Metal Ion Release, Clinical and Radiological Outcomes in Large Diameter Metal-on-Metal Total Hip Arthroplasty at Long-Term Follow-Up

Abstract

Total hip arthroplasty (THA) with metal-on-metal (MoM) bearings have shown problems of biocompatibility linked to metal ion release at the local level causing an adverse reaction to metal debris (ARMD) and at a systemic level. The aim of this study was to evaluate clinical and radiological outcomes, and metal ion concentrations in the blood and urine of patients who underwent THA with the LIMA Met-Met hip system. Patients with ceramic-on-ceramic (CoC) bearings were included as a control group. In this study, 68 patients were enrolled: 34 with MoM THAs and 34 with CoC THAs. Patients were evaluated clinically (Harris Hip Score, SF-36) and radiologically at a median of 7.4 years after surgery. Whole blood and urinary cobalt and chromium levels were also assessed. Both types of implants were comparable in terms of clinical and functional results. Ion levels were significantly higher in the MoM group compared with CoC group 7 years after surgery. No correlations were found between metal ion levels and patient demographics, functional and radiological outcomes, and prosthesis features. Patient monitoring is thus advised to establish if prosthesis revision is necessary, especially in the case of MoM THA.

Psychiatric Disorders and Genotoxicity Following Primary Metal on Polyethylene Total Hip Arthroplasty and Their Correlation to Cobalt/Chromium Levels

“… 65 Many factors may negatively impact this wear process and increase the metal ion release or lead to higher metal ion levels as suboptimal surgical positioning of the implant, 66 impaired renal function and bilateral hip replacement, 67 and mixing components from different manufacturers or different types. 68 The current work showed that age does not correlate to the blood ions levels in accordance with Pozzuoli et al 15 In addition, the ion levels showed a non-significant difference between males and females in contrast to Delaunay et al 69 who reported that female sex seems to be significantly associated with higher circulating metal ions secondary to variations in the metabolism of metal ions. The variability between this study and the current work can be related to the difference in the type of implant.…”

“…12 However, any metal surrounded by biological systems will corrode, leading to the release of metal ions that cause adverse physiological effects including toxicity, and metal allergy. 13,14 Although the majority of cases of hypersensitivity reactions attributed to corrosion products and elevation of cobalt and chromium ions in the blood were reported in metal-onmetal (MOM) implants, [15][16][17] these reactions have been also reported in the metal-on-polyethylene patients. 18 Although Bijukumar et al 19 showed that the metal wear rate of MOM articulation is approximately 20 times lower than that of MOP articulation, the polyethylene particle wear is reduced in the recently introduced highly cross-linked polyethylene.…”

Osteolysis in total hip arthroplasty in relation to metal ion release: Comparison between monolithic prostheses and different modularities

“…In 2020, Pozzuoli et al [ 31 ] , were able to perform a 7-year follow-up, from which they reported a revision-rate for MOM prostheses where they conducted clinical and radiographic evaluations in relation to metal-ion release[ 31 ].…”

Computational Contact Pressure Prediction of CoCrMo, SS 316L and Ti6Al4V Femoral Head against UHMWPE Acetabular Cup under Gait Cycle

“…This is due to these bearings using local materials that are easily available, the ease of the fabrication process, and the relatively affordable cost compared to other bearings. Unfortunately, several complications from metal-on-metal cause considerations that require choosing another bearing for total hip prosthesis [ 2 ]. This is also supported by the statement of the Australian Orthopaedic Association (AOA) [ 3 ], which explains the case of metal-on-metal failure is relatively high compared to the other bearing options available in the market today.…”