Correlation between Serum Metal Ion Levels and Adverse Local Tissue Reactions after Conserve® plus Hip Resurfacing Arthroplasty

Amstutz, Harlan C.; Duff, Michel J. Le

doi:10.5301/hipint.5000481

Cited by 14 publications

(8 citation statements)

References 49 publications

(56 reference statements)

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“…The presence of elevated metal ions in serum and synovial fluid have been associated with the development of ALTRs (Amstutz and Le Duff, 2017). Monitoring Co and Cr levels in serum or whole blood is the current clinical predictor of hip implants malfunction and provides alert to the development of ALTRs.…”

Section: Mechanisms Of Implant Degradationmentioning

confidence: 99%

Mechanisms of Adverse Local Tissue Reactions to Hip Implants

Eltit

Wang

2019

Front. Bioeng. Biotechnol.

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Adverse Local Tissue Reactions (ALTRs) are one of the main causes of hip implant failures. Although the metal release from the implants is considered as a main etiology, the mechanisms, and the roles of the released products are topics of ongoing research. The alloys used in the hip implants are considered biocompatible and show negligible corrosion in the body environment under static conditions. However, modularity and its associated mechanically assisted corrosion have been shown to release metal species into the body fluids. ALTRs associated with metal release have been observed in hip implants with metal-on-metal articulation initially, and later with metal-on-polyethylene articulation, the most commonly used design in current hip replacement. The etiological factors in ALTRs have been the topics of many studies. One commonly accepted theory is that the interactions between the metal species and body proteins and cells generate a delayed type IV hypersensitivity reaction leading to ALTRs. However, lymphocyte reactions are not always observed in ALTRS, and the molecular mechanisms have not been clearly demonstrated. A more accepted mechanism is that cell damage generated by metal ions may trigger the secretion of cytokines leading to the inflammatory reactions observed in ALTRs. In this inflammatory environment, some patients would develop hypersensitivity that is associated with poor outcomes. Concerns over ALTRS have brought significant impact to both the clinical selection and development of hip implants. This review is focused on the mechanisms of ALTRs, specifically, the metal release process and the roles of the metal species released in the etiology and pathogenesis of the disease. Hopefully, our presentation and discussion of this biological process from a material perspective could improve our current understanding on the ALTRs and provide useful guidance in developing preventive solutions.

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Section: Mechanisms Of Implant Degradationmentioning

confidence: 99%

Mechanisms of Adverse Local Tissue Reactions to Hip Implants

Eltit

Wang

2019

Front. Bioeng. Biotechnol.

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“…Several studies have shown the inflammatory and osteolytic effect of cobalt and chromium ions 30,31 . The presence of elevated metal ions in synovial fluid and serum has been associated with the development of adverse local reactions in periprosthetic tissue 32 . A previous study demonstrated a strong correlation between elevated metal ion concentrations and patients with ALTR 33 .…”

Section: Discussionmentioning

confidence: 99%

Inflammatory tissue reactions around aseptically loose cemented hip prostheses: A retrieval study of the Spectron EF stem with Reflection All‐Poly acetabular cup

et al. 2022

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The cemented Spectron EF stem in combination with the cemented non-crosslinked Reflection All-Poly cup showed a high rate of mid-term aseptic loosening. However, the failure mechanisms are not fully known. We assessed the inflammatory tissue reactions and wear particles in periprosthetic tissues, implant wear and blood metal ion levels in 28 patients with failed implants. Histological analysis showed a macrophage pre-dominant pattern with randomly distributed lymphocytes, with various amounts of neutrophils and giant cells. The number of different cell types in the tissue samples from patients in the cup group and in the stem group was similar. Wear particles, mainly ZrO 2 , CoCrMo, and polyethylene particles of different sizes and shapes, were associated with macrophages/giant cells, and total particle load/mm 2 was higher in cases of stem loosening. The Spectron EF stems were heavily worn, abraded, and polished. Stem abrasion correlated with metal ion concentrations in blood. The median polyethylene wear rate of the Reflection cups was 0.23 mm/year.The high proximal roughness of the Spectron EF stem resulted in excessive cement wear during loosening. The resulting inflammatory tissue responses to the degradation products both from the cup and the stem led to massive osteolysis and subsequent implant loosening.

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“…Normal blood concentrations of chromium and cobalt ions are 0.5 μ g/l and 0.8 μ g/l, respectively, often elevated in patients with chromium-cobalt alloys [ 14 ]. An increase in cobalt serum concentrations is a reliable indicator of abnormal metal wear [ 15 – 18 ]. However, a correlation between increasing metal ion concentrations and worsening renal function could not be demonstrated [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Dislocation of a McMinn-Like Prosthesis with Distinctive Metallosis and Fracture of the Os Ilium

Bünemann

Lück

Ohlmeier

et al. 2021

Case Reports in Orthopedics

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Osteoarthritis of the hip joint (coxarthrosis) is the most common hip disease in adults. Since the 1960s, total hip arthroplasty (THA) has made great progress and is nowadays one of the most frequently used procedures in orthopedic surgery. Different bearing concepts exist in various implant designs. A metal-on-metal bearing can create metal debris and lead to metallosis. We present a unique case of a 78-year old woman, who received hip resurfacing with a McMinn-like prosthesis 15 years ago. Over the cause of time, metallosis developed and created a bone cyst in the Os ilium, and osteolysis led to a dislocation of the femoral implant. A minor stumble fall led to a fracture of the Os ilium. We present our treatment method with implantation of a cemented THA and refill of the bone cyst with bone from allogene femoral heads. The surgery led to a reconstruction of the physiological center of rotation in the hip. Consequently, to the inpatient stay, the patient took part in a follow-up treatment with intensive physiotherapy. Taken together, the results after total hip arthroplasty are more superior to other hip surface replacements in terms of longevity and patient satisfaction. Especially, metal-on-metal bearing couples carry a great risk of metallosis, which goes a long with pseudotumors, osteolysis, and the elevated metal ions in the blood. Since this case is unique in the literature, no guidelines are noted for surgical treatment. In our opinion, a periprosthetic fracture of this type should be performed in a hospital using extensive endoprosthetic expertise.

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Correlation between Serum Metal Ion Levels and Adverse Local Tissue Reactions after Conserve® plus Hip Resurfacing Arthroplasty

Abstract: MoM bearings require enough functional coverage of the socket by design and then precise implantation to maximise functional coverage of the femoral ball, enhance lubrication, and avoid edge-loading wear.

Cited by 14 publications

References 49 publications

Mechanisms of Adverse Local Tissue Reactions to Hip Implants

Mechanisms of Adverse Local Tissue Reactions to Hip Implants

Inflammatory tissue reactions around aseptically loose cemented hip prostheses: A retrieval study of the Spectron EF stem with Reflection All‐Poly acetabular cup

Dislocation of a McMinn-Like Prosthesis with Distinctive Metallosis and Fracture of the Os Ilium

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