Elevated Serum Cobalt With Metal-on-metal Articulating Surfaces

Brodner, Wolfram; Bitzan, Peter; Meisinger, V.; Kaider, Alexandra; Gottsauner‐Wolf, Florian; Kotz, R.

doi:10.1302/0301-620x.79b2.7326

Cited by 171 publications

(56 citation statements)

References 47 publications

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“…RCTs were generally small and included between 13 and 117 patients. Two RCTs examined MoM vs. ceramic-polyethylene (CoP) [32], [33], five studies MoM vs. metal-polyethylene (MoP) [34], [35], [36], [37], [38], [39], two studies examined MoM vs. ceramic-ceramic (CoC) [26], [40], [41], and two MoM vs. hip resurfacing arthroplasty (HRA) [42], [43], [44]. LH-THA was investigated in one US-American study [35].…”

Section: Resultsmentioning

confidence: 99%

Metal Ion Concentrations in Body Fluids after Implantation of Hip Replacements with Metal-on-Metal Bearing – Systematic Review of Clinical and Epidemiological Studies

et al. 2013

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IntroductionThe use of metal-on-metal (MoM) total hip arthroplasty (THA) increased in the last decades. A release of metal products (i.e. particles, ions, metallo-organic compounds) in these implants may cause local and/or systemic adverse reactions. Metal ion concentrations in body fluids are surrogate measures of metal exposure.ObjectiveTo systematically summarize and critically appraise published studies concerning metal ion concentrations after MoM THA.MethodsSystematic review of clinical trials (RCTs) and epidemiological studies with assessment of metal ion levels (cobalt, chromium, titanium, nickel, molybdenum) in body fluids after implantation of metalliferous hip replacements. Systematic search in PubMed and Embase in January 2012 supplemented by hand search. Standardized abstraction of pre- and postoperative metal ion concentrations stratified by type of bearing (primary explanatory factor), patient characteristics as well as study quality characteristics (secondary explanatory factors).ResultsOverall, 104 studies (11 RCTs, 93 epidemiological studies) totaling 9.957 patients with measurement of metal ions in body fluids were identified and analyzed. Consistently, median metal ion concentrations were persistently elevated after implantation of MoM-bearings in all investigated mediums (whole blood, serum, plasma, erythrocytes, urine) irrespective of patient characteristics and study characteristics. In several studies very high serum cobalt concentrations above 50 µg/L were measured (detection limit typically 0.3 µg/L). Highest metal ion concentrations were observed after treatment with stemmed large-head MoM-implants and hip resurfacing arthroplasty.DiscussionDue to the risk of local and systemic accumulation of metallic products after treatment with MoM-bearing, risk and benefits should be carefully balanced preoperatively. The authors support a proposed „time out“ for stemmed large-head MoM-THA and recommend a restricted indication for hip resurfacing arthroplasty. Patients with implanted MoM-bearing should receive regular and standardized monitoring of metal ion concentrations. Further research is indicated especially with regard to potential systemic reactions due to accumulation of metal products.

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Section: Resultsmentioning

confidence: 99%

Metal Ion Concentrations in Body Fluids after Implantation of Hip Replacements with Metal-on-Metal Bearing – Systematic Review of Clinical and Epidemiological Studies

et al. 2013

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“…Post-operative pelvic X-ray showing both hips resurfaced with metal-on-metal articulating surfaces[47,48].3.3 Genetic damageMetal-on-metal bearings of larger diameter, however,The possibility of genetic damage has been raised result in a greater systemic exposure of cobalt and more recently. Pilger et al[55] undertook a study chromium ions than bearings of small diameter.…”

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confidence: 99%

Development and problems of metal-on-metal hip arthroplasty

Shetty

Villar

2006

Proc Inst Mech Eng H

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For over 40 years, the metal-on-polyethylene bearing has dominated the field of total hip replacement. Problems of wear, osteolysis (dissolution of bone), and ultimately failure of prostheses have led to the development of alternative bearing surfaces. Metal-on-metal hip resurfacing has taken current orthopaedic surgery almost by storm. However, metal ion release following metal-on-metal hip resurfacing remains a major cause for concern. This article looks into the development and examines problems and issues surrounding metal-on-metal resurfacing arthroplasty.

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“…These patients had multiple sequential blood draws to measure decline in their whole-blood metal ion concentrations. Close surveillance of metal ion decay after revision has not yet become standard in evaluation of problematic implants, but it may be able to guide treatment (Brodner et al 1997, MacDonald et al 2004, De Smet et al 2008, Sampson et al 2012). …”

Section: Discussionmentioning

confidence: 99%

“…The nano-scale particles generated through wear of MoM bearings can enter the reticulo-endothelial system and cross over into the circulation as early as 5 days after implantation (Daniel et al 2007). The specific surface area (surface area to mass ratio) of these particles makes them susceptible to corrosion in vivo (Hart et al 2010), leading to elevated levels of cobalt and chromium ions in the blood, usually ranging from 5 to 10 times normal values (Jacobs et al 1996, Brodner et al 1997, Skipor et al 2002, Dunstan et al 2005, Daniel et al 2009, Hart et al 2009, van der Weegen et al 2011). Possible complications from long-term elevated metal ion levels include immune reactions (Pandit et al 2008), necrosis (Campbell et al 2010), toxicity (Keegan et al 2007, Tower et al 2010, Corradi et al 2011), chromosomal aberrations (Ladon et al 2004), and carcinogenicity (Case et al 1994).…”

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confidence: 99%

Changes in blood ion levels after removal of metal-on-metal hip replacements

Durrani¹,

Noble²,

Sampson³

et al. 2014

Acta Orthopaedica

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Background and purposeIn patients with metal-on-metal (MoM) hip prostheses, pain and joint effusions may be associated with elevated blood levels of cobalt and chromium ions. Since little is known about the kinetics of metal ion clearance from the body and the rate of resolution of elevated blood ion levels, we examined the time course of cobalt and chromium ion levels after revision of MoM hip replacements.Patients and methodsWe included 16 patients (13 female) who underwent revision of a painful MoM hip (large diameter, modern bearing) without fracture or infection, and who had a minimum of 4 blood metal ion measurements over an average period of 6.1 (0–12) months after revision.ResultsAverage blood ion concentrations at the time of revision were 22 ppb for chromium and 43 ppb for cobalt. The change in ion levels after revision surgery varied extensively between patients. In many cases, over the second and third months after revision surgery ion levels decreased to 50% of the values measured at revision. Decay of chromium levels occurred more slowly than decay of cobalt levels, with a 9% lag in return to normal levels. The rate of decay of both metals followed second-order (exponential) kinetics more closely than first-order (linear) kinetics.InterpretationThe elimination of cobalt and chromium from the blood of patients who have undergone revision of painful MoM hip arthroplasties follows an exponential decay curve with a half-life of approximately 50 days. Elevated blood levels of cobalt and chromium ions can persist for at least 1 year after revision, especially in patients with high levels of exposure.

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Elevated Serum Cobalt With Metal-on-metal Articulating Surfaces

Cited by 171 publications

References 47 publications

Metal Ion Concentrations in Body Fluids after Implantation of Hip Replacements with Metal-on-Metal Bearing – Systematic Review of Clinical and Epidemiological Studies

Metal Ion Concentrations in Body Fluids after Implantation of Hip Replacements with Metal-on-Metal Bearing – Systematic Review of Clinical and Epidemiological Studies

Development and problems of metal-on-metal hip arthroplasty

Changes in blood ion levels after removal of metal-on-metal hip replacements

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