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Zhong Q, Pan X, Chen Y, Lian Q, Gao J, Xu Y, Wang J, Shi Z, Cheng H. Prosthetic Metals: Release, Metabolism and Toxicity. Int J Nanomedicine 2024; 19:5245-5267. [PMID: 38855732 PMCID: PMC11162637 DOI: 10.2147/ijn.s459255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/13/2024] [Indexed: 06/11/2024] Open
Abstract
The development of metallic joint prostheses has been ongoing for more than a century alongside advancements in hip and knee arthroplasty. Among the materials utilized, the Cobalt-Chromium-Molybdenum (Co-Cr-Mo) and Titanium-Aluminum-Vanadium (Ti-Al-V) alloys are predominant in joint prosthesis construction, predominantly due to their commendable biocompatibility, mechanical strength, and corrosion resistance. Nonetheless, over time, the physical wear, electrochemical corrosion, and inflammation induced by these alloys that occur post-implantation can cause the release of various metallic components. The released metals can then flow and metabolize in vivo, subsequently causing potential local or systemic harm. This review first details joint prosthesis development and acknowledges the release of prosthetic metals. Second, we outline the metallic concentration, biodistribution, and elimination pathways of the released prosthetic metals. Lastly, we discuss the possible organ, cellular, critical biomolecules, and significant signaling pathway toxicities and adverse effects that arise from exposure to these metals.
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Affiliation(s)
- Qiang Zhong
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Xin Pan
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Yuhang Chen
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Qiang Lian
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Jian Gao
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Yixin Xu
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Jian Wang
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Zhanjun Shi
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Hao Cheng
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
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Gómez-Álvarez J, Miranda I, Álvarez-Llanas A, Lisón JF, Bosch-Morell F, Doménech J. Influence of Physical Activity and Cup Orientation on Metal Ion Release and Oxidative Stress in Metal-on-Metal and Ceramic-on-Metal Total Hip Arthroplasty. J Clin Med 2024; 13:527. [PMID: 38256664 PMCID: PMC10816639 DOI: 10.3390/jcm13020527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/30/2023] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Metal-on-metal (M-M) total hip arthroplasty (THA) has shown adverse reactions to metal debris, abnormal soft-tissue reactions, and high blood metal ion levels. This study aims to: (1) assess whether the toxicity of high levels of ions is related to altered oxidative stress and (2) evaluate tribological factors related to increased blood levels of chromium (Cr) and cobalt (Co) ions. METHODS A cross-sectional analytical descriptive study was conducted on 75 patients. A total of 25 underwent M-M THA, 25 ceramic-on-metal (C-M) THA, and 25 were on the THA waiting list. Ion metallic levels in blood, oxidative stress, physical activity, and implant position were compared. RESULTS In the M-M group, Co and Cr levels were significantly higher than those found in the C-M group and the control group (p < 0.01). We found no differences in terms of oxidative stress between the groups. Also, we did not find a correlation between metal blood levels and oxidative stress indicators, the physical activity of the patients or the position of the implants between groups. CONCLUSIONS The use of M-M bearing surfaces in THA raises the levels of metals in the blood without modifying oxidative stress regardless of the physical activity levels of the patients. Therefore, although patients with M-M bearings require close monitoring, it does not seem necessary to recommend the restriction of physical activity in patients with M-M or C-M arthroplasties.
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Affiliation(s)
- Jorge Gómez-Álvarez
- Department of Orthopedic Surgery, Clínica Universidad de Navarra, 31008 Pamplona, Spain;
| | - Ignacio Miranda
- Department of Orthopedic Surgery, Hospital Arnau de Vilanova, 46015 Valencia, Spain
- Faculty of Health Sciences, Universidad Católica de Valencia, 46001 Valencia, Spain
| | - Alejandro Álvarez-Llanas
- Department of Orthopedic Surgery, Hospital Arnau de Vilanova, 46015 Valencia, Spain
- Faculty of Health Sciences, Universidad Católica de Valencia, 46001 Valencia, Spain
| | - Juan F. Lisón
- Department of Biomedical Sciences, Faculty of Health Sciences, University CEU Cardenal Herrera, 46115 Alfara del Patriarca, Spain; (J.F.L.); (F.B.-M.)
- CIBER de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Francisco Bosch-Morell
- Department of Biomedical Sciences, Faculty of Health Sciences, University CEU Cardenal Herrera, 46115 Alfara del Patriarca, Spain; (J.F.L.); (F.B.-M.)
| | - Julio Doménech
- Department of Orthopedic Surgery, Clínica Universidad de Navarra, 31008 Pamplona, Spain;
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Saracco M, Ciriello V, Spinarelli A, Solarino G, Goderecci R, Logroscino G. Ceramic-on-Metal Bearing in Total Hip Arthroplasty—Was It So Bad? A Narrative Review and a Critical Analysis of the Literature. JOURNAL OF COMPOSITES SCIENCE 2023; 8:9. [DOI: https:/doi.org/10.3390/jcs8010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2023]
Abstract
Hip replacement has significantly improved the quality of life of patients with symptomatic hip osteoarthritis. Various bearings have been developed over the years. Each of these has advantages and disadvantages. On the one hand, Metal-on-Metal (MoM) has been associated with a high level of wear and metal ion release of chromium (Cr) and cobalt (Co). On the other hand, Ceramic-on-Ceramic (CoC) bearings, known to have a wear rate close to zero, have been associated with an increased risk of squeaking and component fracture. Ceramic-on-Metal (CoM), a hybrid hard-on-hard bearing, was proposed to overcome the CoC and MoM limits. Preliminary clinical and radiographical results have been described as favourable. Due to the failure of MoM and the increased risk of ion release and metal toxicity, CoM was withdrawn from the market without causing significant clinical complications. Data from the literature showed that CoM bearings are reliable and safe at medium- and long-term follow-up, if correctly implanted. In this narrative review, we analysed the real risks and benefits associated with the implantation of CoM bearings.
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Affiliation(s)
- Michela Saracco
- Department of Orthopaedics, ASL Napoli 2 Nord, 80027 Naples, Italy
| | - Vincenzo Ciriello
- Department of Surgery, Orthopaedic and Trauma Unit, S. Croce e Carle Hospital, 12100 Cuneo, Italy
| | - Antonio Spinarelli
- Department of Translational Biomedicine and Neuroscience, School of Medicine, University of Bari Aldo Moro, AOU Consorziale ‘Policlinico’, 70100 Bari, Italy
| | - Giuseppe Solarino
- Department of Translational Biomedicine and Neuroscience, School of Medicine, University of Bari Aldo Moro, AOU Consorziale ‘Policlinico’, 70100 Bari, Italy
| | - Remo Goderecci
- Department of Life, Health and Environmental Sciences, Orthopaedic Unit, University of L’Aquila, 67100 L’Aquila, Italy
| | - Giandomenico Logroscino
- Department of Life, Health and Environmental Sciences, Orthopaedic Unit, University of L’Aquila, 67100 L’Aquila, Italy
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Migliorini F, Pilone M, Bell A, Merfort R, Giorgino R, Maffulli N. Serum cobalt and chromium concentration following total hip arthroplasty: a Bayesian network meta-analysis. Sci Rep 2023; 13:6918. [PMID: 37106086 PMCID: PMC10140036 DOI: 10.1038/s41598-023-34177-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/25/2023] [Indexed: 04/29/2023] Open
Abstract
The present systematic review investigated the concentration of chromium (Cr) and cobalt (Co) in serum in patients who have undergone total hip arthroplasty (THA). The first outcome of interest was to investigate the mean concentration in serum of Cr and Co using different material combinations and to verify whether their concentrations change significantly using different patterns of head and liner in THA. The second outcome of interest was to investigate whether the time elapsed from the index surgery to the follow-up, BMI, sex, and side exert an influence on the mean concentration of Cr and Co in serum in patients who have undergone THA. The following material combinations were investigated (head-liner): Ceramic-Co Cr (CoCr), CoCr-CoCr, CoCr-Polyethylene, CoCr high carbide-CoCr high carbide. Data from 2756 procedures were retrieved. The mean length of follow-up was 69.3 ± 47.7 months. The ANOVA test evidenced good comparability in age, length of follow-up, BMI, and sex (P > 0.1). In patients who have undergone THA, the mean concentration in the serum of Co ranged between 0.5 µg/L and 3.5 µg/L, and the mean concentration of Cr from 0.6 to 2.6 µg/L. The difference in the concentration of Co and Cr in serum is strictly related to the implant configuration, with the coupling CoCr-CoCr showing the highest and CoCr-Polyethylene showing the lowest concentration. Patient characteristics, BMI, sex, side and the time elapsed from the index surgery to the last follow-up did not exert a significant influence on the concentration of Co and Cr in serum in patients who have undergone total hip arthroplasty (THA).
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St.Brigida, 52152, Simmerath, Germany.
| | - Marco Pilone
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
| | - Andreas Bell
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St.Brigida, 52152, Simmerath, Germany
| | - Ricarda Merfort
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Riccardo Giorgino
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy
- School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, ST4 7QB, Stoke On Trent, England
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, Mile End Hospital, E1 4DG, London, England
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Logroscino G, Saracco M, Maccauro G, Urbani A, Ciavardelli D, Consalvo A, Ferraro D, Falez F. Ceramic-on-metal coupling in THA: long term clinical and radiographic outcomes using two different short stems. BMC Musculoskelet Disord 2022; 22:1065. [PMID: 35193540 PMCID: PMC8864779 DOI: 10.1186/s12891-022-05077-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 01/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hip prosthetic replacement surgery is the gold standard for patients affected by symptomatic osteoarthritis. The ceramic-on-metal hybrid hard-on-hard bearing was initially launched on the market with the purpose of reducing adhesive and corrosion wear, loss of metal debris and ions and risk of fracture and squeaking. However, this bearing was withdrawn from the market, in the apprehension of local and systemic toxicity. The aim of this study is to evaluate the reliability and safety of ceramic-on-metal bearing at long term follow-up. METHODS From 2 cohorts of patients suffering of hip osteoarthritis who underwent total hip arthroplasty using ceramic-on-metal bearing with two different short stems, 19 of the GROUP A and 25 of the GROUP B were suitable for this study. All patients were compared clinically using the Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analogue scale (VAS), 12-item Short Form Health Survey (SF12P/M), and radiographically. Blood samples were collected in order to evaluate chromium and cobalt ions level. The two groups were compared in terms of metal ions blood levels, and finally all the implanted prostheses were compared with a healthy control group. RESULTS All the implanted stems were well-positioned and osseointegrated at a mean follow-up of 114 months. Improvements were observed for all clinical scores comparing preoperative and postoperative values in both groups. Radiographic evaluation showed a good ability to restore proper articular geometry. Chromium and cobalt ion analysis revealed values below the safety threshold except for 1 case in GROUP A (cup malposition) and 2 cases in GROUP B (6.1%). No revision occurred. CONCLUSIONS Ceramic-on-metal bearing is safe and reliable at long term follow-up in association to short stems arthroplasty, if the implant is correctly positioned. Chromium and cobalt metal ions blood levels evaluation should be performed annually.
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Affiliation(s)
- Giandomenico Logroscino
- Mininvasive and Computer-Assisted Orthopaedic Surgery, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Michela Saracco
- Department of Orthopaedics, Catholic University of Rome-Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito,1, 00168, Rome, Italy.
| | - Giulio Maccauro
- Department of Orthopaedics, Catholic University of Rome-Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito,1, 00168, Rome, Italy
| | - Andrea Urbani
- Institute of Biochemistry and Clinical Biochemistry, Catholic University of Rome-Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Domenico Ciavardelli
- School of Medicine and Surgery, University "Kore" of Enna, Enna, Italy
- Center for Advanced Studies and Technology (C.A.S.T.), University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Ada Consalvo
- Center for Advanced Studies and Technology (C.A.S.T.), University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Daniele Ferraro
- Department of Orthopaedics and Traumatology, ASL Roma 1, S. Filippo Neri Hospital and S. Spirito Hospital, Rome, Italy
| | - Francesco Falez
- Department of Orthopaedics and Traumatology, ASL Roma 1, S. Filippo Neri Hospital and S. Spirito Hospital, Rome, Italy
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Saracco M, Maccauro G, Urbani A, Ciavardelli D, Persichilli S, Ancillai G, Pasqualetti P, Calvisi V, Logroscino G. Ceramic-on-metal bearing in short stem total hip arthroplasty: ions, functional and radiographic evaluation at mid-term follow-up. Hip Int 2020; 30:52-58. [PMID: 33267696 DOI: 10.1177/1120700020971661] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The aim of this study is to evaluate clinical, radiographic and laboratory results of ceramic-on-metal (CoM) (hybrid hard bearing) in total hip arthroplasty (THA), associated with a short stem implant. METHODS From a cohort of 37 patients suffering from primary or secondary hip osteoarthritis who underwent THA using CoM bearing, 19 were suitable for this study. All procedures were performed by the same surgeon using a posterior-lateral approach. All patients were compared clinically using the Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analogue scale (VAS), 12-item Short Form Health Survey (SF12F/M), and radiographically (offset, CD angle, limb length discrepancy, cup inclination and anteversion, subsidence, osseointegration, heterotopic ossification). Blood samples were collected in order to evaluate chromium (Cr) and cobalt (Co) ions level. Radiographic evaluations were carried out by 3 different blinded surgeons. A statistical analysis was performed. RESULTS At a mean follow-up of 97 (73-125) months all implanted stems were well-positioned and osseointegrated. Clear improvements were observed for clinical scores comparing preoperative and postoperative values. Radiographic evaluation showed a good ability to restore proper articular geometry. Cr ion analysis revealed values below the safety threshold except for 1 case. Serum levels of Co were below the threshold in all patients. There was a statistically significant correlation only between Cr metal ions and length of follow-up. CONCLUSIONS CoM bearing has proven to be reliable and safe at a mean 8-year follow-up for patients in whom the components were correctly implanted. The rise of blood metal ions was minimal and involved neither systemic or local toxicity nor influenced clinical results.
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Affiliation(s)
- Michela Saracco
- Department of Orthopaedics, Catholic University of Rome-Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giulio Maccauro
- Department of Orthopaedics, Catholic University of Rome-Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Andrea Urbani
- Institute of Biochemistry and Clinical Biochemistry, Catholic University of Rome-Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Domenico Ciavardelli
- Centre of Sciences and Aging and Translational Medicine, CeSI-MeT, Chieti, Italy.,School of Human and Social Science, "Kore" University of Enna, Enna, Italy
| | - Silvia Persichilli
- Institute of Biochemistry and Clinical Biochemistry, Catholic University of Rome-Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giulio Ancillai
- Department of Orthopaedics, Catholic University of Rome-Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Patrizio Pasqualetti
- Fondazione Fatebenefratelli per la Ricerca e la Formazione Sanitaria e Sociale, Rome, Italy
| | - Vittorio Calvisi
- Mininvasive and Computer-Assisted Orthopaedic Surgery, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Giandomenico Logroscino
- Mininvasive and Computer-Assisted Orthopaedic Surgery, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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Lin X, Xu T, Wu B, Hu B, Qin M. Correlation of GSTM1 gene deletion in joint synovial fluid with the recovery of patients undergoing artificial hip replacement. Exp Ther Med 2018; 16:3821-3826. [PMID: 30344658 PMCID: PMC6176142 DOI: 10.3892/etm.2018.6661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 07/24/2018] [Indexed: 11/09/2022] Open
Abstract
The present study was designed to investigate the correlation between glutathione S-transferase M1 (GSTM1) gene polymorphism and the recovery of patients undergoing artificial hip replacement. A total of 241 patients including 149 males (61.8%) and 92 females (38.9%) who received artificial hip replacement in People's Hospital of Rizhao between December 2010 and October 2016 were enrolled to serve as the observation group. Patients were divided into two subgroups according to the loss of GSTM1. A total of 80 healthy subjects who udenrwent a physical examination in our hospital at the same period were selected to serve as the control group. The control group included 41 males (51.25%) and 39 females (48.75%). GSTM1 gene genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). All patients were followed up for 12 months. Clinical data were compared between the deletion and non-deletion groups and the hospitalization time and the length of the use of antibiotics were compared. Deletion rate of GSTM1 gene in the observation group was 67.63%, which was significantly different from that in the healthy control group [odds ratio (OR)=1.51, 95% confidence interval (CI): 1.075–2.023, P<0.05]. Notably, a significant difference was indicated in the recovery between patients with and without GSTM1 gene deletion after a year discharged from hospital (P<0.05). There was no significant difference according to sex, age, hypertension, smoking history, leukocyte, hemoglobin, platelet and BMI index between patients in deletion and non-deletion groups (P>0.05). However, there was a significant difference in the number of patients with diabetes between the two groups (P<0.05). Hospitalization time and the length of antibiotics use were significantly longer in deletion group compared with non-deletion group (P<0.05). Infection rate in the deletion group was significantly higher than that in the non-deletion group. Results suggested that GSTM1 gene polymorphism may be correlated with recovery of patients undergoing artificial hip replacement, and GSTM1 gene deletion may correlated with poor recovery.
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Affiliation(s)
- Xiangbo Lin
- Department of Orthopedics, People's Hospital of Rizhao, Rizhao, Shandong 276800, P.R. China
| | - Tao Xu
- Department of Orthopedics, Juxian People's Hospital, Rizhao, Shandong 276500, P.R. China
| | - Bin Wu
- Department of Orthopedics, Affiliated Hospital of Jining Medical University, Jining, Shandong 272001, P.R. China
| | - Bing Hu
- Department of Ultrasound, People's Hospital of Rizhao, Rizhao, Shandong 276800, P.R. China
| | - Ming Qin
- Department of Orthopedics, People's Hospital of Rizhao, Rizhao, Shandong 276800, P.R. China
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Aherwar A, Bahraminasab M. Biocompatibility evaluation and corrosion resistance of tungsten added Co-30Cr-4Mo-1Ni alloy. Biomed Mater Eng 2018; 28:687-701. [PMID: 29171973 DOI: 10.3233/bme-171706] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Biomaterials are continuously being developed to overcome the drawbacks of existing materials and provide improved function in artificial organs. Currently Co-Cr based alloys are used in many medical applications such as hip and knee implants which still require modification to better perform. In this article, therefore, the influence of tungsten allying element on electrochemical corrosion resistance and biocompatibility behaviour of a recently developed Co-30Cr-4Mo-1Ni alloy composition were investigated. The tungsten modified alloys were prepared by using a high temperature vertical vacuum casting technique at five different weight percentages (0-4wt.% tungsten). The electrochemical corrosion behaviour of all the samples under NaCl solution was studied by using potentiodynamic scan method. The corrosion characteristics were investigated in terms of corrosion potential (Ecorr) and corrosion current density (Icorr). From the results of the analysis, it was observed that out of all samples, an alloy with 2wt.% of tungsten in composition (i.e. Co-30Cr-4Mo-1Ni-2W) exhibited better corrosion resistance. Furthermore, histopathological evaluations in subcutaneous tissue were performed in rats according to the standard ISO 10993 to examine the biocompatibility of the prepared samples. The results showed no evidence of inflammatory cell migration, no epidermal necrosis, no vacuolar degeneration of basal cell, no adnexal atrophy and vesicle formation of any samples. The obtained findings indicate that Co-30Cr-4Mo-1Ni-2W can be used in biomedical applications including femoral component of hip and knee implants.
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Affiliation(s)
- Amit Aherwar
- Mechanical Engineering Department, Madhav Institute of Technology and Science, Gwalior-474005, India
| | - Marjan Bahraminasab
- Department of Tissue Engineering and Applied Cell Sciences, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
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Pseudotumor in ceramic-on-metal total hip arthroplasty. Arthroplast Today 2017; 3:220-224. [PMID: 29204484 PMCID: PMC5712035 DOI: 10.1016/j.artd.2017.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 09/01/2017] [Accepted: 09/06/2017] [Indexed: 12/27/2022] Open
Abstract
The increasing demand for total hip arthroplasty (THA) in relatively young, high-demand patients has led to the use of hard-on-hard bearing surfaces. Adverse local tissue reaction/pseudotumor and elevated serum metal ion levels are commonly reported complications encountered in metal-on-metal THA, while audible articulation and rim fracture are reported in ceramic-on-ceramic THA. For this reason, ceramic-on-metal THA was implemented as an ideal hard-on-hard bearing combination. In this report, we describe a case of bilateral simultaneous ceramic-on-metal THA in a 69-year-old woman who presented 7 years postoperatively with unilateral hip pain associated with underlying pseudotumor and elevated serum cobalt and chromium ion levels. Pre-revision workup, intraoperative findings, and postoperative evaluation are included and suggest acetabular malposition as a potential source for complication.
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10
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Schouten R, Malone AA, Frampton CM, Tiffen C, Hooper G. Five-year follow-up of a prospective randomised trial comparing ceramic-on-metal and metal-on-metal bearing surfaces in total hip arthroplasty. Bone Joint J 2017; 99-B:1298-1303. [PMID: 28963150 DOI: 10.1302/0301-620x.99b10.bjj-2016-0905.r1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 04/28/2017] [Indexed: 11/05/2022]
Abstract
AIMS The primary aim of this independent prospective randomised trial was to compare serum metal ion levels for ceramic-on-metal (CoM) and metal-on-metal (MoM) bearing surfaces in total hip arthroplasty (THA). Our one-year results demonstrated elevation in metal ion levels above baseline with no significant difference between the CoM and MoM groups. This paper reviews the five-year data. PATIENTS AND METHODS The implants used in each patient differed only in respect to the type of femoral head (ceramic or metal). At five-year follow-up of the 83 enrolled patients, data from 67 (36 CoM, 31 MoM) was available for comparison. RESULTS The mean serum cobalt (Co) and chromium (Cr) ion levels remained above baseline in both groups (CoM: Co 1.16 μg/l (0.41 to 14.67), Cr 1.05 μg/l (0.16 to 12.58); MoM: Co 2.93 μg/l (0.35 to 30.29), Cr 1.85 μg/l (0.36 to 17.00)) but the increase was significantly less in the CoM cohort (Co difference p = 0.001, Cr difference p = 0.002). These medium-term results, coupled with lower revision rates from national joint registries, suggest that the performance of CoM THA may be superior to that of MoM. CONCLUSION While both bearing combinations have since been withdrawn these results provide useful information for planning clinical surveillance of CoM THAs and warrants continued monitoring. Cite this article: Bone Joint J 2017;99-B:1298-1303.
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Affiliation(s)
- R Schouten
- University of Otago, PO Box 4345, Christchurch, New Zealand
| | - A A Malone
- University of Otago, PO Box 4345, Christchurch, New Zealand
| | - C M Frampton
- University of Otago, PO Box 4345, Christchurch, New Zealand
| | - C Tiffen
- Pacific Radiology, PO Box 130000, Armagh, Christchurch 8141, New Zealand
| | - G Hooper
- University of Otago, PO Box 4345, Christchurch, New Zealand
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Clinical Results and Serum Metal Ion Concentrations following Ceramic-on-Metal Total Hip Arthroplasty at a Mean Follow-Up of 60 Months. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3726029. [PMID: 28373980 PMCID: PMC5360942 DOI: 10.1155/2017/3726029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 02/03/2017] [Accepted: 02/28/2017] [Indexed: 12/14/2022]
Abstract
Background. Increased metal ion levels following total hip arthroplasty (THA) with metal-on-metal bearings are a highly debated topic. Local soft tissue reactions with chronic pain and systemic side effects such as neuropathy are described. The aim of the current study was to determine the serum metal ion concentrations of Cobalt (Co) and Chrome (Cr) after THA with a ceramic-on-metal (CoM) bearing. Patients and Methods. Between 2008 and 2010, 20 patients underwent THA using a CoM bearing. Clinical function was evaluated by standardized scores systems (Harris Hip Score and WOMAC Score) and radiological examination included X-rays. Patient's blood samples were obtained for metal ion analysis and correlation analysis was done between these results and implant position. Results. Overall, 13 patients with 14 CoM devices were available for the current series. The mean age at time of surgery was 61 years (range, 41 to 85). The postoperative follow-up ranged from 49 to 68 months (mean, 58). Metal ion determination showed mean concentrations of 3,1 µg/L (range, 0,3–15,2 µg/L) for Co and 1,6 µg/L (range, 0,1–5,5 µg/L) for Cr, respectively. A correlation between cup anteversion and Co and Cr concentrations was shown. Conclusion. The current series showed increments for Co and Cr following CoM THA. However, these levels are lower compared to metal ion concentrations in patients with metal-on-metal bearings and the international accepted threshold for revision of MoM devices. We recommend routine follow-up including at least one obligatory evaluation of serum metal ion concentrations and an MRI once to exclude local soft tissue reactions.
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Zhu W, Pezzotti G, Boffelli M, Chotanaphuti T, Khuangsirikul S, Sugano N. Chemistry-driven structural alterations in short-term retrieved ceramic-on-metal hip implants: Evidence for in vivo incompatibility between ceramic and metal counterparts. J Biomed Mater Res B Appl Biomater 2016; 105:1469-1480. [PMID: 27087384 DOI: 10.1002/jbm.b.33689] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 03/10/2016] [Accepted: 03/29/2016] [Indexed: 12/11/2022]
Abstract
Ceramic-on-metal (CoM) hip implants were reported to experience lower wear rates in vitro as compared to metal-on-metal (MoM) bearings, thus hinting metal-ion release at lower levels in vivo. In this article, we show a spectroscopic study of two short-term retrieval cases of zirconia-toughened alumina (ZTA) femoral heads belonging to CoM hip prostheses, which instead showed poor wear performances in vivo. Metal contamination and abnormally high fractions of tetragonal-to-monoclinic (t→m) polymorphic transformation of the zirconia phase could be found on both ZTA heads, which contrasted with the optimistic predictions of in vitro experiments. At the molecular scale, incorporation of metal ions into the ceramic lattices could be recognized as due to frictionally assisted phenomena occurring at the ceramic surface. Driven by abnormal friction, diffusion of metal ions induced lattice shrinkage in the zirconia phases, while residual stress fields became stored at the surface of the femoral head. Diffusional alterations destabilized the chemistry of the ceramic surface and resulted in an abnormal increase in t→m phase transformation in vivo. Frictionally driven metal transfer to the ceramic lattice thus hinders the in vivo performance of CoM prostheses. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1469-1480, 2017.
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Affiliation(s)
- Wenliang Zhu
- Department of Medical Engineering for Treatment of Bone and Joint Disorders, Osaka University, Suita, Osaka, 565-0854, Japan
| | - Giuseppe Pezzotti
- Ceramic Physics Laboratory, Kyoto Institute of Technology, Sakyo-ku, Matsugasaki, Kyoto, 606-8585, Japan
| | - Marco Boffelli
- Ceramic Physics Laboratory, Kyoto Institute of Technology, Sakyo-ku, Matsugasaki, Kyoto, 606-8585, Japan
| | - Thanainit Chotanaphuti
- PMK Hip & Knee Surgery, Department of Orthopedics, Phramongkutklao Hospital and College of Medicine, Bangkok, 10330, Thailand
| | - Saradej Khuangsirikul
- PMK Hip & Knee Surgery, Department of Orthopedics, Phramongkutklao Hospital and College of Medicine, Bangkok, 10330, Thailand
| | - Nobuhiko Sugano
- Department of Medical Engineering for Treatment of Bone and Joint Disorders, Osaka University, Suita, Osaka, 565-0854, Japan
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