Cobalt deposition in mineralized bone tissue after metal-on-metal hip resurfacing: Quantitative μ-X-ray-fluorescence analysis of implant material incorporation in periprosthetic tissue

Abstract

Most resurfacing systems are manufactured from cobalt-chromium alloys with metal-on-metal (MoM) bearing couples. Because the quantity of particulate metal and corrosion products which can be released into the periprosthetic milieu is greater in MoM bearings than in metal-on-polyethylene (MoP) bearings, it is hypothesized that the quantity and distribution of debris released by the MoM components induce a compositional change in the periprosthetic bone. To determine the validity of this claim, nondestructive µ-X-ray fluorescence analysis was carried out on undecalcified histological samples from 13 femoral heads which had undergone surface replacement. These samples were extracted from the patients after gradient time points due to required revision surgery. Samples from nonintervened femoral heads as well as from a MoP resurfaced implant served as controls. Light microscopy and µ-X-ray fluorescence analyses revealed that cobalt debris was found not only in the soft tissue around the prosthesis and the bone marrow, but also in the mineralized bone tissue. Mineralized bone exposed to surface replacements showed significant increases in cobalt concentrations in comparison with control specimens without an implant. A maximum cobalt concentration in mineralized hard tissue of up to 380 ppm was detected as early as 2 years after implantation. Values of this magnitude are not found in implants with a MoP surface bearing until a lifetime of more than 20 years. This study demonstrates that hip resurfacing implants with MoM bearings present a potential long-term health risk due to rapid cobalt ion accumulation in periprosthetic hard tissue. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1855-1862, 2017.

Metal‐Specific Biomaterial Accumulation in Human Peri‐Implant Bone and Bone Marrow

“…[41] Studies investigating the Co and Cr content in mineralized matrix in femoral heads collected at revision surgery of hip resurfacing implants identified an increase of the Co content in periimplant bone and a correlation of the Co content with implant life time. [42,43] This is interesting since these hip resurfacing implants are known to cause osteolytic lesions at higher prevalence if compared to other hip implant designs. [5,44] Moreover, there is evidence that dissolved Co interacts with type I collagen, the principle protein in bone, by binding to collagen fibrils leading to diminished collagen density.…”

Prosthetic Metals: Release, Metabolism and Toxicity

“…While Ti deposition from prostheses was not detected in bone and muscle, Ti from dental implants was found in the jawbone and surrounding soft tissue. 95 Evidence of Ti retention in bone is also found in an animal trial. 98 Bone and muscle serve as the primary accumulation sites for Al, with 60% and 10%, respectively.…”

“…Concentration of Co up to 380 ppm was detected in the mineralized periprosthetic bone two years after implantation of the prosthesis. 95 In an animal trial, Co distribution in muscle was also observed. 96 Although the Cr level in the mineralized periprosthetic bone exhibited no significant change, 95 a biokinetic investigation provided evidence of Cr distribution in bone.…”

“… 95 In an animal trial, Co distribution in muscle was also observed. 96 Although the Cr level in the mineralized periprosthetic bone exhibited no significant change, 95 a biokinetic investigation provided evidence of Cr distribution in bone. 97 Biopsy results from THA or TKA patients or animal models failed to present any relevant evidence of Mo accumulation.…”

Potentially toxic metallic wear nanoparticles and trace metal ions release from metal-on-metal orthopedic implants in the human biological specimens: An Overview of in vivo and ex vivo clinical studies

“…The results reported by Hahn et al [79] emphasized the distinction between the effects of MoM and MoP implants. Studies of 13 undecalcified femoral heads which had undergone surface replacement showed increases in cobalt concentrations, up to 380 µg g -1 , compared to control specimens without an implant or with MoP implants.…”