The sensitivity of cobalt (Co) and chromium (Cr) ion-levels in detecting poorly performing metal-on-metal hip implants is low. This study proposes that serial changes in ion-levels are a more accurate marker of arthroplasties at risk.
Methods
Serial metal ion-levels and implant data of 285 patients with ASR resurfacing or replacement were studied. Patient and implant characteristics were analysed using univariate and multivariate analyses.
Results
111 (39%) had revision surgery. Time since index surgery (p≤0.001), acetabular inclination (p≤0.001), their interaction (p≤0.001) and femoral head size (p = 0.01) were significant variables. Head size (≤51 mm) had lower Co and Cr levels (p = 0.01). Cr/Co showed marginal decrease over time in the unrevised group and no decrease prerevision.
Conclusions
Repeated measurement of ion-levels were higher in the revision group suggesting that serial measurements rather than absolute values may have a role to play in predicting implant failure.
National Joint Registry for England and Wales. 8th Annual Report. Surgical data to 31st December 2010. National Joint Registry: 2011.
2.
National Joint Registry for England and Wales. 10th Annual Report. Surgical data to 31st December 2012. National Joint Registry: 2013.
3.
Australian Orthopaedic Association National Joint Replacement Registry. Hip and Knee Arthroplasty. Annual Report, 2012.
4.
HartmannA.HannemannF.LütznerJ.Metal ion concentrations in body fluids after implantation of hip replacements with metal-on-metal bearing—systematic review of clinical and epidemiological studies.PLoS ONE.2013; 8(8): e70359.
5.
NelisR.de Waal MalefijtJ.GosensT.Breast milk metal ion levels in a young and active patient with a metal-on-metal hip prosthesis.J Arthroplasty.2013; 28(1): 196.e19-196.e22.
6.
NikolaouV.S.PetitA.ZukorD.J.PapanastasiouC.HukO.L.AntoniouJ.Presence of cobalt and chromium ions in the seminal fluid of young patients with metal-on-metal total hip arthroplasty.J Arthroplasty.2013; 28(1): 161–167.
7.
PanditH.Glyn-JonesS.McLardy-SmithP.Pseudotumours associated with metal-on-metal hip resurfacings.J Bone Joint Surg Br.2008; 90(7): 847–851.
8.
DohertyA.T.HowellR.T.EllisL.A.Increased chromosome translocations and aneuploidy in peripheral blood lymphocytes of patients having revision arthroplasty of the hip.J Bone Joint Surg Br.2001; 83(7): 1075–1081.
9.
SmithA.J.DieppeP.PorterM.BlomA.W.; National Joint Registry of England and Wales. Risk of cancer in first seven years after metal-on-metal hip replacement compared with other bearings and general population: linkage study between the National Joint Registry of England and Wales and hospital episode statistics.BMJ.2012; 344: e2383.
10.
SinghG.MeyerH.RuetschiM.ChamaonK.FeuersteinB.LohmannC.H.Large-diameter metal-on-metal total hip arthroplasties: a page in orthopedic history?J Biomed Mater Res A.2013; 101(11): 3320–3326.
11.
ClarkeI.C.DonaldsonT.BowsherJ.G.NasserS.TakahashiT.Current concepts of metal-on-metal hip resurfacing.Orthop Clin North Am.2005; 36(2): 143–162, viii.
12.
LangtonD.J.JamesonS.S.JoyceT.J.HallabN.J.NatuS.NargolA.V.Early failure of metal-on-metal bearings in hip resurfacing and large-diameter total hip replacement: A consequence of excess wear.J Bone Joint Surg Br.2010; 92(1): 38–46.
13.
DesyN.M.BergeronS.G.PetitA.HukO.L.AntoniouJ.Surgical variables influence metal ion levels after hip resurfacing.Clin Orthop Relat Res.2011; 469(6): 1635–1641.
14.
BernsteinM.DesyN.M.PetitA.ZukorD.J.HukO.L.AntoniouJ.Long-term follow-up and metal ion trend of patients with metal-on-metal total hip arthroplasty.Int Orthop.2012; 36(9): 1807–1812.
15.
DanielJ.ZiaeeH.KamaliA.PradhanC.McMinnD.What are the risks accompanying the reduced wear benefit of low-clearance hip resurfacing?Clin Orthop Relat Res.2012; 470(10): 2800–2809.
16.
De HaanR.PattynC.GillH.S.MurrayD.W.CampbellP.A.De SmetK.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(10): 1291–1297.
17.
LangtonD.J.SprowsonA.P.JoyceT.J.Blood metal ion concentrations after hip resurfacing arthroplasty: a comparative study of articular surface replacement and Birmingham Hip Resurfacing arthroplasties.J Bone Joint Surg Br.2009; 91(10): 1287–1295.
18.
De SmetK.De HaanR.CalistriA.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.
19.
MatthiesA.UnderwoodR.CannP.Retrieval analysis of 240 metal-on-metal hip components, comparing modular total hip replacement with hip resurfacing.J Bone Joint Surg Br.2011; 93(3): 307–314.
20.
HartA.J.SabahS.A.BandiA.S.Sensitivity and specificity of blood cobalt and chromium metal ions for predicting failure of metal-on-metal hip replacement.J Bone Joint Surg Br.2011; 93(10): 1308–1313.
21.
GriffinW.L.Metal ion levels: how can they help us?J Arthroplasty.2014; 29(4): 659–660.
22.
Medicines and Healthcare Products Regulatory Agency (MHRA; United Kingdom). Medical Device Alert. Ref: MDA/2010/033. Issues. 2010.
23.
SidaginamaleR.P.JoyceT.J.LordJ.K.Blood metal ion testing is an effectivescreening tool to identify poorly performing metal-on-metal bearingsurfaces.Bone Joint Res.2013; 2(5): 84–95.
24.
MalekI.A.KingA.SharmaH.The sensitivity, specificity and predictive values of raised plasma metal ion levels in the diagnosis of adverse reaction to metal debris in symptomatic patients with a metal-on-metal arthroplasty of the hip.J Bone Joint Surg Br.2012; 94(8): 1045–1050.
25.
GriffinW.L.FehringT.K.KudrnaJ.C.Are metal ion levels a useful trigger for surgical intervention?J Arthroplasty.2012; 27(8)(Suppl): 32–36.
26.
BeauléP.E.KimP.R.HamdiA.FazekasA.A prospective metal ion study of large-head metal-on-metal bearing: a matched-pair analysis of hip resurfacing versus total hip replacement.Orthop Clin North Am.2011; 42(2): 251–257, ix.
27.
GarbuzD.S.TanzerM.GreidanusN.V.MasriB.A.DuncanC.P.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(2): 318–325.
28.
ImanishiT.HasegawaM.SudoA.Serum metal ion levels after second-generation metal-on-metal total hip arthroplasty.Arch Orthop Trauma Surg.2010; 130(12): 1447–1450.
29.
HallowsR.K.PeltC.E.EricksonJ.A.PetersC.L.Serum metal ion concentration: comparison between small and large head metal-on-metal total hip arthroplasty.J Arthroplasty.2011; 26(8): 1176–1181.
30.
LangtonD.J.JamesonS.S.JoyceT.J.Accelerating failure rate of the ASR total hip replacement.J Bone Joint Surg Br.2011; 93(8): 1011–1016.
31.
PeltC.E.BergesonA.G.AndersonL.A.StoddardG.J.PetersC.L.Serum metal ion concentrations after unilateral vs bilateral large-head metal-on-metal primary total hip arthroplasty.J Arthroplasty.2011; 26(8): 1494–1500.
32.
WilliamsD.H.GreidanusN.V.MasriB.A.DuncanC.P.GarbuzD.S.Prevalence of pseudotumor in asymptomatic patients after metal-on-metal hip arthroplasty.J Bone Joint Surg Am.2011; 93(23): 2164–2171.
33.
EmmanuelA.R.BerginK.M.KellyG.E.McCoyG.F.WozniakA.P.QuinlanJ.F.The effect of acetabular inclination on metal ion levels following metal-on-metal hip arthroplasty.J Arthroplasty.2014; 29(1): 186–191.
34.
ReitoA.MoilanenT.PuolakkaT.PajamäkiJ.EskelinenA.Repeated metal ion measurements in patients with high risk metal-on-metal hip replacement.Int Orthop.2014; 38(7): 1353–1361.
