Metal wear particle characterization from metal on metal total hip replacements: Transmission electron microscopy study of periprosthetic tissues and isolated particles

Doorn, Peter F.; Campbell, Patricia A.; Worrall, Jack; Benya, Paul D.; McKellop, Harry A.; Amstutz, Harlan C.

doi:10.1002/(sici)1097-4636(199810)42:1<103::aid-jbm13>3.3.co;2-d

Cited by 340 publications

(148 citation statements)

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“…It is certain that metal ions are released because of the combined effect of corrosion of the implant surface and wear particles. Metal wear particles are in the nanometer size range and therefore have a high surface area to volume ratio and are capable of releasing metal ions [8]. Because the amount of wear and corrosion is considered related to the area of the bearing surfaces, the introduction of large-diameter MOM bearings, as used in hip resurfacing, has prompted even more concern.…”

Section: Discussionmentioning

confidence: 99%

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Does Ion Release Differ Between Hip Resurfacing and Metal-on-metal THA?

Moroni

Savarino

Cadossi

et al. 2008

Clinical Orthopaedics &Amp; Related Research

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Modern metal-on-metal hip resurfacing was introduced as a bone-preserving method of joint reconstruction for young and active patients; however, the large diameter of the bearing surfaces is of concern for potential increased metal ion release. We hypothesized there were no differences in serum concentrations of chromium, cobalt, and molybdenum between patients who had metalon-metal hip resurfacing (Group A; average head diameter, 48 mm; median followup, 24 months) and patients who had 28-mm metal-on-metal THA (Group B; median followup, 25 months). Serum concentrations also were compared with concentrations in healthy subjects. We identified no differences in ion levels between Groups A and B. A distinction was made according to gender. Women showed a higher chromium release in Group A whereas men had a higher cobalt release in Group B. Values obtained from Group A were higher than those of the control subjects. Our data suggest metal-on-metal bearings for THA should not be rejected because of concern regarding potential increased metal ion release; however, patients with elevated ion levels, even without loosening or toxicity, could be at higher risk and should be followed up periodically. Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

“…Several studies evaluated ion release in the presence of metallic implants in the hip [8,30] and the knee [23]. There are many complex issues associated with analysis of metal ions, including collection technique, analysis, statistical methodology, and reporting of the results.…”

Section: Discussionmentioning

confidence: 99%

Does Ion Release Differ Between Hip Resurfacing and Metal-on-metal THA?

Moroni

Savarino

Cadossi

et al. 2008

Clinical Orthopaedics &Amp; Related Research

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“…Although MOM-THA is in widespread use [24], concerns remain regarding wear and corrosion of the bearing surfaces and the subsequent increase in serum metal ion levels [2,8,10,18,28]. All metal implants corrode at a rate which is determined partly by their surface area [4].…”

Section: Introductionmentioning

confidence: 99%

Do Ion Levels In Hip Resurfacing Differ From Metal-on-metal THA at Midterm?

Moroni

Savarino

Hoque

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Metal-on-metal Birmingham hip resurfacing (MOM-BHR) is an alternative to metal-on-metal total hip arthroplasty (MOM-THA), especially for young and/or active patients. However, wear resulting in increased serum ion levels is a concern. Questions/purposes We asked whether (1) serum chromium (Cr), cobalt (Co), and molybdenum (Mo) concentrations would differ between patients with either MOM-BHR or MOM-THA at 5 years, (2) confounding factors such as gender would influence ion levels; and (3) ion levels would differ at 2 and 5 years for each implant type. Patients and Methods Ions were measured in two groups with either MOM-BHR (n = 20) or MOM-THA (n = 35) and a mean 5-year followup, and two groups with either MOM-BHR (n = 15) or MOM-THA (n = 25) and a mean 2-year followup. Forty-eight healthy blood donors were recruited for reference values. Results At 5 years, there were no differences in ion levels between patients with MOM-BHR or MOM-THA. Gender was a confounding factor, and in the MOM-BHR group at 5 years, Cr concentrations were greater in females compared with those of males. Mean ion levels were similar in patients with 2 and 5 years of followup for each implant type. Ion levels in patients were sevenfold to 10-fold higher than in controls. Conclusions As the metal ion concentrations in the serum at 5 years were in the range reported in the literature, we do not believe concerns regarding excessive metal ion levels after MOM-BHR are justified. Level of Evidence Level III, therapeutic study. See the Guidelines for Authors for a complete description of level of evidence.

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“…First, by confining our review to studies that included quantitative or semiquantitative grading of the histologic findings, we excluded many publications that have used only qualitative descriptions of periarticular findings [5,12,29,35,42,44,46] or that have focused on particle quantitation [13,30,45], cytokine detection [9,21], or lymphocyte subsets [29]. Among the studies that have graded morphologic features of periprosthetic tissues, many have not included conventional metal-on-PE or ceramic-on-polyethylene cases as controls, and differences in grading criteria among studies preclude pooling the data into larger groups.…”

Section: Discussionmentioning

confidence: 99%

How Have New Bearing Surfaces Altered the Local Biological Reactions to Byproducts of Wear and Modularity?

Bauer

Campbell

Hallerberg

2014

Clin Orthop Relat Res

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Background The biologic reactions to byproducts of wear or corrosion can involve innate and adaptive processes and are dependent on many factors, including the composition, size, surface properties, shape, and concentration of debris. Questions/purposes We used a systematic literature review to compare the reported patterns of inflammation in tissues around total hip implants with the goal of identifying whether there are unique or characteristic patterns associated with the newer bearing options or modular components. Methods A search of the Ovid Medline database between 1996 and early December 2013 identified articles that compared the histology around six implant groups: (1) metal-on-metal; (2) ceramic-on-ceramic; (3) metalon-crosslinked polyethylene; (4) metal-on-conventional polyethylene with or (5) without modularity; and (6) tissue obtained at primary arthroplasty. Our initial search yielded 865 citations. After excluding articles that lacked a quantitative or semiquantitative description of histologic findings in periprosthetic tissue, we reviewed 34 articles. Results No pattern of inflammation is specific for any given bearing combination. Histologic features suggestive of an adaptive immune response appear to be more frequent and of greater magnitude in failed metal-on-metal implants, but tissues around many failed metal-on-metal implants show features of an ''innate'' foreign body reaction without lymphocytes. Occasional nonmetal-on-metal implants show features of an immune reaction, possibly associated with metal particles. Modular connections are one source of metal debris in nonmetal-on-metal implants. Features of an immune reaction appear rare in ceramicon-ceramic implants that lack corrosion. Insufficient reports are available to characterize the biologic response to crosslinked polyethylene.

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Metal wear particle characterization from metal on metal total hip replacements: Transmission electron microscopy study of periprosthetic tissues and isolated particles

Cited by 340 publications

References 0 publications

Does Ion Release Differ Between Hip Resurfacing and Metal-on-metal THA?

Does Ion Release Differ Between Hip Resurfacing and Metal-on-metal THA?

Do Ion Levels In Hip Resurfacing Differ From Metal-on-metal THA at Midterm?

How Have New Bearing Surfaces Altered the Local Biological Reactions to Byproducts of Wear and Modularity?

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