What Are Normal Metal Ion Levels After Total Hip Arthroplasty? A Serologic Analysis of Four Bearing Surfaces

Barlow, Brian; Ortiz, Philippe A.; Boles, John; Lee, Yuo-yu; Padgett, Douglas E.; Westrich, Geoffrey H.

doi:10.1016/j.arth.2016.11.024

Cited by 28 publications

(18 citation statements)

References 18 publications

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“…In agreement with previous literature [ 9 , 33 , 44 , 53 , 54 , 55 ], we found that Co and Cr levels, assessed both in whole blood and urine, were significantly higher in the MoM group compared with the CoC group, in line with our hypothesis. Some authors have reported that metal ions released from large diameter MoM THAs could originate not only at the articulating surfaces but also at the metallic trunnion surfaces, the head-neck taper or adapter [ 11 , 16 ].…”

Section: Discussionsupporting

confidence: 94%

Metal Ion Release, Clinical and Radiological Outcomes in Large Diameter Metal-on-Metal Total Hip Arthroplasty at Long-Term Follow-Up

et al. 2020

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Total hip arthroplasty (THA) with metal-on-metal (MoM) bearings have shown problems of biocompatibility linked to metal ion release at the local level causing an adverse reaction to metal debris (ARMD) and at a systemic level. The aim of this study was to evaluate clinical and radiological outcomes, and metal ion concentrations in the blood and urine of patients who underwent THA with the LIMA Met-Met hip system. Patients with ceramic-on-ceramic (CoC) bearings were included as a control group. In this study, 68 patients were enrolled: 34 with MoM THAs and 34 with CoC THAs. Patients were evaluated clinically (Harris Hip Score, SF-36) and radiologically at a median of 7.4 years after surgery. Whole blood and urinary cobalt and chromium levels were also assessed. Both types of implants were comparable in terms of clinical and functional results. Ion levels were significantly higher in the MoM group compared with CoC group 7 years after surgery. No correlations were found between metal ion levels and patient demographics, functional and radiological outcomes, and prosthesis features. Patient monitoring is thus advised to establish if prosthesis revision is necessary, especially in the case of MoM THA.

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Section: Discussionsupporting

confidence: 94%

Metal Ion Release, Clinical and Radiological Outcomes in Large Diameter Metal-on-Metal Total Hip Arthroplasty at Long-Term Follow-Up

et al. 2020

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“…The clinical significance of these values is unclear as there was no correlation clinically within studies, and additionally there are no established ‘normal’ metal ion levels following THR. 24 Here, the cut-off value of ≥ 1 μg/L was selected as it was the most commonly used. For MoM hip replacements the MHRA (Medicines & Healthcare Products Regulatory Agency, UK regulatory body) advise a cut-off value of ≥ 7 μg/L for either cobalt or chromium.…”

Section: Discussionmentioning

confidence: 99%

“…For metal ion levels, source data were not obtained from individual studies. Two of seven studies did not express incidence of cases with either Co or Cr measurements ≥ 1 μg/L 23 , 24 , and conservative estimates had to be taken from the range, also likely resulting in an under-estimate.…”

Section: Discussionmentioning

confidence: 99%

Adverse reaction to metal debris due to fretting corrosion between the acetabular components of modular dual-mobility constructs in total hip replacement: a systematic review and meta-analysis

et al. 2021

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Modular dual-mobility (MDM) constructs can be used to reduce dislocation rates after total hip replacement (THR). However, there are concerns about adverse reaction to metal debris (ARMD) as a result of fretting corrosion between the metal liner and shell. This systematic review reports outcomes following THR using MDM components. It was registered with PROSPERO and conducted in line with Cochrane and PRISMA recommendations. Sixteen articles were included overall, with meta-analysis performed on relevant subsets using a random intercept logistic regression model. Estimated median incidence of ARMD requiring revision surgery within study follow-up period was 0.3% (95% CI 0.1 – 1.8%, from 11 cohort studies containing 1312 cases). Serum metal ion levels were mildly raised in 7.9% of cases, and significantly raised in 1.8%, but there was no correlation with worse clinical hip function scores within studies. Dislocation rate was 0.8%. Revision rate was 3.3%. There are mixed reports of wear on the backside of the metal liner from the acetabular shell and screw heads. Both implant design and component malseating are implicated, but currently it is unclear to what extent each factor is responsible. Studies were poor quality with high risk of confounding, especially from trunnion corrosion. We have made recommendations for further work. In the meantime, surgeons should be aware of the potential risk of ARMD when considering using an MDM prosthesis, and, if selecting one, must ensure proper seating of the liner and screws intraoperatively. Cite this article: EFORT Open Rev 2021;6:343-353. DOI: 10.1302/2058-5241.6.200146

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“…This interface can potentially lead to fretting, corrosion, metal ion release, and possibly associated adverse local tissue reaction (ALTR) [10,11]. Several studies have analyzed the serum metal ion levels in patients with modular DM constructs [10][11][12][13][14]. Most report low metal ion levels and no adverse sequelae at shortand mid-term follow-up.…”

Section: Introductionmentioning

confidence: 99%

Serum Metal Ions in Contemporary Monoblock and Modular Dual Mobility Articulations

et al. 2021

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What Are Normal Metal Ion Levels After Total Hip Arthroplasty? A Serologic Analysis of Four Bearing Surfaces

Cited by 28 publications

References 18 publications

Metal Ion Release, Clinical and Radiological Outcomes in Large Diameter Metal-on-Metal Total Hip Arthroplasty at Long-Term Follow-Up

Metal Ion Release, Clinical and Radiological Outcomes in Large Diameter Metal-on-Metal Total Hip Arthroplasty at Long-Term Follow-Up

Adverse reaction to metal debris due to fretting corrosion between the acetabular components of modular dual-mobility constructs in total hip replacement: a systematic review and meta-analysis

Serum Metal Ions in Contemporary Monoblock and Modular Dual Mobility Articulations

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