Top

Clinical Orthopaedics and Related Research®

Published in:

01-03-2008 | Original Article

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

Authors: Antonio Moroni, MD, Lucia Savarino, BSc, Matteo Cadossi, MD, Nicola Baldini, MD, Sandro Giannini, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 3/2008

Abstract

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 metal-on-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.

Back DL, Young DA, Shimmin AJ. How do serum cobalt and chromium levels change after metal-on-metal hip resurfacing? Clin Orthop Relat Res. 2005;438:177–181.PubMedCrossRef

Brodner W, Bitzan P, Meisinger V, Kaider A, Gottsauner-Wolf F, Kotz R. Serum cobalt levels after metal-on-metal total hip arthroplasty. J Bone Joint Surg Am. 2003;85:2168–2173.PubMed

Brodner W, Grübl A, Jankovsky R, Meisinger V, Lehr S, Gottsauner-Wolf F. Cup inclination and serum concentration of cobalt and chromium after metal-on-metal total hip arthroplasty. J Arthroplasty. 2004;19(8 suppl 3):66–70.PubMedCrossRef

Butcher DJ, Sneddon J. A practical guide to graphite furnace atomic absorption spectrometry. In: Winefordner JD, ed. Chemical Analysis: A Series of Monographs on Analytical Chemistry and Its Applications. New York, NY: Wiley; 1998.

Clarke MT, Lee PT, Arora A, Villar RN. Levels of metal ions after small- and large-diameter metal-on-metal hip arthroplasty. J Bone Joint Surg Br. 2003;85:913–917.PubMed

Daniel J, Ziaee H, Salama A, Pradhan C, McMinn DJ. The effect of the diameter of metal-on-metal bearings on systemic exposure to cobalt and chromium. J Bone Joint Surg Br. 2006;88:443–448.PubMedCrossRef

dela Rosa MA, Silva M, Heisel C, Reich M, Schmalzried TP. Range of motion after total hip resurfacing. Orthopedics. 2007;30:352–357.PubMed

Doorn PF, Campbell PA, Worrall J, Benya PD, McKellop HA, Amstutz HC. Metal wear particle characterization from metal on metal total hip replacements: transmission electron microscopy study of periprosthetic tissues and isolated particles. J Biomed Mater Res. 1998;42:103–111.PubMedCrossRef

Dorr LD, Kane TJ 3rd, Conaty JP. Long-term results of cemented total hip arthroplasty in patients 45 years old or younger: a 16 year follow-up study. J Arthroplasty. 1994;9:453–456.PubMedCrossRef

10.

Dumbleton JH, Manley MT. Metal-on-metal total hip replacement: what does the literature say? J Arthroplasty. 2005;20:174–188.PubMedCrossRef

11.

Granchi D, Cenni E, Ciapetti G, Savarino L, Stea S, Gamberini S, Gori A, Pizzoferrato A. Cell death induced by metal ions: necrosis or apoptosis? J Mater Sci Mater Med. 1998;9:31–37.PubMedCrossRef

12.

Granchi D, Ciapetti G, Savarino L, Stea S, Filippini F, Sudanese A, Rotini R, Giunti A. Expression of the CD69 activation antigen on lymphocytes of patients with hip prosthesis. Biomaterials. 2000;21:2059–2065.PubMedCrossRef

13.

Granchi D, Ciapetti G, Stea S, Savarino L, Filippini F, Sudanese A, Zinghi GF, Montanaro L. Cytokine release in mononuclear cells of patients with Co-Cr hip prosthesis. Biomaterials. 1999;20:1079–1086.PubMedCrossRef

14.

Granchi D, Savarino L, Ciapetti G, Cenni E, Rotini R, Mieti M, Baldini N, Giunti A. Immunological changes in patients with total joint replacement following idiopathic osteoarthritis of the hip. J Bone Joint Surg Br. 2003;85:758–764.PubMed

15.

Granchi D, Verri E, Ciapetti G, Stea S, Savarino L, Sudanese A, Mieti M, Rotini R, Dallari D, Zinghi G, Montanaro L. Bone resorbing cytokines in serum of patients with aseptic loosening of hip prosthesis. J Bone Joint Surg Br. 1998;80:912–917.PubMedCrossRef

16.

Greim H, Lehnet G. Critical Data Evaluation for BAT and EKA Values, Series: Biological Exposure Values for Occupational Toxicants and Carcinogens H. Vol 2. Weinheim, Germany: Wiley-VCH; 1995.

17.

Hallab N, Merritt K, Jacobs JJ. Metal sensitivity in patients with orthopaedic implants. J Bone Joint Surg Am. 2001;83:428–436.PubMedCrossRef

18.

Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737–755.PubMed

19.

Heisel C, Silva M, Skipor AK, Jacobs JJ, Schmalzried TP. The relationship between activity and ions in patients with metal-on-metal bearing hip prostheses. J Bone Joint Surg Am. 2005;87:781–787.PubMedCrossRef

20.

Jacobs JJ, Roebuck KA, Archibeck M, Hallab NJ, Glant TT. Osteolysis: basic science. Clin Orthop Relat Res. 2001;393:71–77.PubMedCrossRef

21.

Joshi AB, Porter ML, Trail IA, Hunt LP, Murphy JC, Hardinge K. Long term results of Charnley low-friction arthroplasty in young patients. J Bone Joint Surg Br. 1993;75:616–623.PubMed

22.

Lee SH, Brennan FR, Jacobs JJ, Urban RM, Ragasa DR, Glant TT. Human monocyte/macrophage response to cobalt-chromium corrosion products and titanium particles in patients with total joint replacements. J Orthop Res. 1997;15:40–49.PubMedCrossRef

23.

Luetzner J, Krummenauer F, Lengel AM, Ziegler J, Witzleb WC. Serum metal ion exposure after total knee arthroplasty. Clin Orthop Relat Res. 2007;461:136–142.PubMed

24.

MacDonald SJ. Metal-on-metal total hip arthroplasty: the concerns. Clin Orthop Relat Res. 2004;429:86–93.PubMedCrossRef

25.

MacDonald SJ, Brodner W, Jacobs JJ. A consensus paper on metal ions in metal-on-metal hip arthroplasties. J Arthroplasty. 2004;19(8 suppl 3):12–16.PubMedCrossRef

26.

Maezawa K, Nozawa M, Hirose T, Matsuda K, Yasuma M, Shitoto K, Kurosawa H. Cobalt and chromium concentrations in patients with metal-on-metal and other cementless total hip arthroplasty. Arch Orthop Trauma Surg. 2002;122:283–287.PubMedCrossRef

27.

Merritt K, Brown SA. Distribution of cobalt chromium wear and corrosion products and biologic reactions. Clin Orthop Relat Res. 1996;329(suppl):S233–S243.PubMedCrossRef

28.

Montero-Ocampo C, Lopez H, Salinas Rodriguez A. Effect of compressive straining on corrosion resistance of a shape memory Ni-Ti alloy in Ringer’s solution. J Biomed Mater Res. 1996;32:583–591.PubMedCrossRef

29.

Morgan MS. The biological exposure indices: a key component in protecting workers from toxic chemicals. Environ Health Perspect. 1997;105(suppl 1):105–115.PubMedCrossRef

30.

Sargeant A, Goswami T, Swank M. Ion concentrations from hip implants. J Surg Orthop Adv. 2006;15:113–114.PubMed

31.

Savarino L, Granchi D, Ciapetti G, Cenni E, Greco M, Rotini R, Veronesi CA, Baldini N, Giunti A. Ion release in stable hip arthroplasties using metal-on-metal articulating surfaces: a comparison between short- and medium-term results. J Biomed Mater Res. 2003;66:450–456.CrossRef

32.

Savarino L, Granchi D, Ciapetti G, Cenni E, Nardi Pantoli A, Rotini R, Veronesi CA, Baldini N, Giunti A. Ion release in patients with metal-on-metal hip bearings in total joint replacement: a comparison with metal-on-polyethylene bearings. J Biomed Mater Res. 2002;63:467–474.PubMedCrossRef

33.

Savarino L, Granchi D, Ciapetti G, Stea S, Donati ME, Zinghi G, Fontanesi G, Rotini R, Montanaro L. Effects of metal ions on white blood cells of patients with failed total joint arthroplasties. J Biomed Mater Res. 1999;47:543–550.PubMedCrossRef

34.

Savarino L, Stea S, Granchi D, Visentin M, Ciapetti G, Donati ME, Rollo G, Zinghi G, Pizzoferrato A, Montanaro L, Toni A. Sister chromatid exchanges and ion release in patients wearing fracture fixation devices. J Biomed Mater Res. 2000;50:21–26.PubMedCrossRef

35.

Schaffer AW, Pilger A, Engelhardt C, Zweymueller K, Ruediger HW. Increased blood cobalt and chromium after total hip replacement. J Toxicol Clin Toxicol. 1999;37:839–844.PubMedCrossRef

36.

Signorello LB, Ye W, Fryzek JP, Lipworth L, Fraumeni JF Jr, Blot WJ, McLaughlin JK, Nyren O. Nationwide study of cancer risk among hip replacement patients in Sweden. J Natl Cancer Inst. 2001;93:1405–1410.PubMedCrossRef

37.

Skipor AK, Campbell PA, Patterson LM, Amstutz HC, Schmalzried TP, Jacobs JJ. Serum and urine metal levels in patients with metal-on-metal surface arthroplasty. J Mater Sci Mater Med. 2002;13:1227–1234.PubMedCrossRef

38.

Smith SL, Dowson D, Goldsmith AA. The effect of femoral head diameter upon lubrication and wear of metal-on-metal total hip replacement. Proc Inst Mech Eng H. 2001;215:161–170.PubMedCrossRef

39.

Soderman P, Malchau H, Herberts P. Outcome after total hip arthroplasty: Part I. General health evaluation in relation to definition of failure in the Swedish National Total Hip Arthroplasty register. Acta Orthop Scand. 2000;71:354–359.PubMedCrossRef

40.

Stea S, Visentin M, Granchi D, Savarino L, Dallari D, Gualtieri G, Rollo G, Toni A, Pizzoferrato A, Montanaro L. Sister chromatid exchange in patients with joint prostheses. J Arthroplasty. 2000;15:772–777.PubMedCrossRef

41.

Tharani R, Dorey FJ, Schmalzried TP. The risk of cancer following total hip or knee arthroplasty. J Bone Joint Surg Am. 2001;83:774–780.PubMed

42.

Vendittoli PA, Mottard S, Roy AG, Dupont C, Lavigne M. Chromium and cobalt ion release following the Durom high carbon content, forged metal-on-metal surface replacement of the hip. J Bone Joint Surg Br. 2007;89:441–448.PubMedCrossRef

43.

Witzleb WC, Ziegler J, Krummenauer F, Neumeister V, Guenther KP. Exposure to chromium, cobalt and molybdenum from metal-on-metal total hip replacement and hip resurfacing arthroplasty. Acta Orthop. 2006;77:697–705.PubMedCrossRef

Title: Does Ion Release Differ Between Hip Resurfacing and Metal-on-metal THA?
Authors: Antonio Moroni, MD
Lucia Savarino, BSc
Matteo Cadossi, MD
Nicola Baldini, MD
Sandro Giannini, MD
Publication date: 01-03-2008
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 3/2008
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-007-0106-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2008

Projection of the Glenoid Center Point Within the Glenoid Vault

Case Report

Type III Acetabular Defect Revision With Bilobed Components

Biological Augmentation of Rotator Cuff Tendon Repair

Hierarchy of Stability Factors in Reverse Shoulder Arthroplasty

Ischial Spine Projection into the Pelvis