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Di Luzio M, Ronchi A, Amabile M, Tassinari E, Oddone M, D’Agostino G. Correlation Between Co Levels in Hair and Blood of Patients Who Underwent Metal-on-metal Hip Arthroplasty. Arthroplast Today 2022; 18:63-67. [PMID: 36275491 PMCID: PMC9582565 DOI: 10.1016/j.artd.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/06/2022] [Accepted: 09/12/2022] [Indexed: 11/06/2022] Open
Abstract
Background The purpose of this paper is to study the dependence of Co levels in hair on Co levels in blood after metal-on-metal (MoM) hip replacement and prove the suitability of hair analysis coupled to blood analysis in the decision process regarding implant revision evaluation. Methods Hair samples of 19 MoM patients having both well-functioning and malfunctioning implants and Co mass concentration levels in blood between 0.2 μg L-1 and 221.0 μg L-1 were included. A method based on inductively coupled plasma mass spectrometry was validated and used to measure the Co level in hair. Results The Co mass fraction in the hair of patients ranged between 0.011 mg kg-1 and 0.712 mg kg-1. A correlation analysis showed a statistically significant positive correlation (r = 0.932, P < .001) between Co in the hair and that in the blood in the full-level range and a statistically nonsignificant positive correlation (r = 0.595, P = .091) in the low-level range. Conclusions A correlation between the Co level in the hair and that in the blood exists when the latter is clearly above the 7 μg L-1 mass concentration threshold suggested for implant revision evaluation. The correlation disappears when the Co level in blood approaches or falls down the mass concentration threshold and that in the hair approaches or falls within the normal population range of 0.004-0.14 mg kg-1. Accordingly, clinicians could consider a hair analysis coupled to a blood analysis to assess the revision of malfunctioning MoM implants that release metals in patient’s body.
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Affiliation(s)
- Marco Di Luzio
- Istituto Nazionale di Ricerca Metrologica (INRIM), Pavia, Italy
| | - Anna Ronchi
- Laboratorio di Tossicologia Clinica e Sperimentale, Centro Antiveleni di Pavia - Centro Nazionale di Informazione Tossicologica, Istituti Clinici Sientifici Maugeri IRCCS Pavia, Pavia, Italy
| | - Marilina Amabile
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Enrico Tassinari
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Massimo Oddone
- Istituto Nazionale di Ricerca Metrologica (INRIM), Pavia, Italy,Dipartimento di Chimica, Università di Pavia, Pavia, Italy
| | - Giancarlo D’Agostino
- Istituto Nazionale di Ricerca Metrologica (INRIM), Pavia, Italy,Corresponding author. Istituto Nazionale di Ricerca Metrologica (INRIM), via Taramelli 12, 27100 Pavia, Italy. Tel.: +39 3493208619.
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Manninen E, Lainiala O, Karsikas M, Reito A, Jämsä P, Eskelinen A. Do cobalt or chromium accumulate in metal-on-metal hip arthroplasty patients who have mild, moderate, or severe renal insufficiency? Bone Joint J 2021; 103-B:1231-1237. [PMID: 34192941 DOI: 10.1302/0301-620x.103b7.bjj-2020-0836.r2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To find out if there is an inverse association between estimated glomerular filtration rate (eGFR) and whole blood cobalt (Co) and chromium (Cr) levels in patients with metal-on-metal (MoM) hip arthroplasties and renal insufficiency, suggesting that renal insufficiency could cause accumulation of Co and Cr in blood. METHODS Out of 2,520 patients with 3,013 MoM hip arthroplasties, we identified 1,244 patients with whole blood Co, Cr, and creatinine measured within no more than a one-year interval. We analyzed the correlation of blood metal ion levels and eGFR to identify a potential trend of accumulating Co or Cr with decreasing eGFR. RESULTS Of the 1,244 patients, 112 had normal renal function (eGFR > 90 ml/min/1.73 m2), 715 had mild renal insufficiency (eGFR 60 to 89), 384 had moderate renal insufficiency (eGFR 30 to 59), 27 had severe renal insufficiency (eGFR 15 to 29), and six had end-stage renal insufficiency (eGFR < 15). Median eGFR was 68 ml/min/1.73 m2 (interquartile range (IQR) 56 to 82), median whole blood Co was 3.3 µg/l (IQR 1.1 to 9.9), and median Cr was 2.0 µg/l (IQR 1.2 to 3.6). We did not observe an association between decreased eGFR and increased whole blood Co and Cr concentrations, but instead both increased Co and Cr were associated with higher eGFR, indicating better kidney function. CONCLUSION As patients with MoM hip arthroplasties get older, the prevalence of renal insufficiency among them will increase, and orthopaedic surgeons will increasingly have to evaluate whether or not this affects patient follow-up. The USA Food and Drug Administration suggests that closer follow-up may be needed for MoM patients with renal insufficiency. We did not observe accumulation of blood Co or Cr in MoM hip arthroplasty patients with mild to severe renal insufficiency. Cite this article: Bone Joint J 2021;103-B(7):1231-1237.
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Affiliation(s)
- Eveliina Manninen
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland
| | - Olli Lainiala
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland.,Department of Radiology, Tampere University Hospital, Tampere, Finland
| | - Mari Karsikas
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland.,Center For Life Course Health Research, University of Oulu, Oulu, Finland
| | - Aleksi Reito
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland
| | - Pyry Jämsä
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland
| | - Antti Eskelinen
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland
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Impingement of metal-polyethylene hip prostheses : Potential cause of high systemic titanium levels? DER ORTHOPADE 2021; 49:1066-1071. [PMID: 33025036 DOI: 10.1007/s00132-020-03998-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
High blood metal levels have been described in the past, primarily in metal-on-metal bearings. Other possible causes are often underestimated. This report presents the case of a 70-year-old female patient who suffered from pronounced neurological symptoms (especially fatigue and concentration problems) 13 years after implantation of a hip endoprosthesis with metal-polyethylene (ME-PE) bearing. An osteolysis in the pelvis and loosening of the acetabular component were detected. In addition, large quantities of metallic black discolored granulomas were detected in the periarticular environment during surgery. A ventral impingement with destruction of the titanium cup and the PE insert was identified as the suspected cause of this condition. The postoperative course of the blood metal levels was unexpected as titanium levels increased massively in the blood. Anamnesis, course of the disease and the surgical procedure as well as especially the course of the metal values in the blood of the patient are presented. Possible causes for the excessive occurrence of metal abrasion, the systemic distribution and potential toxic effects of titanium are explained and discussed in detail. In addition, the currently available literature on the subject is critically examined.
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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.
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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
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Jelsma J, Schotanus MGM, van Kuijk SMJ, Buil ITAF, Heyligers IC, Grimm B. Quality, but not quantity of physical activity is associated with metal ion concentrations in unilateral hip resurfacing. J Orthop Res 2020; 38:2206-2212. [PMID: 32086825 DOI: 10.1002/jor.24637] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 02/19/2020] [Indexed: 02/04/2023]
Abstract
Little is known about the influence of physical activity (PA) on metal ion concentrations in subjects with metal-on-metal hip arthroplasty. Implant wear is thought to be a function of use and thus of patient activity levels. It is hypothesized that daily habitual PA of patients with hip resurfacing arthroplasty (HRA) is associated with metal ion concentrations. Therefore a study was conducted in patients with a unilateral HRA at 10-years follow-up. Blood metal ion concentrations were determined. An acceleration-based activity monitor was used to measure PA in daily life. The cohort consisted of 12 males (75%) and 4 females (25%) with a median age at surgery of 55.5 ± 9.7 years [43.0-67.9] and a median follow-up of 9.9 ± 1.0 years [9.1-10.9]. The median cobalt and chromium ion concentrations were 25 ± 13 and 38 ± 28 nmol/L. A significant association between sit-stand transfers and high-intensity peaks with cobalt ion concentrations were found. Regarding PA and metal ion concentrations as a proxy of wear in HRA, specific activities like transfers or qualitative aspects of activity behavior like intensity, seem to matter more than the quantity of low-intensity activities like walking or cycling. This suggests that patients may safely engage in such activities to achieve important general health benefits and quality of life.
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Affiliation(s)
- Jetse Jelsma
- Department of Orthopedics, Zuyderland Medisch Centrum, Sittard-Geleen, The Netherlands
| | - Martijn G M Schotanus
- Department of Orthopedics, Zuyderland Medisch Centrum, Sittard-Geleen, The Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht, The Netherlands
| | - Ivo T A F Buil
- Department of Innovation and Funding, Zuyderland Medisch Centrum, Sittard-Geleen, The Netherlands
| | - Ide C Heyligers
- Department of Orthopedics, Zuyderland Medisch Centrum, Sittard-Geleen, The Netherlands
| | - Bernd Grimm
- Luxembourg Institute of Health, Human Motion Orthopaedics, Sports Science, Strassen, Luxembourg
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6
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Dover C, Kuiper JH, Craig P, Shaylor P. Ten years on: increased metal ion levels in a cohort of patients who underwent uncemented metal-on-polyethylene total hip arthroplasty. Bone Joint J 2020; 102-B:832-837. [DOI: 10.1302/0301-620x.102b7.bjj-2019-1372.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims We have previously demonstrated raised cobalt and chromium levels in patients with larger diameter femoral heads, following metal-on-polyethylene uncemented total hip arthroplasty. Further data have been collected, to see whether these associations have altered with time and to determine the long-term implications for these patients and our practice. Methods Patients from our previous study who underwent Trident-Accolade primary total hip arthroplasties using a metal-on-polyethylene bearing in 2009 were reviewed. Patients were invited to have their cobalt and chromium levels retested, and were provided an Oxford Hip Score. Serum ion levels were then compared between groups (28 mm, 36 mm, and 40 mm heads) and over time. Results Metal ion levels were repeated in 33 patients. When comparing the results of serum metal ion levels over time, regardless of head size, there was a significant increase in both cobalt and chromium levels (p < 0.001). Two patients with larger head sizes had undergone revision arthroplasty with evidence of trunnion damage at surgery. Two patients within the 40 mm subgroup had metal ion levels above the MHRA (Medicines and Healthcare Products Regulatory Agency) threshold for detailed investigation. The increase in cobalt and chromium, when comparing the 36 mm and 40 mm groups with those of the 28 mm group, was not significant (36 mm vs 28 mm; p = 0.092/p = 0.191; 40 mm vs 28 mm; p = 0.200/p = 0.091, respectively). There was no difference, between femoral head sizes, when comparing outcome as measured by the Oxford Hip Score. Conclusion This study shows an increase in cobalt and chromium levels over time for all modular femoral head sizes in patients with metal-on-polyethylene bearings, with two patients demonstrating ion levels above the MHRA threshold for failure, and a further two patients requiring revision surgery. These results may have clinical implications regarding longer term follow-up of patients and future implant choice, particularly among younger patients. Cite this article: Bone Joint J 2020;102-B(7):832–837.
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Affiliation(s)
- Caroline Dover
- The Robert Jones and Agnes Hunt Orthopaedic Hospital, UK
- University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Oswestry, UK
| | - Jan Herman Kuiper
- The Robert Jones and Agnes Hunt Orthopaedic Hospital, UK
- School of Pharmacy and Bioengineering, Keele University, Keele, UK
| | - Peter Craig
- The Holland Orthopaedic and Arthritic Centre, University of Toronto, Toronto, Canada
| | - Phillip Shaylor
- University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Oswestry, UK
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Jelsma J, Schotanus MG, Senden R, Heyligers IC, Grimm B. Metal ion concentrations after metal-on-metal hip arthroplasty are not correlated with habitual physical activity levels. Hip Int 2019; 29:638-646. [PMID: 30479165 DOI: 10.1177/1120700018814225] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Metal-on-metal (MoM) hip arthroplasties have shown high clinical failure rates with many patients at risk for a revision and under surveillance for high metal ion concentrations. Implant wear releasing such ions is assumed to be a function of use, i.e. the patient's physical activity. This study aimed to assess whether habitual physical activity levels of MoM patients are correlated with metal ion concentrations and are higher in patients with high (at risk) than in patients with low (safe) metal ion concentrations. METHODS A cohort study was conducted of patients with any type of MoM hip prosthesis. Metal ion concentrations were determined using ICP-MS. Habitual physical activity of subjects was measured in daily living using an acceleration-based activity monitor. Outcome consisted of quantitative and qualitative activity parameters. RESULTS In total, 62 patients were included. Mean age at surgery was 60.8 ± 9.3 years and follow-up was 6.3 ± 1.4 years. Cobalt concentrations were highly elevated overall (112.4 ± 137.9 nmol/L) and significantly more in bilateral (184.8 ± 106.5 nmol/L) than in unilateral cases (87.8 ± 139.4 nmol/L). No correlations were found between physical activity parameters and metal ion concentrations. Subgroup analysis of patients with low versus high cobalt concentration showed no significant differences in habitual physical activity. DISCUSSION No correlation was found between physical activity levels and metal ion concentrations. Implant use by normal habitual activities of daily living seems not to influence metal ion concentrations.
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Affiliation(s)
- Jetse Jelsma
- Department of Orthopaedics, Zuyderland Medical Centre, Sittard-Geleen/Heerlen, The Netherlands
| | - Martijn Gm Schotanus
- Department of Orthopaedics, Zuyderland Medical Centre, Sittard-Geleen/Heerlen, The Netherlands
| | - Rachel Senden
- Department of Orthopaedics, Zuyderland Medical Centre, Sittard-Geleen/Heerlen, The Netherlands
| | - Ide C Heyligers
- Department of Orthopaedics, Zuyderland Medical Centre, Sittard-Geleen/Heerlen, The Netherlands
| | - Bernd Grimm
- Department of Orthopaedics, Zuyderland Medical Centre, Sittard-Geleen/Heerlen, The Netherlands
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Marie-Hardy L, O'Laughlin P, Bonnin M, Ait Si Selmi T. Are dual mobility cups associated with increased metal ions in the blood? Clinical study of nickel and chromium levels with 29 months' follow-up. Orthop Traumatol Surg Res 2018; 104:1179-1182. [PMID: 30297115 DOI: 10.1016/j.otsr.2018.08.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 07/28/2018] [Accepted: 08/25/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Dual mobility cups have become the implant of choice for older patients with a high risk of dislocation. However, to our knowledge, no study has explored the possibility of metal ion production with these implants that incorporate a polyethylene-on-metal bearing. This led us to conduct a prospective study to determine whether use of a dual mobility cup is accompanied by increased levels of nickel and chromium in the blood. HYPOTHESIS Use of a dual mobility cup is accompanied by an increase of nickel and chromium levels in the blood. METHODS Between 2012 and 2015, 16 consecutive patients were enrolled in the study. They underwent primary hip arthroplasty with a ceramic Biolox™ head (CeramTec, Plochingen, Germany), Corail™ titanium alloy stem (DePuy Synthes, Saint Priest, France) and a Novae™ dual mobility cup (SERF, Décines-Charpieu, France) consisting of 19% chromium (Cr) and 13-15% nickel (Ni). Patients who had other potential sources of nickel or chromium in their body (joint implants, dental implants, etc.) were excluded. The blood levels (μg/L) of nickel and chromium were measured preoperatively and at 2 years' follow-up by an independent laboratory (Biomnis) using inductively coupled plasma mass spectrometry. The upper limits set by the laboratory were<0.87μg/L for chromium and<1.0μg/L for nickel. AP and lateral X-rays of the pelvis were taken preoperatively and at each postoperative follow-up visit to look for signs of loosening. The Postel-Merle-d'Aubigné (PMA) score was determined preoperatively and at each postoperative follow-up visit. Surgical revision procedures for any cause were also documented. RESULTS The mean follow-up was 29 months [13-39]. Preoperatively, blood nickel ion levels were measured in 7 patients; they were below 1μg/L in 6 patients (86%) and at 1.5μg/L in 1 patient (14%). The mean preoperative chromium ion levels (n=7) was 0.2μg/L [0-0.8μg/L]. Postoperatively, all 16 enrolled patients had their blood ion levels checked at a mean follow-up of 29 months. The nickel ion levels averaged 1.69±1.49 [0.2-5.6] (with 4/16 having>2μg/L and 12/16>1μg/L) and the chromium ion levels averaged 0.5±0.11 [0.4-0.7] (with no patients>0.7μg/L). There were no signs of loosening or osteolysis on the follow-up radiographs. The mean PMA score at 2 years was 17.8 [17,18]. CONCLUSION We found that dual mobility cups generate increased nickel but not chromium ions in the blood. The levels measured are comparable to those for other orthopedic implants such as spine implants. The clinical consequences of these increased levels are not known. Nevertheless, there were no clinical or radiological signs of loosening, although the follow-up was only 2 years. LEVEL OF EVIDENCE IV, Cohort study.
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Affiliation(s)
- Laura Marie-Hardy
- Centre orthopédique Paul-Santy-Mermoz, 24, avenue Paul-Santy, 69008 Lyon, France.
| | - Padhraig O'Laughlin
- Centre orthopédique Paul-Santy-Mermoz, 24, avenue Paul-Santy, 69008 Lyon, France
| | - Michel Bonnin
- Centre orthopédique Paul-Santy-Mermoz, 24, avenue Paul-Santy, 69008 Lyon, France
| | - Tarik Ait Si Selmi
- Centre orthopédique Paul-Santy-Mermoz, 24, avenue Paul-Santy, 69008 Lyon, France
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9
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Fernández-Fairen M, Punset M, Murcia-Asensio A, Ferrero-Manzanal F, Sueiro J, Gil J. Microstructure and Surface Damage in Retrieved Metal-on-Metal Hip Arthroplasties. J Arthroplasty 2017; 32:3782-3795. [PMID: 28754580 DOI: 10.1016/j.arth.2017.06.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 06/13/2017] [Accepted: 06/26/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Besides promising results of metal-on-metal (MOM) hip arthroplasty (HA), frequent failures have been reported even in the short term. Many host, surgical, design, metallurgical, and processing factors have been evoked in the base of these events. We have tried to characterize and to evaluate metallurgical and processing features present in this type of implants. METHODS The acetabular and femoral components of 20 MOM HAs collected from a multicenter retrieval program were examined. All the specimens were inspected with naked eye, with confocal microscopy and vertical scanning interferometry, scanning electron microscopy, back-scattered electron imaging, and energy-dispersive X-ray spectroscopy, in 25 zones of each articular component. RESULTS Gas pores, shrinkage voids and holes of detached carbides, carbides on surface, embedded particles, scratches and marks of wear, surface discoloration, surface deposits, and tribochemical reaction layers were widely dispersed through a substantial percentage of the total bearing surface in all the implanted components. Surface cup and head voids, and cup scratches showed significant correlation with the clearance of pair. A higher surface damage of the cup and head was observed mainly in the low clearance prostheses. There was no other significant correlation or difference in the incidence and importance of any of these defects between resurfacing hip arthroplasties and total hip arthroplasties, or according to the pair diameter. CONCLUSION Some metallurgical features and surface damage were significantly present in the retrieved implants of MoM HAs. It would be desirable to improve the structure and metallurgical characteristics of these implants to avoid those effects and optimize their performance.
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Affiliation(s)
| | - Miquel Punset
- Departamento de Ciencia de los Materiales, ETSEIB, Universidad Politécnica de Cataluña, Barcelona, Spain
| | | | | | | | - Javier Gil
- Departamento de Ciencia de los Materiales, ETSEIB, Universidad Politécnica de Cataluña, Barcelona, Spain
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10
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Ricciardi BF, Nocon AA, Jerabek SA, Wilner G, Kaplowitz E, Goldring SR, Purdue PE, Perino G. Histopathological characterization of corrosion product associated adverse local tissue reaction in hip implants: a study of 285 cases. BMC Clin Pathol 2016; 16:3. [PMID: 26924942 PMCID: PMC4769839 DOI: 10.1186/s12907-016-0025-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 02/22/2016] [Indexed: 12/12/2022] Open
Abstract
Background Adverse local tissue reaction (ALTR), characterized by a heterogeneous cellular inflammatory infiltrate and the presence of corrosion products in the periprosthetic soft tissues, has been recognized as a mechanism of failure in total hip replacement (THA). Different histological subtypes may have unique needs for longitudinal clinical follow-up and complication rates after revision arthroplasty. The purpose of this study was to describe the histological patterns observed in the periprosthetic tissue of failed THA in three different implant classes due to ALTR and their association with clinical features of implant failure. Methods Consecutive patients presenting with ALTR from three major hip implant classes (N = 285 cases) were identified from our prospective Osteolysis Tissue Database and Repository. Clinical characteristics including age, sex, BMI, length of implantation, and serum metal ion levels were recorded. Retrieved synovial tissue morphology was graded using light microscopy. Clinical characteristics and features of synovial tissue analysis were compared between the three implant classes. Histological patterns of ALTR identified from our observations and the literature were used to classify each case. The association between implant class and histological patterns was compared. Results Our histological analysis demonstrates that ALTR encompasses three main histological patterns: 1) macrophage predominant, 2) mixed lymphocytic and macrophagic with or without features of associated with hypersensitivity/allergy or response to particle toxicity (eosinophils/mast cells and/or lymphocytic germinal centers), and 3) predominant sarcoid-like granulomas. Implant classification was associated with histological pattern of failure, and the macrophagic predominant pattern was more common in implants with metal-on-metal bearing surfaces (MoM HRA and MoM LHTHA groups). Duration of implantation and composition of periprosthetic cellular infiltrates was significantly different amongst the three implant types examined suggesting that histopathological features of ALTR may explain the variability of clinical implant performance in these cases. Conclusions ALTR encompasses a diverse range of histological patterns, which are reflective of both the implant configuration independent of manufacturer and clinical features such as duration of implantation. The macrophagic predominant pattern and its mechanism of implant failure represent an important subgroup of ALTR which could become more prominent with increased length of implantation.
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Affiliation(s)
- Benjamin F Ricciardi
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY USA
| | - Allina A Nocon
- Healthcare Research Institute, Hospital for Special Surgery, New York, NY USA
| | - Seth A Jerabek
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY USA
| | - Gabrielle Wilner
- Division of Research, Hospital for Special Surgery, New York, NY USA
| | - Elianna Kaplowitz
- Division of Research, Hospital for Special Surgery, New York, NY USA
| | - Steven R Goldring
- Division of Research, Hospital for Special Surgery, New York, NY USA
| | - P Edward Purdue
- Division of Research, Hospital for Special Surgery, New York, NY USA
| | - Giorgio Perino
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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11
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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.
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Elkins JM, Callaghan JJ, Brown TD. Stability and trunnion wear potential in large-diameter metal-on-metal total hips: a finite element analysis. Clin Orthop Relat Res 2014; 472:529-42. [PMID: 24218160 PMCID: PMC3890205 DOI: 10.1007/s11999-013-3244-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Large-diameter femoral heads for metal-on-metal THA hold theoretical advantages of joint stability and low bearing surface wear. However, recent reports have indicated an unacceptably high rate of wear-associated failure with large-diameter bearings, possibly due in part to increased wear at the trunnion interface. Thus, the deleterious consequences of using large heads may outweigh their theoretical advantages. QUESTIONS/PURPOSES We investigated (1) to what extent femoral head size influenced stability in THA for several dislocation-prone motions; and the biomechanics of wear at the trunnion interface by considering the relationship between (2) wear potential and head size and (3) wear potential and other factors, including cup orientation, type of hip motion, and assembly/impaction load. METHODS Computational simulations were executed using a previously validated nonlinear contact finite element model. Stability was determined at 36 cup orientations for five distinct dislocation challenges. Wear at the trunnion interface was calculated for three separate cup orientations subjected to gait, stooping, and sit-to-stand motions. Seven head diameters were investigated: 32 to 56 mm, in 4-mm increments. RESULTS Stability improved with increased diameter, although diminishing benefit was seen for sizes of greater than 40 mm. By contrast, contact stress and computed wear at the trunnion interface all increased unabatedly with increasing head size. Increased impaction forces resulted in only small decreases in trunnion wear generation. CONCLUSIONS These data suggest that the theoretical advantages of large-diameter femoral heads have a limit. Diameters of greater than 40 mm demonstrated only modest improvement in terms of joint stability yet incurred substantial increase in wear potential at the trunnion. CLINICAL RELEVANCE Our model has potential to help investigators and designers of hip implants to better understand the optimization of trunnion design for long-term durability.
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Affiliation(s)
- Jacob M. Elkins
- />Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA USA , />Department of Biomedical Engineering, University of Iowa, Iowa City, IA USA
| | - John J. Callaghan
- />Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA USA , />Department of Biomedical Engineering, University of Iowa, Iowa City, IA USA , />Iowa City Veterans Administration Medical Center, Iowa City, IA USA
| | - Thomas D. Brown
- />Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA USA , />Department of Biomedical Engineering, University of Iowa, Iowa City, IA USA , />Orthopaedic Biomechanics Laboratory, University of Iowa, 2181 Westlawn, Iowa City, IA 52242 USA
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13
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Abstract
BACKGROUND Jogging has been classified as a high-impact sport, and jogging after total hip arthroplasty (THA) has not been well documented. PURPOSE To investigate the participation rate for postoperative jogging as well as jogging parameters and the influence of jogging on implant stability and bearing wear. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Included in this study were 804 hips in 608 patients (85 men, 523 women) who underwent THA between 2005 and 2011 with follow-up longer than 1 year. The mean patient age was 62 years (range, 26-98 years), and mean follow-up duration was 4.8 years (range, 2.3-7.8 years). Hip resurfacing arthroplasty (HRA) was performed in 81 patients and conventional THA in 527 patients. During routine postsurgical visits, patients were given a questionnaire concerning preoperative and postoperative jogging routines. For joggers, frequency, distance, duration, and velocity of jogging were recorded. Patients who did not jog postoperatively were asked to provide reasons for not jogging. Radiographs concerning implant migration and polyethylene wear were evaluated with specialized software, and serum cobalt and chromium ion concentrations were investigated for patients with metal-on-metal articulation. RESULTS A total of 33 patients (5.4%) performed jogging preoperatively, and 23 patients (3.8%) performed jogging postoperatively. Of the 23 who jogged postoperatively, conventional THA was performed in 13 patients and HRA in 10 patients. Postoperatively, joggers trained a mean of 4 times (range, 1-7 times) per week, covering a mean distance of 3.6 km (range, 0.5-15 km) in a mean time of 29 minutes (range, 5-90 minutes) per session and at a mean speed of 7.7 km/h (range, 3-18 km/h). No patient complained of pain or showed serum cobalt and chromium ion elevation greater than 7 ppb. No hip showed loosening, abnormal component migration, or excessive wear at a mean 5-year follow-up. There were 74 postoperative non-joggers with an interest in jogging. The reasons given for avoiding jogging included anxiety (45 patients; 61%); impossible because of several reasons, including pain, decreased range of motion, and muscle weakness (18 patients; 24%); and lumbar or knee pain (11 patients; 15%). Multivariate analysis revealed that male sex and a history of preoperative jogging demonstrated significant relationships with postoperative jogging. CONCLUSION A total of 3.8% of THA patients participated in postoperative jogging. Short-term postoperative follow-up did not identify any negative influence of jogging on implant survival.
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Affiliation(s)
- Hirohito Abe
- Takashi Sakai, Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan.
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Sidaginamale RP, Joyce TJ, Lord JK, Jefferson R, Blain PG, Nargol AVF, Langton DJ. Blood metal ion testing is an effectivescreening tool to identify poorly performing metal-on-metal bearingsurfaces. Bone Joint Res 2013; 2:84-95. [PMID: 23836464 PMCID: PMC3670540 DOI: 10.1302/2046-3758.25.2000148] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objectives The aims of this piece of work were to: 1) record the background
concentrations of blood chromium (Cr) and cobalt (Co) concentrations
in a large group of subjects; 2) to compare blood/serum Cr and Co
concentrations with retrieved metal-on-metal (MoM) hip resurfacings;
3) to examine the distribution of Co and Cr in the serum and whole
blood of patients with MoM hip arthroplasties; and 4) to further
understand the partitioning of metal ions between the serum and
whole blood fractions. Methods A total of 3042 blood samples donated to the local transfusion
centre were analysed to record Co and Cr concentrations. Also, 91
hip resurfacing devices from patients who had given pre-revision
blood/serum samples for metal ion analysis underwent volumetric
wear assessment using a coordinate measuring machine. Linear regression analysis
was carried out and receiver operating characteristic curves were
constructed to assess the reliability of metal ions to identify
abnormally wearing implants. The relationship between serum and
whole blood concentrations of Cr and Co in 1048 patients was analysed
using Bland-Altman charts. This relationship was further investigated
in an in vitro study during which human blood was
spiked with trivalent and hexavalent Cr, the serum then separated
and the fractions analysed. Results Only one patient in the transfusion group was found to have a
blood Co > 2 µg/l. Blood/Serum Cr and Co concentrations were reliable
indicators of abnormal wear. Blood Co appeared to be the most useful
clinical test, with a concentration of 4.5 µg/l showing sensitivity
and specificity for the detection of abnormal wear of 94% and 95%, respectively.
Generated metal ions tended to fill the serum compartment preferentially in
vivo and this was replicated in the in vitro study
when blood was spiked with trivalent Cr and bivalent Co. Conclusions Blood/serum metal ion concentrations are reliable indicators
of abnormal wear processes. Important differences exist however
between elements and the blood fraction under study. Future guidelines
must take these differences into account.
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Affiliation(s)
- R P Sidaginamale
- Newcastle University, StephensonBuilding, Claremont Road, Newcastleupon Tyne NE1 7RU, UK
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15
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Results of metal-on-metal hip resurfacing in patients 40 years old and younger. Arch Orthop Trauma Surg 2013; 133:267-73. [PMID: 23135156 DOI: 10.1007/s00402-012-1640-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Indexed: 10/27/2022]
Abstract
The prevalence of total hip arthroplasty in young patients is small but increasing. We analyzed the results of metal-on-metal hip resurfacing (MMHR) in patients aged 40 years or less. In total 74 operations were performed on 64 patients. Mean age at operation was 33.2 years. HHS averaged 92.3 points at latest follow-up, mean UCLA activity was 8.2. Patients with comorbidity evinced lower scores in HHS, in UCLA activity and in quality of life than patients without comorbidities. Eight revisions (10.8 %) were performed, of which seven due to adverse reaction to metal debris. Seven-year survival was 90.5 %. The functional outcome of hip resurfacing in this cohort was excellent, but overall survival was unsatisfactory. Further analysis is required to verify the role of hip resurfacing among young and active patients.
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16
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Hasegawa M, Yoshida K, Wakabayashi H, Sudo A. Cobalt and chromium ion release after large-diameter metal-on-metal total hip arthroplasty. J Arthroplasty 2012; 27:990-6. [PMID: 22325959 DOI: 10.1016/j.arth.2011.12.016] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 12/12/2011] [Indexed: 02/01/2023] Open
Abstract
Seventy-five patients underwent unilateral metal-on-metal total hip arthroplasty using a large-diameter head. Serum levels of cobalt and chromium were determined. Significant increases in both cobalt and chromium were observed at 3 months (cobalt, 1.4 μg/L; chromium, 1.4 μg/L) compared with preoperative values (P < .001). At 1 year, the median cobalt and chromium levels were 2.3 and 2.1 μg/L, respectively, and the levels had increased significantly compared with 3 months (P < .001). There were no significant differences between levels of either metal at 1 or 2 years (cobalt, 2.3 μg/L; chromium, 1.6 μg/L). Pseudotumor occurred in 2 hips. Patients with large-diameter metal-on-metal total hip arthroplasty had higher circulating metal ion levels at 3 months and 1 year, with no additional significant increases at 2 years.
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Affiliation(s)
- Masahiro Hasegawa
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu City, Mie, Japan
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17
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Minimum 5-year results of modular metal-on-metal total hip arthroplasty. J Arthroplasty 2012; 27:545-50. [PMID: 21908166 DOI: 10.1016/j.arth.2011.07.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Accepted: 07/05/2011] [Indexed: 02/01/2023] Open
Abstract
This study reports minimum 5-year results of 95 hips implanted with a Pinnacle (DePuy, Warsaw, Ind) modular metal-on-metal acetabular prosthesis. Clinical scores such as the Harris Hip and Western Ontario and McMaster Universities Arthritis Index revealed excellent clinical outcomes at mean 6-year follow-up. With the use of large-diameter femoral heads, dislocation was rare, occurring in only 1 hip. Moreover, no acetabular and only 3 femoral osteolytic lesions were detected. Kaplan-Meier survivorship at 7 years after arthroplasty was 97.8% for the total hip arthroplasty construct and 100% for the acetabular shell. No unexplained pain or other complication attributable to wear debris or the metal-on-metal articulation was observed. These findings indicate that total hip arthroplasty with this specific modular metal-on-metal bearing performed well in a high-demand population at midterm follow-up.
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18
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Sampson B, Hart A. Clinical usefulness of blood metal measurements to assess the failure of metal-on-metal hip implants. Ann Clin Biochem 2012; 49:118-31. [PMID: 22155921 PMCID: PMC4527411 DOI: 10.1258/acb.2011.011141] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2011] [Indexed: 02/06/2023]
Abstract
In April 2010, a Medicines and Healthcare Products Regulatory Agency safety alert concerning all metal-on-metal (MOM) hip replacements recommended measuring chromium and cobalt concentrations when managing patients with painful prostheses. The need for this review is illustrated by the recent surge in requests for these blood tests from orthopaedic surgeons following this alert. The aim is to provide guidance to laboratories in assessing these requests and advising clinicians on interpretation. First, we summarize the basic terminology regarding the types of hip replacements, with emphasis on the MOM type. Second, we describe the clinical concerns over implant-derived wear debris in the local tissues and distant sites. Analytical aspects of the measurement of the relevant metal ions and what factors affect the levels measured are discussed. The application of inductively coupled plasma mass spectrometry techniques to the measurement of these metals is considered in detail. The biological effects of metal wear products are summarized with local toxicity and systemic biological effects considered, including carcinogenicity, genotoxicity and systemic toxicity. Clinical cases are used to illustrate pertinent points.
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Affiliation(s)
- Barry Sampson
- Department of Clinical Biochemistry, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, UK.
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19
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Elkins JM, Kruger KM, Pedersen DR, Callaghan JJ, Brown TD. Edge-loading severity as a function of cup lip radius in metal-on-metal total hips--a finite element analysis. J Orthop Res 2012; 30:169-77. [PMID: 21812025 PMCID: PMC5160130 DOI: 10.1002/jor.21524] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 07/14/2011] [Indexed: 02/04/2023]
Abstract
While favorable tribological properties and allowance for larger femoral head sizes have made metal-on-metal (MoM) bearings an increasingly popular choice for total hip arthroplasty, concerns have mounted regarding adverse reactions to metal wear debris and ions. MoM cups differ from conventional polyethylene cups in terms of edge profile design and reductions from full hemisphericity, suggesting differences in loading at or near the cup edge, especially during subluxation events. Finite element analysis was used to investigate the effects of cup orientation and lip edge curvature on damage propensity for edge or near-edge loading during subluxation. Increased cup lip radius (resulting in reduced articular arc) had a detrimental effect upon subluxation-free hip range of motion and upon dislocation resistance. Contact stresses near the cup edge demonstrated complex relationships between edge radius and cup orientation, with peak stresses being influenced by both variables. The tendency for scraping wear at the egress site demonstrated similarly complex dependencies. These data indicate that acetabular cup design is an important determinant of edge and near-edge loading damage propensity.
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Affiliation(s)
- Jacob M. Elkins
- Department of Orthopaedics and Rehabilitation, University of Iowa
- Department of Biomedical Engineering, University of Iowa
| | - Karen M. Kruger
- Department of Orthopaedics and Rehabilitation, University of Iowa
- Department of Biomedical Engineering, University of Iowa
| | - Douglas R. Pedersen
- Department of Orthopaedics and Rehabilitation, University of Iowa
- Department of Biomedical Engineering, University of Iowa
| | - John J. Callaghan
- Department of Orthopaedics and Rehabilitation, University of Iowa
- Department of Biomedical Engineering, University of Iowa
- Iowa City Veterans Administration Medical Center
| | - Thomas D. Brown
- Department of Orthopaedics and Rehabilitation, University of Iowa
- Department of Biomedical Engineering, University of Iowa
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20
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Qu X, Huang X, Dai K. Metal-on-metal or metal-on-polyethylene for total hip arthroplasty: a meta-analysis of prospective randomized studies. Arch Orthop Trauma Surg 2011; 131:1573-83. [PMID: 21643799 DOI: 10.1007/s00402-011-1325-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND There has been recent concern regarding the increased use of metal-on-metal total hip arthroplasty (MOM-THA) as an alternative to contemporary metal-on-polyethylene total hip arthroplasty (MOP-THA), and the choice remains controversial. We performed a meta-analysis to evaluate and compare metal ion concentrations, complications, reoperation rates, clinical outcomes and radiographic outcomes of MOM-THA and MOP-THA. METHODS We performed a systematic review of English and non-English articles identified from MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, PreMEDLINE and HealthSTAR. Metal ion concentrations, complications, reoperation rates and other outcomes of MOM bearings were compared with MOP bearings in THA based on relative risks, mean differences and standardized mean difference statistics. RESULTS Eight prospective randomized trials were identified from 1,075 citations. Our results demonstrated significantly elevated erythrocyte, serum and urine levels of metal ions (cobalt and chromium) among patients who received MOM-THA. No significant differences in titanium concentrations or total complication or reoperation rates were found between MOM-THA and MOP-THA. Clinical function scores and radiographic evaluations were similar between the two groups. CONCLUSIONS This analysis found insufficient evidence to identify any clinical advantage of MOM-THA compared with MOP-THA. Although cobalt and chromium concentrations were elevated after MOM-THA, there were no significant differences in total complication rates (including all-case mortality) between the two groups in the short- to mid-term follow-up period. The MOM bearing option for THA should be used with caution.
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Affiliation(s)
- Xinhua Qu
- Shanghai Key Laboratory of Orthopaedic Implant, Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, People's Republic of China
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21
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Desy NM, Bergeron SG, Petit A, Huk OL, Antoniou J. Surgical variables influence metal ion levels after hip resurfacing. Clin Orthop Relat Res 2011; 469:1635-41. [PMID: 20972653 PMCID: PMC3094610 DOI: 10.1007/s11999-010-1636-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Metal-on-metal bearings in surface arthroplasty are associated with prolonged periods of elevated ion circulation. However, there exists some controversy regarding the effect of different surgical variables on the concentration of metal ions in whole blood of patients after hip resurfacing. QUESTIONS/PURPOSES We sought to confirm which clinical and radiographic parameters are associated with elevated levels of cobalt, chromium, and molybdenum after unilateral metal-on-metal surface arthroplasty. METHODS We retrospectively reviewed 91 patients with a minimum followup of 24 months (mean, 37 months; range, 24-55 months). The clinical variables consisted of age, gender, preoperative severity of osteoarthritis, component size, and functional outcome measures using the Harris hip score and UCLA activity score. The radiographic parameters included acetabular inclination and version as well as femoral component alignment from both the anteroposterior and lateral radiographs. RESULTS A smaller femoral head diameter was associated with larger levels of cobalt and chromium. We observed a negative correlation between ion levels and the Harris hip score or UCLA score. A larger acetabular inclination showed a direct relationship with the concentration of metal ions. Severity of preoperative osteoarthritis, acetabular version, femoral stem-shaft and valgus angle, and anterior orientation of the femoral component had no effect on the circulating metal ion levels. CONCLUSIONS The data suggest a smaller implant diameter, larger cup inclination, and lower postoperative functional scores are associated with increased cobalt and chromium levels after metal-on-metal hip resurfacing.
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Affiliation(s)
- Nicholas M. Desy
- Division of Orthopaedic Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, QC Canada
| | - Stephane G. Bergeron
- Division of Orthopaedic Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, QC Canada
| | - Alain Petit
- Division of Orthopaedic Surgery, McGill University and Lady Davis Institute for Medical Research, SMBD-Jewish General Hospital, 3755 Chemin de la Côte Ste-Catherine, Room E-003, Montreal, QC H3T 1E2 Canada
| | - Olga L. Huk
- Division of Orthopaedic Surgery, McGill University and Lady Davis Institute for Medical Research, SMBD-Jewish General Hospital, 3755 Chemin de la Côte Ste-Catherine, Room E-003, Montreal, QC H3T 1E2 Canada
| | - John Antoniou
- Division of Orthopaedic Surgery, McGill University and Lady Davis Institute for Medical Research, SMBD-Jewish General Hospital, 3755 Chemin de la Côte Ste-Catherine, Room E-003, Montreal, QC H3T 1E2 Canada
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Langton DJ, Joyce TJ, Mangat N, Lord J, Van Orsouw M, De Smet K, Nargol AVF. Reducing metal ion release following hip resurfacing arthroplasty. Orthop Clin North Am 2011; 42:169-80, viii. [PMID: 21435493 DOI: 10.1016/j.ocl.2011.01.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Recent guidelines have suggested that routine postoperative care of patients with metal-on-metal hip prostheses should involve metal ion analysis. This study sought to investigate the relationship between bearing surface wear rates of metal components and serum metal ion analysis and also to quantify the incidence of excessive increases in serum metal ion concentrations post-hip resurfacing arthroplasty.
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Affiliation(s)
- David J Langton
- Joint Replacement Unit, University Hospital of North Tees, Hardwick, Stockton-on-Tees, UK.
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23
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Amstutz HC, Le Duff MJ, Campbell PA, Wisk LE, Takamura KM. Complications after metal-on-metal hip resurfacing arthroplasty. Orthop Clin North Am 2011; 42:207-30, viii. [PMID: 21435496 DOI: 10.1016/j.ocl.2010.12.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This article determines the incidence and cause of the complications commonly associated with metal-on-metal hip resurfacing implants and the proposed methods to prevent these complications. The literature available in PubMed was reviewed. Complication rates after hip resurfacing are low, and the procedure has shown both safety and efficacy in the hands of surgeons trained in specialized centers. Proper surgical technique can further reduce the incidence of femoral neck fracture, component loosening, and abnormal wear of the prosthesis. A more systematic detection of adverse local tissue reactions is needed to provide accurate assessments of their prevalence.
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Affiliation(s)
- Harlan C Amstutz
- Joint Replacement Institute at Saint Vincent Medical Center, Los Angeles, CA 90057, USA.
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24
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Abstract
In this article, a concise review of the current literature on metal-on-metal hip resurfacing (MoMHR) is given. In contrast to conventional total hip arthroplasty, older age, female sex and small femoral head sizes predispose to failure. Neck fracture and metal wear-related complications account for the most frequent reasons for re-operations. Although the long-term consequences of metal ion release remain unknown, the increasing prevalence of soft tissue related problems with potentially devastating functional consequences in this younger patient group are of concern. Outcome after revision for metal wear related failure of MoMHR is poor. In our opinion, patients with this device should be managed in dedicated centers with facilities for data collection and monitoring. The majority of proposed advantages of MoMHR cannot be supported by the published evidence.
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Affiliation(s)
- Gavin J Macpherson
- Department of Orthopaedic Surgery, The Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK
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25
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Abstract
BACKGROUND Despite the clinical success of modern metal-on-metal articulations, concerns with wear-related release of metal ions persist. Evidence suggests metal ion release is related to the effective coverage of the head in the metal shell (the cup's functional articular arc). A recent study suggests a reduced functional articular arc is associated with increased ion release and the arc is a function of component design, size, and the abduction angle. QUESTIONS/PURPOSES The purposes of this study were to (1) measure the functional articular arc in different sizes of currently available one-piece metal shells from several different manufacturers; and (2) compare the functional articular arc of these one-piece metal shells with the 180 masculine arc of conventional hip arthroplasty acetabular components. METHODS We calculated the available articular surface arc for 33 one-piece metal cups using measurements of cup depth and internal cup radius. RESULTS The arc of the articular surface varied among manufacturers and generally decreased with decreasing shell diameter. The mean functional articular arc was 160.5 degrees +/- 3.6 degrees (range, 151.8 degrees -165.8 degrees), which was less than the 180 degrees arc of a conventional acetabular component. CONCLUSIONS Our data show certain cup designs are at higher risk for failure as a result of the decreased articular surface arc. This, along with analysis of abduction angles, supports the recent findings of bearing failure with vertically placed implants. Care must be taken when implanting these shells to ensure they are placed in less abduction to avoid edge loading and the potential for early bearing failure.
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26
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Kamali A, Hussain A, Li C, Pamu J, Daniel J, Ziaee H, Daniel J, McMinn DJW. Tribological performance of various CoCr microstructures in metal-on-metal bearings: the development of a more physiological protocol in vitro. ACTA ACUST UNITED AC 2010; 92:717-25. [PMID: 20436012 DOI: 10.1302/0301-620x.92b5.23320] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Hip simulators have been used for ten years to determine the tribological performance of large-head metal-on-metal devices using traditional test conditions. However, the hip simulator protocols were originally developed to test metal-on-polyethylene devices. We have used patient activity data to develop a more physiologically relevant test protocol for metal-on-metal devices. This includes stop/start motion, a more appropriate walking frequency, and alternating kinetic and kinematic profiles. There has been considerable discussion about the effect of heat treatments on the wear of metal-on-metal cobalt chromium molybdenum (CoCrMo) devices. Clinical studies have shown a higher rate of wear, levels of metal ions and rates of failure for the heat-treated metal compared to the as-cast metal CoCrMo devices. However, hip simulator studies in vitro under traditional testing conditions have thus far not been able to demonstrate a difference between the wear performance of these implants. Using a physiologically relevant test protocol, we have shown that heat treatment of metal-on-metal CoCrMo devices adversely affects their wear performance and generates significantly higher wear rates and levels of metal ions than in as-cast metal implants.
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Affiliation(s)
- A Kamali
- Implant Development Centre, Smith and Nephew Orthopaedics, Aurora House, Spa Park, Harrison Way, Leamington Spa CV31 3HL, UK.
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