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Clinical Orthopaedics and Related Research®
Published in: Clinical Orthopaedics and Related Research® 2/2013

01-02-2013 | Symposium: Papers Presented at the Annual Meetings of The Hip Society

The 2012 Otto Aufranc Award: The Interpretation of Metal Ion Levels in Unilateral and Bilateral Hip Resurfacing

Authors: Catherine Van Der Straeten, MD, George Grammatopoulos, MD, Harinderjit S. Gill, BEng, DPhil, Alessandro Calistri, MD, Patricia Campbell, PhD, Koen A. De Smet, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 2/2013

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Abstract

Background

The interpretation of metal ion concentrations and their role in clinical management of patients with metal-on-metal implants is still controversial.

Questions/Purposes

We questioned whether patients undergoing hip resurfacing with no clinical problems could be differentiated from those with clinical (pain, loss of function) and/or radiographic (component malpositioning, migration, bone loss), problems based on metal ion levels, and if there was a threshold metal level that predicted the need for clinical intervention. Furthermore, we asked if patient and implant factors differed between these functional groups.

Methods

We retrospectively identified 453 unilateral and 139 bilateral patients with ion measurements at minimum followup of 12 months (mean, 4.3 years; range, 1–12.9 years). Patients were designated as well functioning or poorly functioning based on strict criteria. The acceptable upper levels within the well-functioning group were determined from the 75th percentile plus 1.5× interquartile range. The sensitivity and specificity of these levels to predict clinical problems were calculated.

Results

Well-functioning group ions were lower than the poorly functioning group ion levels. The acceptable upper levels were: chromium (Cr) 4.6 μg/L, cobalt (Co) 4.0 μg/L unilateral and Cr 7.4 μg/L, Co 5.0 μg/L bilateral. The specificity of these levels in predicting poor function was high (95%) and sensitivity was low (25%). There were more males in the well-functioning group and more females and smaller femoral components in the poorly functioning group.

Conclusions

Metal levels higher than these proposed safe upper limits can predict problems with metal-on-metal resurfacings and are important parameters in the management of at-risk patients.

Level of Evidence

Level II, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.
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Metadata
Title
The 2012 Otto Aufranc Award: The Interpretation of Metal Ion Levels in Unilateral and Bilateral Hip Resurfacing
Authors
Catherine Van Der Straeten, MD
George Grammatopoulos, MD
Harinderjit S. Gill, BEng, DPhil
Alessandro Calistri, MD
Patricia Campbell, PhD
Koen A. De Smet, MD
Publication date
01-02-2013
Publisher
Springer-Verlag
Published in
Clinical Orthopaedics and Related Research® / Issue 2/2013
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-012-2526-x

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