Serum Cobalt Levels After Metal-on-Metal Total Hip Arthroplasty

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

doi:10.2106/00004623-200311000-00017

Cited by 266 publications

(147 citation statements)

References 9 publications

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“…Our data indicate excessive levels in the large-head metal-on-metal hip arthroplasty are probably not solely from the bearing surface since the two groups had the same bearing surface. Furthermore, the results of serum cobalt and chromium in our resurfacing arm are consistent with the literature [3,9,35]. By having identical articulations in the two groups, the only plausible explanation for the markedly elevated serum cobalt and chromium levels relates to the two areas of modularity for the attachment of the femoral head to the stem.…”

Section: Discussionsupporting

confidence: 89%

The John Charnley Award: Metal-on-Metal Hip Resurfacing versus Large-diameter Head Metal-on-Metal Total Hip Arthroplasty

Garbuz

Tänzer

Greidanus

et al. 2010

Clinical Orthopaedics &Amp; Related Research

305

190

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Resurfacing arthroplasty has become an attractive option for young patients who want to maintain a high activity level. One recent study reported modestly increased activity levels for patients with resurfacing compared to standard total hip arthroplasty (THA). We conducted a prospective randomized clinical trial to compare clinical outcomes of resurfacing versus large-head metal-on-metal total hip arthroplasty. We randomized 107 patients deemed eligible for resurfacing arthroplasty to have either resurfacing or standard THA. Patients were assessed for quality-of-life outcomes using the PAT-5D

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Section: Discussionsupporting

confidence: 89%

The John Charnley Award: Metal-on-Metal Hip Resurfacing versus Large-diameter Head Metal-on-Metal Total Hip Arthroplasty

Garbuz

Tänzer

Greidanus

et al. 2010

Clinical Orthopaedics &Amp; Related Research

305

190

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“…However, patients with elevated ion levels, even without evident signs of loosening or toxicity, could be at higher risk and warrant medium-and long-term studies and heightened surveillance. Moreover, we are of the opinion that MOM bearings should be contraindicated in patients with renal malfunction, as very high levels of Co are associated with chronic renal failure [2].…”

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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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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“…Although the wear rates at the surfaces of MoM bearings are lower than for conventional MoP bearings, the number of nanometer-sized particles generated is up to 500 times more than for MoP bearings (Sieber et al 1999). The dissolution of metal wear particles results in measurable increases in cobalt (Co) and chromium (Cr) ions in the serum, erythrocytes, and urine of patients with MoM bearings (Coleman et al 1973, Jacobs et al 1998, Savarino et al 2002, Brodner et al 2003, MacDonald et al 2003, Rasquinha et al 2006. The potential effects of elevated levels of metal particles and ions are poorly defined, but they may lead to adverse biological reactions including local soft tissue toxicity, hypersensitivity reactions, bone loss, and risk of carcinogenesis (Gillespie et al 1996, Willert et al 2005, Keegan et al 2007, Lidgren 2008.…”

mentioning

confidence: 99%