Top

Clinical Orthopaedics and Related Research®

Published in:

01-06-2011 | Symposium: Update on Hard-on-Hard Bearings in Hip Arthroplasty

Femoral Head Size Does Not Affect Ion Values in Metal-on-Metal Total Hips

Authors: Mitchell Bernstein, MD, Alan Walsh, MD, Alain Petit, PhD, David J. Zukor, MD, John Antoniou, MD, PhD

Published in: Clinical Orthopaedics and Related Research® | Issue 6/2011

Abstract

Background

Metal-on-metal articulations can release substantial amounts of particles containing cobalt and chromium into the surrounding milieu, causing concern for cellular toxicity and adverse local soft tissue reactions. The diameter of the femoral head has been one of the variables that inversely affects wear of metal-on-metal total hip arthroplasty (THA). The oxidative stress of increased metal ions can be measured with serum markers. It is still controversial if larger femoral head diameters decrease wear rates in patients with metal-on-metal THA and if the increased metal ions alter the body’s antioxidant status.

Questions/purposes

We therefore (1) determined whole blood metal ions in patients with small (28 mm and 36 mm) and large (40 mm and 44 mm) diameter femoral heads; (2) measured oxidative stress markers (total antioxidants, nitrotyrosine, and peroxides); and (3) determined whether acetabular version or inclination influenced ion levels.

Methods

One hundred four patients were retrospectively studied. We recorded Harris hip scores and UCLA activity scores. All patients were followed at 1 year.

Results

The activity scores were similar in the two groups. There was no difference in metal ion levels or oxidative stress markers between patients with small- or large-diameter femoral heads. Acetabular inclination and anteversion had no effect on the metal ion levels.

Conclusions

The data suggest there is no difference in ion values in patients with large or small metal-on-metal THA and the increased metal ions do not alter the oxidant status of the patient.

Level of Evidence

Level III, retrospective comparative study. See Guidelines for Authors for a complete description of levels of evidence.

Anissian HL, Stark A, Gustafson A, Good V, Clarke IC. Metal-on-metal bearing in hip prosthesis generates 100-fold less wear debris than metal-on-polyethylene. Acta Orthop Scand. 1999;70:578–582.PubMedCrossRef

Antoniou J, Zukor DJ, Mwale F, Minarik W, Petit A, Huk OL. Metal ion levels in the blood of patients after hip resurfacing: a comparison between twenty-eight and thirty-six-millimeter-head metal-on-metal prostheses. J Bone Joint Surg Am. 2008;90(Suppl 3):142–148.PubMedCrossRef

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

Beckman JS, Koppenol WH. Nitric oxide, superoxide, and peroxynitrite: the good, the bad, and ugly. Am J Physiol. 1996;271:C1424–1437.PubMed

Berger RA, Jacobs JJ, Quigley LR, Rosenberg AG, Galante JO. Primary cementless acetabular reconstruction in patients younger than 50 years old. 7- to 11-year results. Clin Orthop Relat Res. 1997;344:216–226.PubMedCrossRef

Brodner W, Grohs JG, Bitzan P, Meisinger V, Kovarik J, Kotz R. Serum cobalt and serum chromium level in 2 patients with chronic renal failure after total hip prosthesis implantation with metal-metal gliding contact [in German]. Z Orthop Ihre Grenzgeb. 2000;138:425–429.PubMedCrossRef

Brodner W, Grubl 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;19:66–70.PubMedCrossRef

Burroughs BR, Hallstrom B, Golladay GJ, Hoeffel D, Harris WH. Range of motion and stability in total hip arthroplasty with 28-, 32-, 38-, and 44-mm femoral head sizes. J Arthroplasty. 2005;20:11–19.PubMedCrossRef

Burroughs BR, Rubash HE, Harris WH. Femoral head sizes larger than 32 mm against highly cross-linked polyethylene. Clin Orthop Relat Res. 2002;405:150–157.PubMedCrossRef

10.

Case CP, Ellis L, Turner JC, Fairman B. Development of a routine method for the determination of trace metals in whole blood by magnetic sector inductively coupled plasma mass spectrometry with particular relevance to patients with total hip and knee arthroplasty. Clin Chem. 2001;47:275–280.PubMed

11.

Case CP, Langkamer VG, Lock RJ, Perry MJ, Palmer MR, Kemp AJ. Changes in the proportions of peripheral blood lymphocytes in patients with worn implants. J Bone Joint Surg Br. 2000;82:748–754.PubMedCrossRef

12.

Chan FW, Bobyn JD, Medley JB, Krygier JJ, Tanzer M. The Otto Aufranc Award. Wear and lubrication of metal-on-metal hip implants. Clin Orthop Relat Res. 1999;369:10–24.PubMedCrossRef

13.

Chan FW, Bobyn JD, Medley JB, Krygier JJ, Yue S, Tanzer M. Engineering issues and wear performance of metal on metal hip implants. Clin Orthop Relat Res. 1996;333:96–107.PubMedCrossRef

14.

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

15.

Daniel J, Ziaee H, Pynsent PB, McMinn DJ. The validity of serum levels as a surrogate measure of systemic exposure to metal ions in hip replacement. J Bone Joint Surg Br. 2007;89:736–741.PubMedCrossRef

16.

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

17.

Davies AP, Sood A, Lewis AC, Newson R, Learmonth ID, Case CP. Metal-specific differences in levels of DNA damage caused by synovial fluid recovered at revision arthroplasty. J Bone Joint Surg Br. 2005;87:1439–1444.PubMedCrossRef

18.

Davies AP, Willert HG, Campbell PA, Learmonth ID, Case CP. An unusual lymphocytic perivascular infiltration in tissues around contemporary metal-on-metal joint replacements. J Bone Joint Surg Am. 2005;87:18–27.PubMedCrossRef

19.

De Haan R, Pattyn C, Gill HS, Murray DW, Campbell PA, De Smet K. Correlation between inclination of the acetabular component and metal ion levels in metal-on-metal hip resurfacing replacement. J Bone Joint Surg Br. 2008;90:1291–1297.PubMedCrossRef

20.

De Smet K, De Haan R, Calistri A, Campbell PA, Ebramzadeh E, Pattyn C, Gill HS. Metal ion measurement as a diagnostic tool to identify problems with metal-on-metal hip resurfacing. J Bone Joint Surg Am. 2008;90(Suppl 4):202–208.PubMedCrossRef

21.

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

22.

Dowson D. New joints for the Millennium: wear control in total replacement hip joints. Proc Inst Mech Eng H. 2001;215:335–358.PubMedCrossRef

23.

Engh CA Jr, Claus AM, Hopper RH Jr, Engh CA. Long-term results using the anatomic medullary locking hip prosthesis. Clin Orthop Relat Res. 2001;393:137–146.PubMedCrossRef

24.

Garbuz DS, Tanzer M, Greidanus NV, Masri BA, Duncan CP. The John Charnley Award: metal-on-metal hip resurfacing versus large-diameter head metal-on-metal total hip arthroplasty: a randomized clinical trial. Clin Orthop Relat Res. 2010;468:318–325.PubMedCrossRef

25.

Goldberg JR, Gilbert JL, Jacobs JJ, Bauer TW, Paprosky W, Leurgans S. A multicenter retrieval study of the taper interfaces of modular hip prostheses. Clin Orthop Relat Res. 2002;401:149–161.PubMedCrossRef

26.

Hallab NJ, Anderson S, Caicedo M, Skipor A, Campbell P, Jacobs JJ. Immune responses correlate with serum-metal in metal-on-metal hip arthroplasty. J Arthroplasty. 2004;19:88–93.PubMedCrossRef

27.

Hallab NJ, Caicedo M, Finnegan A, Jacobs JJ. Th1 type lymphocyte reactivity to metals in patients with total hip arthroplasty. J Orthop Surg. 2008;3:6.CrossRef

28.

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

29.

Hart AJ, Buddhdev P, Winship P, Faria N, Powell JJ, Skinner JA. Cup inclination angle of greater than 50 degrees increases whole blood concentrations of cobalt and chromium ions after metal-on-metal hip resurfacing. Hip Int. 2008;18:212–219.PubMed

30.

Hart AJ, Hester T, Sinclair K, Powell JJ, Goodship AE, Pele L, Fersht NL, Skinner J. The association between metal ions from hip resurfacing and reduced T-cell counts. J Bone Joint Surg Br. 2006;88:449–454.PubMedCrossRef

31.

Hart AJ, Skinner JA, Winship P, Faria N, Kulinskaya E, Webster D, Muirhead-Allwood S, Aldam CH, Anwar H, Powell JJ. Circulating levels of cobalt and chromium from metal-on-metal hip replacement are associated with CD8+ T-cell lymphopenia. J Bone Joint Surg Br. 2009;91:835–842.PubMedCrossRef

32.

Huk OL, Catelas I, Mwale F, Antoniou J, Zukor DJ, Petit A. Induction of apoptosis and necrosis by metal ions in vitro. J Arthroplasty. 2004;19:84–87.PubMedCrossRef

33.

Hur CI, Yoon TR, Cho SG, Song EK, Seon JK. Serum ion level after metal-on-metal THA in patients with renal failure. Clin Orthop Relat Res. 2008;466:696–699.PubMedCrossRef

34.

Iida H, Kaneda E, Takada H, Uchida K, Kawanabe K, Nakamura T. Metallosis due to impingement between the socket and the femoral neck in a metal-on-metal bearing total hip prosthesis. A case report. J Bone Joint Surg Am. 1999;81:400–403.PubMed

35.

Jacobs JJ, Skipor AK, Campbell PA, Hallab NJ, Urban RM, Amstutz HC. Can metal levels be used to monitor metal-on-metal hip arthroplasties. J Arthroplasty. 2004;19:59–65.PubMedCrossRef

36.

Jacobs JJ, Skipor AK, Doorn PF, Campbell P, Schmalzried TP, Black J, Amstutz HC. Cobalt and chromium concentrations in patients with metal on metal total hip replacements. Clin Orthop Relat Res. 1996;329(Suppl):S256–263.PubMedCrossRef

37.

Jacobs JJ, Urban RM, Gilbert JL, Skipor AK, Black J, Jasty M, Galante JO. Local and distant products from modularity. Clin Orthop Relat Res. 1995;319:94–105.PubMed

38.

Khan M, Takahashi T, Kuiper JH, Sieniawska CE, Takagi K, Richardson JB. Current in vivo wear of metal-on-metal bearings assessed by exercise-related rise in plasma cobalt level. J Orthop Res. 2006;24:2029–2035.PubMedCrossRef

39.

Kim YH, Oh SH, Kim JS. Primary total hip arthroplasty with a second-generation cementless total hip prosthesis in patients younger than fifty years of age. J Bone Joint Surg Am. 2003;85:109–114.PubMedCrossRef

40.

Kothari M, Bartel DL, Booker JF. Surface geometry of retrieved McKee-Farrar total hip replacements. Clin Orthop Relat Res. 1996;329(Suppl):S141–147.PubMedCrossRef

41.

Krismer M, Bauer R, Tschupik J, Mayrhofer P. EBRA: a method to measure migration of acetabular components. J Biomech. 1995;28:1225–1236.PubMedCrossRef

42.

Langton DJ, Jameson SS, Joyce TJ, Webb J, Nargol AV. The effect of component size and orientation on the concentrations of metal ions after resurfacing arthroplasty of the hip. J Bone Joint Surg Br. 2008;90:1143–1151.PubMed

43.

Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am. 1978;60:217–220.PubMed

44.

McKellop H, Park SH, Chiesa R, Doorn P, Lu B, Normand P, Grigoris P, Amstutz H. In vivo wear of three types of metal on metal hip prostheses during two decades of use. Clin Orthop Relat Res. 1996;329(Suppl):S128–140.PubMedCrossRef

45.

Pandit H, Glyn-Jones S, McLardy-Smith P, Gundle R, Whitwell D, Gibbons CL, Ostlere S, Athanasou N, Gill HS, Murray DW. Pseudotumours associated with metal-on-metal hip resurfacings. J Bone Joint Surg Br. 2008;90:847–851.PubMedCrossRef

46.

Rae T. A study on the effects of particulate metals of orthopaedic interest on murine macrophages in vitro. J Bone Joint Surg Br. 1975;57:444–450.PubMed

47.

Schmalzried TP, Huk OL. Patient factors and wear in total hip arthroplasty. Clin Orthop Relat Res. 2004;418:94–97.PubMedCrossRef

48.

Schmalzried TP, Peters PC, Maurer BT, Bragdon CR, Harris WH. Long-duration metal-on-metal total hip arthroplasties with low wear of the articulating surfaces. J Arthroplasty. 1996;11:322–331.PubMedCrossRef

49.

Schmalzried TP, Shepherd EF, Dorey FJ, Jackson WO, dela Rosa M, Fa’vae F, McKellop HA, McClung CD, Martell J, Moreland JR, Amstutz HC. The John Charnley Award. Wear is a function of use, not time. Clin Orthop Relat Res. 2000;381:36–46.PubMedCrossRef

50.

Shanbhag AS, Jacobs JJ, Black J, Galante JO, Glant TT. Human monocyte response to particulate biomaterials generated in vivo and in vitro. J Orthop Res. 1995;13:792–801.PubMedCrossRef

51.

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

52.

Stohs SJ, Bagchi D. Oxidative mechanisms in the toxicity of metal ions. Free Radic Biol Med. 1995;18:321–336.PubMedCrossRef

53.

Therond P, Bonnefont-Rousselot D, Davit-Spraul A, Conti M, Legrand A. Biomarkers of oxidative stress: an analytical approach. Curr Opin Clin Nutr Metab Care. 2000;3:373–384.PubMedCrossRef

54.

Vendittoli PA, Roy A, Mottard S, Girard J, Lusignan D, Lavigne M. Metal ion release from bearing wear and corrosion with 28 mm and large-diameter metal-on-metal bearing articulations: a follow-up study. J Bone Joint Surg Br. 2010;92:12–19.PubMed

55.

Willert HG, Buchhorn GH, Fayyazi A, Flury R, Windler M, Koster G, Lohmann CH. Metal-on-metal bearings and hypersensitivity in patients with artificial hip joints. A clinical and histomorphological study. J Bone Joint Surg Am. 2005;87:28–36.PubMedCrossRef

56.

Zahiri CA, Schmalzried TP, Szuszczewicz ES, Amstutz HC. Assessing activity in joint replacement patients. J Arthroplasty. 1998;13:890–895.PubMedCrossRef

57.

Ziaee H, Daniel J, Datta AK, Blunt S, McMinn DJ. Transplacental transfer of cobalt and chromium in patients with metal-on-metal hip arthroplasty: a controlled study. J Bone Joint Surg Br. 2007;89:301–305.PubMed

Title: Femoral Head Size Does Not Affect Ion Values in Metal-on-Metal Total Hips
Authors: Mitchell Bernstein, MD
Alan Walsh, MD
Alain Petit, PhD
David J. Zukor, MD
John Antoniou, MD, PhD
Publication date: 01-06-2011
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 6/2011
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-010-1630-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Femoral Head Size Does Not Affect Ion Values in Metal-on-Metal Total Hips

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

Please log in to get access to this content

Other articles of this Issue 6/2011

50 Years Ago in CORR: The Value of the Resection of the Femoral Head in the Repair of the Hip Joint Arnold Soren MD, PhD CORR 1960;18:221–230

Avoiding Short-term Femoral Neck Fracture With Imageless Computer Navigation for Hip Resurfacing

Is Resurfacing Arthroplasty Appropriate for Posttraumatic Osteoarthritis?

Preoperative Radiographic Assessment of Limb-length Discrepancy in Total Hip Arthroplasty

Does Acetabular Inclination Angle Affect Survivorship of Alumina-ceramic Articulations?

Is Mid-head Resection a Durable Conservative Option in the Presence of Poor Femoral Bone Quality and Distorted Anatomy?