Serum aluminium and cobalt levels after ceramic-on-ceramic and metal-on-metal total hip replacement

Abstract

In a randomised study, 28 patients with a mean age of 62.2 years (32 to 81) with osteoarthritis or avascular necrosis of the hip received either a ceramic-on-ceramic or a metal-on-metal total hip replacement. Apart from the liners the acetabular and femoral components were made of Ti-Al-Nb alloy. The serum aluminium and cobalt levels were measured before, and at one year after surgery. The 15 patients in the ceramic-on-ceramic group had a median pre-operative aluminium level of 1.3 microg/l (0.25 to 8.4) and a cobalt level below the detection limit. At one year the aluminium level was 1.1 microg/l (0.25 to 2.3) and the cobalt level was 0.4 microg/l (0.15 to 0.7). The 13 patients in the metal-on-metal group had a median pre-operative aluminium level of 1.9 microg/l (0.25 to 4.4) and a cobalt level below the detection limit. At one year the median aluminium level was 0.9 microg/l (0.25 to 3.9) whereas the cobalt level was 1.4 microg/l (0.5 to 10.5). This increase in the cobalt level at one year was significant (p < 0.001). Our findings indicate that ceramic-on-ceramic bearings do not cause elevated levels of serum aluminium in the first post-operative year.

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

“…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].…”

“…All RCTs reported pre- and postoperative Co-concentrations. Nine [32], [33], [34], [35], [36], [38], [39], [40], [41], [43], [44] RCTs preferred serum as medium for metal ion assessment. Long-term measurement ≥24 months were reported in five RCTs [33], [36], [37], [38], [39], [41]…”

Levels of systemic metal ions in patients with intramedullary nails

“…Concentrations below the detection level were approximated to be onehalf of the detection level in order to permit statistical analysis (Jacobs et al 1998b, Grubl et al 2006.…”

In vivo production of nanosized metal wear debris formed by tribochemical reaction as confirmed by high‐resolution TEM and XPS analyses

“…In occupational biomonitoring, blood and urine metal concentrations are used as biomarkers to assess exposure 8, 9. Similarly, serum or blood concentrations of cobalt and chromium have been used to detect increased metal concentrations in patients with metal‐on‐metal (MOM) prostheses 10, 11…”