Metal-on-metal metaphyseal and ceramic-on-ceramic femoral neck arthroplasty: the impact on clinical results, oxidative stress and concentration of metal ions in serum and blood

Abstract

Purpose Growing number of hip arthroplasty in Poland performed with the use of metaphyseal stems results from the decreasing age of patients qualified for procedures and is consistent with the corresponding trends in European countries. To this day, a significant population functions after undergoing hip replacement using metal-on-metal implant. This study was aimed at the assessment of the variability of the oxidative system, as well as the concentrations of chromium and cobalt ions in serum and blood and their potential impact on postoperative clinical status. Material and methods The analysis included 58 men. The first group—operated using J&J DePuy ASR metal-on-metal implant with metaphyseal stem ProximaTm. Second group—operated using K-Implant SPIRON® femoral neck prosthesis in full ceramic articulation. Selected parameters of oxidative stress and the antioxidant system as well as the concentration of metal ions in blood were determined twice. Each patient underwent two clinical evaluations using acclaimed physical examination scale systems. Results In the first group, significantly higher concentrations of Cr (p = 0.028) and Co (p = 0.002) were demonstrated compared to the group of femoral neck arthroplasty. The mean concentrations of Cr and Co, 10.45 and 9.26 μg/l, respectively, were higher in patients operated bilaterally. In the ASR group, greater pain intensity in the operated hip and higher indicators of oxidative stress were found. Conclusions Metal-on-metal articulation of the hip significantly increases the concentration of Cr and Co in blood, induces oxidative stress and modifies function of the antioxidant system and generates greater pain in the operated hip.

Influence of Physical Activity and Cup Orientation on Metal Ion Release and Oxidative Stress in Metal-on-Metal and Ceramic-on-Metal Total Hip Arthroplasty

“…In a patient undergoing hip replacement revision with elevated blood and urinary concentrations of Cr and Co, an association was reported between metallosis and increased expression of NADPH-Oxidase 4 (NOX4), a well-known compound responsible for ROS generation in muscle tissue [23]. Other studies have suggested a relationship between metallosis and oxidative stress [24,25,59]. According to these reports, our initial hypothesis was that the patients with M-M, with higher Cr and Co levels than the C-M group and the control group, should have greater systemic oxidative stress.…”

“…However, the mechanism by which toxicity is mediated is still not well understood, nor is the reason why some patients have higher levels than others regardless of renal function. Chromium (Cr) and Co-as redox-active metals-have been shown to be a source of reactive oxygen species (ROS) and various in vitro and in vivo evidence suggests that the toxicity is mediated by the production of ROS and, consequently, oxidative stress [23][24][25][26]. ROS are highly reactive molecules containing oxygen, such as free radicals, generated during cellular processes like metabolism.…”