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International Orthopaedics

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01-09-2012 | Original Paper

Long-term follow-up and metal ion trend of patients with metal-on-metal total hip arthroplasty

Authors: Mitchell Bernstein, Nicholas M. Desy, Alain Petit, David J. Zukor, Olga L. Huk, John Antoniou

Published in: International Orthopaedics | Issue 9/2012

Abstract

Purpose

Long-term studies are required to support the use of metal-on-metal (MoM) bearings in total hip arthroplasty (THA) given the concern about systemic metal ion release and reports of adverse local soft tissue reactions. The purpose of this study was to report the seven to 13-year clinical, radiographic, and metal ion results in patients following MoM THA.

Methods

We studied 163 prostheses after second-generation MoM THA between July 1997 and November 2003. Cobalt and chromium metal ions were collected using whole and analysed by inductively-coupled plasma-mass spectrometry.

Results

The mean follow-up was 8.87 years (range, 7–13 years). Four hips (2.5 %) were revised. The Kaplan-Meier survivorship was 91.3 % for revision for all causes, and 97.5 % when excluding the hips revised for a manufacturer’s defect. Median whole blood cobalt levels peaked at a value of 2.87 μg/L at four years (p < 0.0001 vs. pre-operative) and subsequently decreased to 2.0 μg/L after nine years (p = 0.002 vs. four years). Median chromium levels maximally increased up to 0.75 μg/L after five years (p < 0.0001 vs. pre-operative) and tended to decrease thereafter to values of 0.56 μg/L after seven years.

Conclusions

This seven to 13-year follow-up study indicates that the clinical and radiological results following MoM THA are satisfactory with low revision rates. Cobalt and chromium ion levels peaked at four and five years, respectively, and gradually decreased thereafter.

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

Girard J, Bocquet D, Autissier G, Fouilleron N, Fron D, Migaud H (2010) Metal-on-metal hip arthroplasty in patients thirty years of age or younger. J Bone Joint Surg Am 92(14):2419–2426PubMedCrossRef

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

Prosser GH, Yates PJ, Wood DJ, Graves SE, de Steiger RN, Miller LN (2010) Outcome of primary resurfacing hip replacement: evaluation of risk factors for early revision. Acta Orthop 81(1):66–71PubMedCrossRef

Jacobs JJ, Skipor AK, Patterson LM, Hallab NJ, Paprosky WG, Black J, Galante JO (1998) Metal release in patients who have had a primary total hip arthroplasty. A prospective, controlled, longitudinal study. J Bone Joint Surg Am 80(10):1447–1458PubMed

Antoniou J, Zukor DJ, Mwale F, Minarik W, Petit A, Huk OL (2008) 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 90(Suppl 3):142–148PubMedCrossRef

Vendittoli PA, Amzica T, Roy AG, Lusignan D, Girard J, Lavigne M (2011) Metal ion release with large-diameter metal-on-metal hip arthroplasty. J Arthroplasty 26(2):282–288PubMedCrossRef

Walter LR, Marel E, Harbury R, Wearne J (2008) Distribution of chromium and cobalt ions in various blood fractions after resurfacing hip arthroplasty. J Arthroplasty 23(6):814–821PubMedCrossRef

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

10.

Davies AP, Sood A, Lewis AC, Newson R, Learmonth ID, Case CP (2005) Metal-specific differences in levels of DNA damage caused by synovial fluid recovered at revision arthroplasty. J Bone Joint Surg Br 87(10):1439–1444PubMedCrossRef

11.

Huk OL, Catelas I, Mwale F, Antoniou J, Zukor DJ, Petit A (2004) Induction of apoptosis and necrosis by metal ions in vitro. J Arthroplasty 19(8 Suppl 3):84–87PubMedCrossRef

12.

Eswaramoorthy V, Moonot P, Kalairajah Y, Biant LC, Field RE (2008) The Metasul metal-on-metal articulation in primary total hip replacement: clinical and radiological results at ten years. J Bone Joint Surg Br 90(10):1278–1283PubMedCrossRef

13.

Grubl A, Marker M, Brodner W, Giurea A, Heinze G, Meisinger V, Zehetgruber H, Kotz R (2007) Long-term follow-up of metal-on-metal total hip replacement. J Orthop Res 25(7):841–848PubMedCrossRef

14.

Maezawa K, Nozawa M, Yuasa T, Aritomi K, Matsuda K, Shitoto K (2010) Seven years of chronological changes of serum chromium levels after Metasul metal-on-metal total hip arthroplasty. J Arthroplasty 25(8):1196–1200PubMedCrossRef

15.

Neumann DR, Thaler C, Hitzl W, Huber M, Hofstädter T, Dorn U (2010) Long-term results of a contemporary metal-on-metal total hip arthroplasty: a 10-year follow-up study. J Arthroplasty 25(5):700–708PubMedCrossRef

16.

Saito S, Ishii T, Mori S, Hosaka K, Ootaki M, Tokuhashi Y (2010) Long-term results of metasul metal-on-metal total hip arthroplasty. Orthopedics 33(8):548

17.

Dastane M, Wan Z, Deshmane P, Long WT, Dorr LD (2011) Primary hip arthroplasty with 28-mm Metasul articulation. J Arthroplasty 26(4):662–664PubMedCrossRef

18.

Milosev I, Trebse R, Kovac S, Cör A, Pisot V (2006) Survivorship and retrieval analysis of Sikomet metal-on-metal total hip replacements at a mean of seven years. J Bone Joint Surg Am 88(6):1173–1182PubMedCrossRef

19.

Randelli F, Banci L, D’Anna A, Visentin O, Randelli G (2012) Cementless Metasul metal-on-metal total hip arthroplasties at 13 years. J Arthroplasty 27(2):186–192PubMedCrossRef

20.

Blumenfeld TJ, Bargar WL (2006) Early aseptic loosening of a modern acetabular component secondary to a change in manufacturing. J Arthroplasty 21(5):689–695PubMedCrossRef

21.

Krismer M, Bauer R, Tschupik J, Mayrhofer P (1995) EBRA: a method to measure migration of acetabular components. J Biomech 28(10):1225–1236PubMedCrossRef

22.

Case CP, Ellis L, Turner JC, Fairman B (2001) 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 47(2):275–280PubMed

23.

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

24.

De Haan R, Pattyn C, Gill HS, Murray DW, Campbell PA, De Smet K (2008) Correlation between inclination of the acetabular component and metal ion levels in metal-on-metal hip resurfacing replacement. J Bone Joint Surg Br 90(10):1291–1297PubMedCrossRef

25.

Hart AJ, Hester T, Sinclair K, Powell JJ, Goodship AE, Pele L, Fersht NL, Skinner J (2006) The association between metal ions from hip resurfacing and reduced T-cell counts. J Bone Joint Surg Br 88(4):449–454PubMedCrossRef

26.

Hart AJ, Skinner JA, Winship P, Faria N, Kulinskaya E, Webster D, Muirhead-Allwood S, Aldam CH, Anwar H, Powell JJ (2009) Circulating levels of cobalt and chromium from metal-on-metal hip replacement are associated with CD8+ T-cell lymphopenia. J Bone Joint Surg Br 91(6):835–842PubMedCrossRef

27.

Kwon YM, Thomas P, Summer B, Pandit H, Taylor A, Beard D, Murray DW, Gill HS (2010) Lymphocyte proliferation responses in patients with pseudotumors following metal-on-metal hip resurfacing arthroplasty. J Orthop Res 28(4):444–450PubMed

28.

Willert HG, Buchhorn GH, Fayyazi A, Flury R, Windler M, Köster G, Lohmann CH (2005) Metal-on-metal bearings and hypersensitivity in patients with artificial hip joints. A clinical and histomorphological study. J Bone Joint Surg Am 87(1):28–36PubMedCrossRef

29.

Williams S, Leslie I, Isaac G, Jin Z, Ingham E, Fisher J (2008) Tribology and wear of metal-on-metal hip prostheses: influence of cup angle and head position. J Bone Joint Surg Am 90(Suppl 3):111–117PubMedCrossRef

30.

Daniel J, Ziaee H, Pynsent PB, McMinn DJ (2007) The validity of serum levels as a surrogate measure of systemic exposure to metal ions in hip replacement. J Bone Joint Surg Br 89(6):736–741PubMedCrossRef

31.

Hur CI, Yoon TR, Cho SG, Song EK, Seon JK (2008) Serum ion level after metal-on-metal THA in patients with renal failure. Clin Orthop Relat Res 466(3):696–699PubMedCrossRef

Title: Long-term follow-up and metal ion trend of patients with metal-on-metal total hip arthroplasty
Authors: Mitchell Bernstein
Nicholas M. Desy
Alain Petit
David J. Zukor
Olga L. Huk
John Antoniou
Publication date: 01-09-2012
Publisher: Springer-Verlag
Published in: International Orthopaedics / Issue 9/2012
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-012-1570-1

At a glance: The STEP trials

Springer Medicine

Long-term follow-up and metal ion trend of patients with metal-on-metal total hip arthroplasty

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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