oswestry, Shropshire SY10 7AG, United Kingdom
| | - J H Kuiper
- Institute of Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic and District Hospital, Oswestry, Shropshire SY10 7AG, United Kingdom
| | - Christine Sieniawska
- Department of Clinical Biochemistry, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, United Kingdom
| | - J B Richardson
- Institute of Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic and District Hospital, Oswestry, Shropshire SY10 7AG, United Kingdom
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Fox CM, Bergin KM, Kelly GE, McCoy GF, Ryan AG, Quinlan JF. MRI findings following metal on metal hip arthroplasty and their relationship with metal ion levels and acetabular inclination angles. J Arthroplasty 2014; 29:1647-52. [PMID: 24793890 DOI: 10.1016/j.arth.2014.03.030] [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: 11/29/2013] [Revised: 03/16/2014] [Accepted: 03/25/2014] [Indexed: 02/01/2023] Open
Abstract
Following the global recall of all ASR metal on metal hip products, our aim was to correlate MRI findings with acetabular inclination angles and metal ion levels in patients with these implants. Both cobalt and chromium levels were significantly higher in the presence of a periprosthetic fluid collection. There was no association between the presence of a periprosthetic mass, bone marrow oedema, trochanteric bursitis or greater levels of abductor muscle destruction for cobalt or chromium. There was no association between the level of periprosthetic tissue reaction and the acetabular inclination angle with any of the pathologies identified on MRI. The relationship between MRI pathology, metal ion levels and acetabular inclination angles in patients with ASR implants remains unclear adding to the complexity of managing patients.
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Affiliation(s)
- Ciara M Fox
- Lourdes Orthopaedic Hospital, Kilcreene, Kilkenny, Ireland
| | - Karen M Bergin
- Lourdes Orthopaedic Hospital, Kilcreene, Kilkenny, Ireland
| | - Gabrielle E Kelly
- School of Mathematical Sciences, University College Dublin, Belfield, Dublin 4, Ireland
| | - Gerry F McCoy
- Lourdes Orthopaedic Hospital, Kilcreene, Kilkenny, Ireland
| | - Anthony G Ryan
- Department of Radiology, Waterford Regional Hospital, Waterford, Ireland
| | - John F Quinlan
- Lourdes Orthopaedic Hospital, Kilcreene, Kilkenny, Ireland
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Lombardi AV. Case studies in management of THA failure secondary to taper corrosion, modular junctions and metal-on-metal bearings. J Arthroplasty 2014; 29:663-7. [PMID: 24655612 DOI: 10.1016/j.arth.2014.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 02/03/2014] [Indexed: 02/01/2023] Open
Abstract
The diagnosis and treatment of patients with painful total hip arthroplasties secondary to taper corrosion and wear of modular junctions and metal-on-metal bearings represents a major challenge for the orthopaedic clinician. Guidelines are evolving as we analyze the growing body of evidence regarding metal-related failures of orthopaedic implants and adverse reactions to metal debris. In this article 6 case examples are presented to enhance understanding and application of current evidence into practice. Clinical expertise is integrated with the best available evidence from research and national joint registries data into the decision making process relevant for patient care in everyday practice. Issues addressed include understanding taper corrosion and metal failure mechanisms, clinical presentation of adverse soft tissue reactions, utility of specialized tests such as metal ion analysis and cross-sectional imaging studies, the utility of modular components for primary THA, dealing with recalled component, and current recommendations.
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Affiliation(s)
- Adolph V Lombardi
- Joint Implant Surgeons, Inc., New Albany, Ohio; Mount Carmel Health System, New Albany, Ohio; Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Kazi HA, Perera JR, Gillott E, Carroll FA, Briggs TWR. A prospective study of a ceramic-on-metal bearing in total hip arthroplasty. Bone Joint J 2013; 95-B:1040-4. [DOI: 10.1302/0301-620x.95b8.31574] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We prospectively assessed the efficacy of a ceramic-on-metal (CoM) hip bearing with uncemented acetabular and femoral components in which cobalt–chrome acetabular liners and alumina ceramic heads were used. The cohort comprised 94 total hip replacements (THRs) in 83 patients (38 women and 45 men) with a mean age of 58 years (42 to 70). Minimum follow-up was two years. All patients had pre- and post-operative assessment using the Western Ontario and McMaster Universities osteoarthritis index (WOMAC), Oxford hip score and Short-Form 12 scores. All showed a statistically significant improvement from three months post-operatively onwards (all p < 0.001). After two years whole blood metal ion levels were measured and chromosomal analysis was performed. The levels of all metal ions were elevated except vanadium. Levels of chromium, cobalt, molybdenum and titanium were significantly higher in patients who underwent bilateral THR compared with those undergoing unilateral THR (p < 0.001). Chromosomal analysis demonstrated both structural and aneuploidy mutations. There were significantly more breaks and losses than in the normal population (p < 0.001). There was no significant difference in chromosomal aberration between those undergoing unilateral and bilateral procedures (all analyses p ≥ 0.62). The use of a CoM THR is effective clinically in the short-term, with no concerns, but the significance of high metal ion levels and chromosomal aberrations in the long-term remains unclear. Cite this article: Bone Joint J 2013;95-B:1040–44.
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Affiliation(s)
- H. A. Kazi
- Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, 43 Wellesley Street East, Toronto, M4Y 1H1, Canada
| | - J. R. Perera
- Royal National Orthopaedic Hospital, Brockley
Hill, Stanmore, Middlesex
HA7 4LP, UK
| | - E. Gillott
- Royal National Orthopaedic Hospital, Brockley
Hill, Stanmore, Middlesex
HA7 4LP, UK
| | - F. A. Carroll
- Wirral University Teaching Hospital NHS
Foundation Trust, Arrowe Park Road, Upton, Wirral
CH49 5PE, UK
| | - T. W. R. Briggs
- Royal National Orthopaedic Hospital, Brockley
Hill, Stanmore, Middlesex
HA7 4LP, UK
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Schouten R, Malone AA, Tiffen C, Frampton CM, Hooper G. A prospective, randomised controlled trial comparing ceramic-on-metal and metal-on-metal bearing surfaces in total hip replacement. ACTA ACUST UNITED AC 2013; 94:1462-7. [PMID: 23109623 DOI: 10.1302/0301-620x.94b11.29343] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In a double-blinded randomised controlled trial, 83 patients with primary osteoarthritis of the hip received either a ceramic-on-metal (CoM) or metal-on-metal (MoM) total hip replacement (THR). The implants differed only in the bearing surfaces used. The serum levels of cobalt and chromium and functional outcome scores were compared pre-operatively and at six and 12 months post-operatively. Data were available for 41 CoM and 36 MoM THRs (four patients were lost to follow-up, two received incorrect implants). The baseline characteristics of both cohorts were similar. Femoral head size measured 36 mm in all but two patients who had 28 mm heads. The mean serum cobalt and chromium levels increased in both groups, with no difference noted between groups at six months (cobalt p = 0.67, chromium p = 0.87) and 12 months (cobalt p = 0.76, chromium p = 0.76) post-operatively. Similarly, the mean Oxford hip scores, Western Ontario and McMaster Universities Osteoarthritis index and University of California, Los Angeles activity scores showed comparable improvement at 12 months. Our findings indicate that CoM and MoM couplings are associated with an equivalent increase in serum cobalt and chromium levels, and comparable functional outcome scores at six and 12-months follow-up.
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Affiliation(s)
- R Schouten
- Christchurch Hospital, Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, P.O. Box 4345, Christchurch, New Zealand.
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Lombardi AV, Barrack RL, Berend KR, Cuckler JM, Jacobs JJ, Mont MA, Schmalzried TP. The Hip Society: algorithmic approach to diagnosis and management of metal-on-metal arthroplasty. ACTA ACUST UNITED AC 2013; 94:14-8. [PMID: 23118373 DOI: 10.1302/0301-620x.94b11.30680] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Since 1996 more than one million metal-on-metal articulations have been implanted worldwide. Adverse reactions to metal debris are escalating. Here we present an algorithmic approach to patient management. The general approach to all arthroplasty patients returning for follow-up begins with a detailed history, querying for pain, discomfort or compromise of function. Symptomatic patients should be evaluated for intra-articular and extra-articular causes of pain. In large head MoM arthroplasty, aseptic loosening may be the source of pain and is frequently difficult to diagnose. Sepsis should be ruled out as a source of pain. Plain radiographs are evaluated to rule out loosening and osteolysis, and assess component position. Laboratory evaluation commences with erythrocyte sedimentation rate and C-reactive protein, which may be elevated. Serum metal ions should be assessed by an approved facility. Aspiration, with manual cell count and culture/sensitivity should be performed, with cloudy to creamy fluid with predominance of monocytes often indicative of failure. Imaging should include ultrasound or metal artifact reduction sequence MRI, specifically evaluating for fluid collections and/or masses about the hip. If adverse reaction to metal debris is suspected then revision to metal or ceramic-on-polyethylene is indicated and can be successful. Delay may be associated with extensive soft-tissue damage and hence poor clinical outcome.
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Affiliation(s)
- A V Lombardi
- The Ohio State University, Department of Orthopaedics and Department of Biomedical Engineering, 7277 Smith's Mill Road, Suite 200, New Albany, Ohio 43054, USA.
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Lu F, Royle M, Lali FV, Hart AJ, Collins S, Housden J, Shelton JC. Simple isolation method for the bulk isolation of wear particles from metal on metal bearing surfaces generated in a hip simulator test. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2012; 23:891-901. [PMID: 22391991 DOI: 10.1007/s10856-012-4573-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 01/27/2012] [Indexed: 05/31/2023]
Abstract
Isolation and characterization of metal-on-metal (MoM) wear particles from simulator lubricants is essential to understand wear behaviour, ion release and associated corrosive activity related to the wear particles. Substantial challenges remain to establish a simple, precise and repeatable protocol for the isolation and analysis of wear particles due to their extremely small size, their tendency to agglomerate and degrade. In this paper, we describe a simple and efficient method for the bulk isolation and characterisation of wear particles from MoM bearings. Freeze drying was used to remove the large volume of water from the serum lubricant, enzymes used to digest the proteins and ultracentrifugation to finally isolate and purify the particles. The present study involved a total of eight steps for the isolation process and a wear particle extraction efficiency of 45% was achieved.
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Affiliation(s)
- Fang Lu
- School of Engineering and Material Science, Queen Mary University of London, London, UK
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Khan M, Kuiper JH, Richardson JB. The exercise-related rise in plasma cobalt levels after metal-on-metal hip resurfacing arthroplasty. ACTA ACUST UNITED AC 2008; 90:1152-7. [DOI: 10.1302/0301-620x.90b9.20243] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Wear of metal-on-metal bearings causes elevated levels of cobalt and chromium in blood and body fluids. Metal-on-metal bearings have two distinct wear phases. In the early phase, the wear rate is high. Later, it decreases and the bearing enters a steady-state phase. It is expected that as the wear rates decline, the level of cobalt detected in plasma will also decrease. We studied the baseline and exercise-related cobalt rise in 21 patients (13 men and eight women) with a mean age of 54 years (38 to 80) who had undergone successful hip resurfacing at a mean of 44 months (10 to 96) earlier. Our results showed that circulating baseline cobalt levels were not significantly correlated with the time since implantation (r = 0.08, p = 0.650). By contrast, the exercise-related cobalt rise was directly correlated with the inclination angle of the acetabular component (r = 0.47, p = 0.032) and inversely correlated with the time since implantation (r = −0.5, p = 0.020). Inclination of the acetabular component should be kept less than 40° to decrease the production of wear debris.
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Affiliation(s)
- M. Khan
- Institute of Orthopaedics The Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, Shropshire SY10 7AG, UK
| | - J.-H. Kuiper
- Institute of Orthopaedics The Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, Shropshire SY10 7AG, UK
| | - J. B. Richardson
- Institute of Orthopaedics The Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, Shropshire SY10 7AG, UK
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