Serum Metal Ion Levels Following Total Hip Arthroplasty With Modular Dual Mobility Components

Ko, Laura J. Matsen; Pollag, Kimberley E.; Yoo, Joanne Y.; Sharkey, Peter F.

doi:10.1016/j.arth.2015.07.035

Cited by 97 publications

(35 citation statements)

References 27 publications

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“…After reviewing the abstracts of these, 75 were screened for eligibility and 16 were identified for inclusion. Fifty-nine articles were excluded because reporting no IPD episodes (30 articles) [7] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , IPD episodes were not mentioned (13) [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , reporting delayed IPD episodes (13) [8] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , reporting early IPD episodes with old DM designs with small femoral heads (2) [9] , [69] , and reporting a suspicious IPD episode (1) [70] ( Fig. 1 ).…”

Section: Resultsmentioning

confidence: 99%

Early intraprosthetic dislocation in dual-mobility implants: a systematic review

et al. 2017

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BackgroundDual mobility implants are subject to a specific implant-related complication, intraprosthetic dislocation (IPD), in which the polyethylene liner dissociates from the femoral head. For older generation designs, IPD was attributable to late polyethylene wear and subsequent failure of the head capture mechanism. However, early IPDs have been reportedly affecting contemporary designs.MethodsA systematic review of the literature according to the preferred reporting items for systematic reviews and meta-analyses guidelines was performed. A comprehensive search of PubMed, MEDLINE, Embase, and Google Scholar was conducted for English articles between January 1974 and August 2016 using various combinations of the keywords “intraprosthetic dislocation,” “dual mobility,” “dual-mobility,” “tripolar,” “double mobility,” “double-mobility,” “hip,” “cup,” “socket,” and “dislocation.”ResultsIn all, 16 articles met our inclusion criteria. Fourteen were case reports and 2 were retrospective case series. These included a total of 19 total hip arthroplasties, which were divided into 2 groups: studies dealing with early IPD after attempted closed reduction and those dealing with early IPD with no history of previous attempted closed reduction. Early IPD was reported in 15 patients after a mean follow-up of 3.2 months (2.9 SD) in the first group and in 4 patients after a mean follow-up of 15.1 months (9.9 SD) in the second group.ConclusionsBased on the current data, most cases have been preceded by an attempted closed reduction in the setting of outer, large articulation dislocation, perhaps indicating an iatrogenic etiology for early IPD. Recognition of this possible failure mode is essential to its prevention and treatment.

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Section: Resultsmentioning

confidence: 99%

Early intraprosthetic dislocation in dual-mobility implants: a systematic review

et al. 2017

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“…We report a severe complication and failure of a contemporary DM cup in an asymptomatic patient. DM cups are especially used in revision surgery; however, their use in primary hip surgery and in a younger population is increasing worldwide [1] , [4] , [5] , [6] , [7] , [8] , [9] , [13] . With the increased use of this relatively new bearing, concerns rise about the possible complications and wear problems.…”

Section: Discussionmentioning

confidence: 99%

“…Matsen Ko et al. [9] investigated serum cobalt and chromium levels in a group of 100 patients with a DM bearing. In 24 patients, an increased serum level of cobalt or chromium was observed.…”

Section: Discussionmentioning

confidence: 99%

“…With the expanding indication for the use of DM cups and their use in younger and more demanding patients [5] , [8] , concerns rise about the long-term survival. Owing to the large diameter of articulation and multiple surfaces, an increase in polyethylene wear, fretting corrosion, and release of metal ions may lead to complications and revision surgeries [2] , [9] , [10] , [11] .…”

Section: Introductionmentioning

confidence: 99%

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Asymptomatic intraprosthetic dual mobility cup dislocation with increased metal ion levels

2019

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With the increased use of dual-mobility cups (DMCs) in total-and revision hip arthroplasties, surgeons can expect an increase of known and new complications. During routine follow-up, we observed an asymptomatic patient with an intraprosthetic-dislocation (IPD) and elevated levels of serum metal ions (1.8 ppb of cobalt and 28.0 ppb of chromium). Revision surgery was inevitable. Perioperative metallosis and severe wear of the metal shell and metal femoral head supported the IPD. Literature showed that the modularity of the DMC can result in increased serum metal ions, create excessive wear, and possibly affect implant survival. Our case and review of the literature may form an argument not to consider DMC for primary cases. Furthermore, we advise yearly clinical and radiological follow-up and, on indication, metal ion testing for DMCs.

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“…In arthroplasty, cobalt is the main constituent (mass fraction > 60 %) of CoCrMo alloys that are used for bearing surfaces, but also for nonarticulating components, such as modular neck-stem taper junctions of (revision) hip prostheses. Systemic exposure to cobalt has been repeatedly demonstrated for all bearing surface combinations in patients with hip and/or knee joint replacements (▶ Table 1) [12][13][14]. Toxicologically relevant cobalt levels have, however, been primarily reported as sequelae of hip replacements with metal-on-metal bearings or following the use of metal heads in revision of fractured ceramic heads or articulations [4,15].…”

Section: Cobaltmentioning

confidence: 99%

Systemic Effects of Metals Released from Arthroplasty Implants – a Brief Summary

Rakow

Schoon

2020

Z Orthop Unfall

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In recent years, increasing concern has been raised regarding potential systemic toxicity of metals released from arthroplasty implants. A lack of valid metal thresholds for human (organ) toxicity and the prospect of multi-decade survival of modern hip and knee replacements pose special challenges. Indeed, evidence of systemic effects of metals released from such implants is largely missing. Systemic cobalt exposure has repeatedly been associated with cardiotoxic and neurotoxic effects, and also with thyroid dysfunction. The toxic potential of chromium is considered less pronounced. Yet, in arthroplasty there is usually a co-exposure to chromium and cobalt which complicates evaluation of element-specific effects. Toxicity of titanium dioxide nanoparticles has been subject to debate among international regulatory authorities. Their wide use in a variety of products in everyday life, such as toothpaste, cosmetics and food colorants, hampers the assessment of an arthroplasty-induced systemic titanium exposure. To date there is no clear evidence for systemic complications due to titanium dioxide released from arthroplasty implants. Release of further metals such as tantalum, niobium, nickel, vanadium and zirconium from hip and knee replacement implants has been described occasionally, but systemic effects of respective long-term exposure scenarios are unknown. Generally, the characterization of all released metals regarding their chemical and physical specifications is critical for the evaluation of potential systemic risks. Systematic studies investigating the accumulation of metals relevant in arthroplasty in different organs/organ systems and the biological consequences of such accumulations are urgently needed.

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Serum Metal Ion Levels Following Total Hip Arthroplasty With Modular Dual Mobility Components

Cited by 97 publications

References 27 publications

Early intraprosthetic dislocation in dual-mobility implants: a systematic review

Early intraprosthetic dislocation in dual-mobility implants: a systematic review

Asymptomatic intraprosthetic dual mobility cup dislocation with increased metal ion levels

Systemic Effects of Metals Released from Arthroplasty Implants – a Brief Summary

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