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Levett JJ, Alatassi R, Huk OL, Antoniou J. Immunoglobulin A Nephropathy in a Patient With Bilateral Metal-on-Metal Hip Arthroplasty. Arthroplast Today 2024; 27:101407. [PMID: 38946922 PMCID: PMC11214374 DOI: 10.1016/j.artd.2024.101407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/21/2024] [Accepted: 04/27/2024] [Indexed: 07/02/2024] Open
Abstract
Immunoglobulin A (IgA) nephropathy in the presence of a metal-on-metal (MoM) hip arthroplasty is a rare condition that requires close monitoring. A 61-year-old male with bilateral hip osteoarthritis underwent resurfacing hip arthroplasty with MoM articulating surfaces. Prior to his four-year postoperative visit, the patient was diagnosed with IgA nephropathy. During this visit, the patient reported clicking in the left resurfacing hip arthroplasty, and serum metal ions were significantly elevated. Consequently, the patient underwent conversion to bilateral ceramic-on-cross-linked polyethylene total hip arthroplasty, which resulted in the restoration of metal ion levels to normal. This case highlights that IgA nephropathy played a critical role in impeding the clearance of metal ions. Routine metal ion counts are warranted in patients with MoM articulating interfaces and a newly diagnosed nephropathy.
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Affiliation(s)
- Jordan J. Levett
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Raheef Alatassi
- Department of Orthopaedic Surgery, London Health Sciences Centre, University Hospital, London, Ontario, Canada
- Division of Orthopedic Surgery, Department of Surgery, King Faisal Specialist Hospital & Research Centre, Jeddah, Saudi Arabia
| | - Olga L. Huk
- Department of Orthopaedic Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - John Antoniou
- Department of Orthopaedic Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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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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Manninen E, Lainiala O, Karsikas M, Reito A, Jämsä P, Eskelinen A. Do cobalt or chromium accumulate in metal-on-metal hip arthroplasty patients who have mild, moderate, or severe renal insufficiency? Bone Joint J 2021; 103-B:1231-1237. [PMID: 34192941 DOI: 10.1302/0301-620x.103b7.bjj-2020-0836.r2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To find out if there is an inverse association between estimated glomerular filtration rate (eGFR) and whole blood cobalt (Co) and chromium (Cr) levels in patients with metal-on-metal (MoM) hip arthroplasties and renal insufficiency, suggesting that renal insufficiency could cause accumulation of Co and Cr in blood. METHODS Out of 2,520 patients with 3,013 MoM hip arthroplasties, we identified 1,244 patients with whole blood Co, Cr, and creatinine measured within no more than a one-year interval. We analyzed the correlation of blood metal ion levels and eGFR to identify a potential trend of accumulating Co or Cr with decreasing eGFR. RESULTS Of the 1,244 patients, 112 had normal renal function (eGFR > 90 ml/min/1.73 m2), 715 had mild renal insufficiency (eGFR 60 to 89), 384 had moderate renal insufficiency (eGFR 30 to 59), 27 had severe renal insufficiency (eGFR 15 to 29), and six had end-stage renal insufficiency (eGFR < 15). Median eGFR was 68 ml/min/1.73 m2 (interquartile range (IQR) 56 to 82), median whole blood Co was 3.3 µg/l (IQR 1.1 to 9.9), and median Cr was 2.0 µg/l (IQR 1.2 to 3.6). We did not observe an association between decreased eGFR and increased whole blood Co and Cr concentrations, but instead both increased Co and Cr were associated with higher eGFR, indicating better kidney function. CONCLUSION As patients with MoM hip arthroplasties get older, the prevalence of renal insufficiency among them will increase, and orthopaedic surgeons will increasingly have to evaluate whether or not this affects patient follow-up. The USA Food and Drug Administration suggests that closer follow-up may be needed for MoM patients with renal insufficiency. We did not observe accumulation of blood Co or Cr in MoM hip arthroplasty patients with mild to severe renal insufficiency. Cite this article: Bone Joint J 2021;103-B(7):1231-1237.
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Affiliation(s)
- Eveliina Manninen
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland
| | - Olli Lainiala
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland.,Department of Radiology, Tampere University Hospital, Tampere, Finland
| | - Mari Karsikas
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland.,Center For Life Course Health Research, University of Oulu, Oulu, Finland
| | - Aleksi Reito
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland
| | - Pyry Jämsä
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland
| | - Antti Eskelinen
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland
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4
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Oyagbemi AA, Akinrinde AS, Adebiyi OE, Jarikre TA, Omobowale TO, Ola-Davies OE, Saba AB, Emikpe BO, Adedapo AA. Luteolin supplementation ameliorates cobalt-induced oxidative stress and inflammation by suppressing NF-кB/Kim-1 signaling in the heart and kidney of rats. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2020; 80:103488. [PMID: 32898663 DOI: 10.1016/j.etap.2020.103488] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 07/02/2020] [Accepted: 09/01/2020] [Indexed: 06/11/2023]
Abstract
Cobalt-induced cardiomyopathy and renal toxicity have been reported in workers in processing plants, hard metal industries, diamond polishing and manufacture of ceramics. This study was designed to investigate the influence of Luteolin supplementation on cobalt-induced cardiac and renal toxicity in rats. Exposure of rats to cobalt chloride (CoCl2) alone caused significant (p < 0.05) increases in cardiac and renal H2O2, malondialdehyde (MDA) and nitric oxide (NO), along with increased serum myeloperoxidase (MPO) activity. In addition, there were significant (p < 0.05) reductions in cardiac and renal glutathione peroxidase (GPx), glutathione S-transferase (GST) and reduced glutathione (GSH). CoCl2 induced higher immuno-staining of nuclear factor kappa beta (NF-κB) in the heart and kidneys, and the kidney injury molecule (Kim-1) in the kidneys. Treatment with Luteolin or Gallic acid produced significant reversal of the oxidative stress parameters with reductions in NF-κB and Kim-1 expressions, leading to suppression of histopathological lesions observed in the tissues.
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Affiliation(s)
- Ademola Adetokunbo Oyagbemi
- Department of Veterinary Physiology and Biochemistry, Faculty of Veterinary Medicine, University of Ibadan, Nigeria
| | - Akinleye Stephen Akinrinde
- Department of Veterinary Physiology and Biochemistry, Faculty of Veterinary Medicine, University of Ibadan, Nigeria.
| | - Olamide Elizabeth Adebiyi
- Department of Veterinary Physiology and Biochemistry, Faculty of Veterinary Medicine, University of Ibadan, Nigeria
| | | | | | - Olufunke Eunice Ola-Davies
- Department of Veterinary Physiology and Biochemistry, Faculty of Veterinary Medicine, University of Ibadan, Nigeria
| | - Adebowale Benard Saba
- Department of Veterinary Pharmacology and Toxicology, Faculty of Veterinary Medicine, University of Ibadan, Nigeria
| | - Benjamin Obukowho Emikpe
- Department of Veterinary Medicine, Faculty of Veterinary Medicine, University of Ibadan, Nigeria
| | - Adeolu Alex Adedapo
- Department of Veterinary Pharmacology and Toxicology, Faculty of Veterinary Medicine, University of Ibadan, Nigeria
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Carulli C, Sani G, Matassi F, Civinini R, Innocenti M. A Mid- to Long-Term Follow-Up Experience with a Specific Metal-on-Metal Total Hip Arthroplasty Design. JOINTS 2020; 7:91-97. [PMID: 34195536 PMCID: PMC8236331 DOI: 10.1055/s-0040-1710388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 04/04/2020] [Indexed: 11/09/2022]
Abstract
Purrpose
Metal-on-metal (MoM) total hip arthroplasty (THA) has been a subject of recent discussion and concern due to the early failures caused by local and systemic adverse reactions related to specific designs. The aim of this study is to analyze the outcomes and survival rates of a single brand of MoM implants implanted in a consecutive series of patients at a single institution.
Methods
Between 2007 and 2012, 116 (118 hips) patients were evaluated at a mean follow-up of 6.6 years after primary THA. The diagnosis leading to surgery was osteoarthritis (80 patients) and proximal femoral fracture (36 patients). A single design of THA was implanted. All patients were evaluated before surgery and postoperatively at 1, 3, 6, and 12 months by clinical scores and radiographic studies. The data analysis was made using Student's
t
-test.
Results
The minimum follow-up was of 4 years, with a mean follow-up of 6.6 years. Two aseptic loosenings of the acetabular component were recorded (one per group), which were not associated with local or systemic complications related to metal ion release. Both were revised by an isolated acetabular cup substitution with metal-on-polyethylene couplings. Nonprogressive radiolucency lines < 2 mm in zone 2 were observed in other six patients around the acetabular component without clinical manifestation (four in the arthritis group and two in the fracture group). Postoperative Harris Hip Score and SF-36 (36-Item Short Form Survey) score improved in both groups.
Conclusion
Despite several MoM implants showing early complications and failures, a specific MoM design may be associated with good clinical results at a mid- to long-term follow-up.
Level of Evidence
This is a therapeutic case series, Level 4 study.
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Affiliation(s)
| | - Giacomo Sani
- Orthopaedic Clinic, University of Florence, Florence, Italy
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Contreras K, Rodriguez D, Bernal-Gutiérrez M, Villamizar JP, Baquero-Galvis R, Arguello-Morales O, Montoya-Cárdenas C, Buitrago G. Incidence of chronic kidney disease in patients undergoing arthroplasty: A systematic review of the literature. Orthop Rev (Pavia) 2019; 11:8157. [PMID: 31897277 PMCID: PMC6912148 DOI: 10.4081/or.2019.8157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 11/03/2019] [Indexed: 11/30/2022] Open
Abstract
Patients undergoing arthroplasty are exposed to different interventions that can lead to renal dysfunction. There is abundant evidence of the incidence and factors associated with acute kidney injury (AKI); however, the incidence and the factors associated with chronic kidney disease (CKD) are not clear. The objective of this study is to determine the incidence and associated factors in arthroplasty patients. A systematic review of the literature was carried out following the recommendations of PRISMA and the Cochrane Collaboration (PROSPERO Protocol CRD42018075929). The search was carried out in Medline, Embase, Cochrane and LILACS. No language or date limits were set. Observational studies were included: cases and controls, and cohorts. The revision of titles and abstracts and the reading of the full texts was performed in a paired manner. The quality of the evidence was evaluated with the Newcastle-Ottawa tool. The initial search found 1279 titles and abstracts. We excluded 115 duplicates, and 1153 in the reading of titles and abstracts. Three articles met the inclusion criteria and were of acceptable quality. The incidence of severe CKD after hip or knee arthroplasty was 1.2% at 1 year up to 6.5% at 9 years. The evidence of the incidence and risk factors associated with CKD in patients undergoing arthroplasty is very scarce and heterogeneous. Further primary studies are required in order to have more valid and trustable results.
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Affiliation(s)
- Kateir Contreras
- Department of Internal Medicine, School of Medicine, Universidad Nacional de Colombia, Bogotá D.C
- Hospital Universitario Nacional de Colombia, Bogotá D.C
| | - Dayany Rodriguez
- Institute of Clinical Research, Department of Surgery, Universidad Nacional de Colombia, Bogotá D.C
- Semillero de Investigación Clínica, School of Medicine, Universidad Nacional de Colombia, Bogotá D.C, Colombia
| | - Marcela Bernal-Gutiérrez
- Institute of Clinical Research, Department of Surgery, Universidad Nacional de Colombia, Bogotá D.C
- Semillero de Investigación Clínica, School of Medicine, Universidad Nacional de Colombia, Bogotá D.C, Colombia
| | - Juan Pedro Villamizar
- Institute of Clinical Research, Department of Surgery, Universidad Nacional de Colombia, Bogotá D.C
- Semillero de Investigación Clínica, School of Medicine, Universidad Nacional de Colombia, Bogotá D.C, Colombia
| | - Romar Baquero-Galvis
- Institute of Clinical Research, Department of Surgery, Universidad Nacional de Colombia, Bogotá D.C
- Semillero de Investigación Clínica, School of Medicine, Universidad Nacional de Colombia, Bogotá D.C, Colombia
| | - Oscar Arguello-Morales
- Institute of Clinical Research, Department of Surgery, Universidad Nacional de Colombia, Bogotá D.C
- Semillero de Investigación Clínica, School of Medicine, Universidad Nacional de Colombia, Bogotá D.C, Colombia
| | - Carlos Montoya-Cárdenas
- Institute of Clinical Research, Department of Surgery, Universidad Nacional de Colombia, Bogotá D.C
- Semillero de Investigación Clínica, School of Medicine, Universidad Nacional de Colombia, Bogotá D.C, Colombia
| | - Giancarlo Buitrago
- Hospital Universitario Nacional de Colombia, Bogotá D.C
- Institute of Clinical Research, Department of Surgery, Universidad Nacional de Colombia, Bogotá D.C
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8
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Lainiala O, Reito A, Jämsä P, Eskelinen A. Mild or moderate renal insufficiency does not increase circulating levels of cobalt and chromium in patients with metal-on-metal hip arthroplasty. Bone Joint J 2017; 99-B:1147-1152. [DOI: 10.1302/0301-620x.99b9.bjj-2016-0773.r2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 05/16/2017] [Indexed: 11/05/2022]
Abstract
Aims To determine whether there is any association between glomerular filtration rate (GFR) and blood cobalt (Co) and chromium (Cr) levels in patients with metal-on-metal (MoM) hip arthroplasty. Patients and Methods We identified 179 patients with a unilateral 36 mm diameter head as part of a stemmed Summit-Pinnacle MoM hip arthroplasty. GFR was calculated using the Modification of Diet in Renal Disease formula. Results Normal renal function (GFR ≥ 90 ml/min/1.73 m2) was seen in 74 patients. Mild renal insufficiency (GFR 60 to 89 ml/min/1.73 m2) was seen in 90 patients and moderate renal insufficiency (GFR 30 to 59 ml/min/1.73 m2) in 15. There was no statistical difference in Co and Cr levels between patients with normal renal function and those with mild or moderate renal insufficiency. No correlation was seen between creatinine and blood metal ion levels or between GFR and blood metal ion levels. Linear regression analysis did not show any association between Co and Cr levels and GFR. Conclusion We did not find any association between GFR and blood metal ion levels. Consequently, the accumulation of Co and Cr in blood due to renal insufficiency does not seem to be a major risk in patients with mild or moderate renal insufficiency. Cite this article Bone Joint J 2017;99-B:1147–52
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Affiliation(s)
- O. Lainiala
- Coxa Hospital for Joint Replacement, Biokatu
6B, 33520 Tampere, Finland
| | - A. Reito
- Coxa Hospital for Joint Replacement, Biokatu
6B, 33520 Tampere, Finland
| | - P. Jämsä
- Coxa Hospital for Joint Replacement, Biokatu
6B, 33520 Tampere, Finland
| | - A. Eskelinen
- Coxa Hospital for Joint Replacement, Biokatu
6B, 33520 Tampere, Finland
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Cip J, Bach C, Widemschek M, Luegmair M, Martin A. Revision of Articular Surface Replacement (ASR) Total Hip Arthroplasty: Correlation of Perioperative Data and Early Post-Revision Outcome Results. J Arthroplasty 2015; 30:1607-17. [PMID: 25956526 DOI: 10.1016/j.arth.2015.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 03/24/2015] [Accepted: 04/06/2015] [Indexed: 02/01/2023] Open
Abstract
The articular surface replacement (ASR) total hip arthroplasty (THA) showed accelerated failure rates due to adverse-reaction to metal debris (ARMD). Literature correlating preoperative with intraoperative revision findings respectively post-revision outcome results are rare. 30 of 99 available ASR THA were revised due to ARMD. Mean post-revision follow-up term was 2.3 years. In part, preoperative data did not correlate with intraoperative revision findings. ARMD was even found in asymptomatic patients with non-elevated ion levels. Postoperative pain and metal ions decreased significantly (P ≤ 0.016). Cobalt decreased faster than chrome. Patients with intraoperative pseudotumors, osteolysis or bilateral THA did not have higher pre- or postoperative ion values (P ≥ 0.053). Females showed higher postoperative chrome levels (P=0.031). One major post-revision complication (femoral nerve palsy) and one re-revision (late onset infection) occurred.
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Affiliation(s)
- Johannes Cip
- Department of Orthopedic Surgery, Academic Teaching Hospital Feldkirch, Medical University of Innsbruck, Feldkirch, Austria
| | - Christian Bach
- Department of Orthopedic Surgery, Academic Teaching Hospital Feldkirch, Medical University of Innsbruck, Feldkirch, Austria
| | - Mark Widemschek
- Department of Orthopedic Surgery, Academic Teaching Hospital Feldkirch, Medical University of Innsbruck, Feldkirch, Austria
| | - Matthias Luegmair
- Department of Orthopedic Surgery, Academic Teaching Hospital Feldkirch, Medical University of Innsbruck, Feldkirch, Austria
| | - Arno Martin
- Department of Orthopedic Surgery, Academic Teaching Hospital Feldkirch, Medical University of Innsbruck, Feldkirch, Austria
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Cobalt to Chromium Ratio is Not a Key Marker for Adverse Local Tissue Reaction (ALTR) in Metal on Metal Hips. J Arthroplasty 2015; 30:107-9. [PMID: 26100470 DOI: 10.1016/j.arth.2015.02.049] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 01/23/2015] [Accepted: 02/11/2015] [Indexed: 02/01/2023] Open
Abstract
The diagnosis of adverse local tissue reaction (ALTR) after metal-on-metal total hip arthroplasty (MoMTHA) presents a significant challenge. No single biomarker is specific for ALTR. The purpose of this study was to determine if the ratio of cobalt to chromium ions is useful for diagnosing ALTR in MoMTHA. In 89 bearing-related revision THAs, preoperative cobalt and chromium ion levels were compared to an intraoperative soft tissue damage grading scale. The average cobalt to chromium ratio was 2.96 (0-20). There was no correlation between the tissue scale and the cobalt to chromium ratio (R=0.095; P=0.41). Many variables affecting ion production/excretion mitigate the use of the ion ratio. The cobalt to chromium ratio is not a predictive biomarker for ALTR in MoMTHA.
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Stiehler M, Zobel F, Hannemann F, Schmitt J, Lützner J, Kirschner S, Günther KP, Hartmann A. [Complications of metal-on-metal tribological pairing]. DER ORTHOPADE 2014; 43:79-91. [PMID: 24356820 DOI: 10.1007/s00132-013-2131-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Metal-on-metal (MoM) tribological pairing results in less volumetric abrasion than pairing with the conventionally used polyethylene and is associated with a lower risk of material failure compared to other hard-hard pairings. An increased frequency of problem cases in recent years has led to a great increase in uncertainty. Against this background in this article the current aspects of epidemiology, etiology, diagnostics and treatment of complications in MoM hip joint endoprostheses will be discussed. EPIDEMIOLOGY AND ETIOLOGY Based on the results from national endoprosthesis registers and selected clinical studies an evaluation of the rate of local complications from MoM tribological pairings was undertaken. A differentiation was made between MoM pairings in pedicled small head prostheses (≤ 32 mm), large head (> 32 mm) and surface replacement (OFE) endoprostheses. Each year MoM endoprostheses release on average 10(12)-10(14) cobalt (Co) and chromium (Cr) nanoparticles per patient. This release of metal ions and particles can lead to a variety of tissue reactions. DIAGNOSTICS A differentiation must be made between regular routine diagnostics within the framework of implant follow-up screening and specific investigations due to the occurrence of complaints. The diagnostics for patients treated with MoM hip endoprostheses consists of a standardized step-wise approach considering possible differential diagnoses and the utilization of modern laboratory chemical and radiological methods. When problems occur, a differentiation should preferentially be made between complaints not caused by metal and mechanical problems (e.g. prosthesis loosening and impingement) and symptoms due to periprosthetic infections. THERAPY OF COMPLICATIONS The normal standards for hip endoprosthetics are also valid for periprosthetic infections, fractures and other general complications. Specific measures are, however, necessary for complications due to metal-specific risks.
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Affiliation(s)
- M Stiehler
- UniversitätsCentrum für Orthopädie und Unfallchirurgie, Klinik für Orthopädie, Universitätsklinikum Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
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Lass R, Grübl A, Kolb A, Stelzeneder D, Pilger A, Kubista B, Giurea A, Windhager R. Comparison of synovial fluid, urine, and serum ion levels in metal-on-metal total hip arthroplasty at a minimum follow-up of 18 years. J Orthop Res 2014; 32:1234-40. [PMID: 24841922 DOI: 10.1002/jor.22652] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 05/02/2014] [Indexed: 02/04/2023]
Abstract
Diagnosis of adverse reactions to metal debris in metal-on-metal hip arthroplasty is a multifactorial process. Systemic ion levels are just one factor in the evaluation and should not be relied upon solely to determine the need for revision surgery. Furthermore, the correlation between cobalt or chromium serum, urine, or synovial fluid levels and adverse local tissue reactions is still incompletely understood. The hypothesis was that elevated serum and urine metal-ion concentrations are associated with elevated local metal-ion concentrations in primary total hip arthroplasties (THA) and with failure of metal-on-metal articulations in the long-term. In our present study, we evaluated these concentrations in 105 cementless THA with metal-on-metal articulating surfaces with small head diameter at a minimum of 18 years postoperatively. Spearman correlation showed a high correlation between the joint fluid aspirate concentration of cobalt and chromium with the serum cobalt (r = 0.81) and chromium level (r = 0.77) in patients with the THA as the only source of metal-ions. In these patients serum metal-ion analysis is a valuable method for screening. In patients with more than one source of metal or renal insufficiency additional investigations, like joint aspirations are an important tool for evaluation of wear and adverse tissue reactions in metal-on-metal THA.
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Affiliation(s)
- Richard Lass
- Department of Orthopaedics, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria
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Durrani SK, Noble PC, Sampson B, Panetta T, Liddle AD, Sabah SA, Chan NK, Skinner JA, Hart AJ. Changes in blood ion levels after removal of metal-on-metal hip replacements: 16 patients followed for 0-12 months. Acta Orthop 2014; 85:259-65. [PMID: 24758321 PMCID: PMC4062792 DOI: 10.3109/17453674.2014.913223] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE In patients with metal-on-metal (MoM) hip prostheses, pain and joint effusions may be associated with elevated blood levels of cobalt and chromium ions. Since little is known about the kinetics of metal ion clearance from the body and the rate of resolution of elevated blood ion levels, we examined the time course of cobalt and chromium ion levels after revision of MoM hip replacements. PATIENTS AND METHODS We included 16 patients (13 female) who underwent revision of a painful MoM hip (large diameter, modern bearing) without fracture or infection, and who had a minimum of 4 blood metal ion measurements over an average period of 6.1 (0-12) months after revision. RESULTS Average blood ion concentrations at the time of revision were 22 ppb for chromium and 43 ppb for cobalt. The change in ion levels after revision surgery varied extensively between patients. In many cases, over the second and third months after revision surgery ion levels decreased to 50% of the values measured at revision. Decay of chromium levels occurred more slowly than decay of cobalt levels, with a 9% lag in return to normal levels. The rate of decay of both metals followed second-order (exponential) kinetics more closely than first-order (linear) kinetics. INTERPRETATION The elimination of cobalt and chromium from the blood of patients who have undergone revision of painful MoM hip arthroplasties follows an exponential decay curve with a half-life of approximately 50 days. Elevated blood levels of cobalt and chromium ions can persist for at least 1 year after revision, especially in patients with high levels of exposure.
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Affiliation(s)
| | - Philip C Noble
- Institute of Orthopedic Research and Education,Baylor College of Medicine, Houston, TX, USA
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Hartmann A, Hannemann F, Lützner J, Seidler A, Drexler H, Günther KP, Schmitt J. 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:e70359. [PMID: 23950923 PMCID: PMC3737219 DOI: 10.1371/journal.pone.0070359] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 06/16/2013] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION The use of metal-on-metal (MoM) total hip arthroplasty (THA) increased in the last decades. A release of metal products (i.e. particles, ions, metallo-organic compounds) in these implants may cause local and/or systemic adverse reactions. Metal ion concentrations in body fluids are surrogate measures of metal exposure. OBJECTIVE To systematically summarize and critically appraise published studies concerning metal ion concentrations after MoM THA. METHODS Systematic review of clinical trials (RCTs) and epidemiological studies with assessment of metal ion levels (cobalt, chromium, titanium, nickel, molybdenum) in body fluids after implantation of metalliferous hip replacements. Systematic search in PubMed and Embase in January 2012 supplemented by hand search. Standardized abstraction of pre- and postoperative metal ion concentrations stratified by type of bearing (primary explanatory factor), patient characteristics as well as study quality characteristics (secondary explanatory factors). RESULTS Overall, 104 studies (11 RCTs, 93 epidemiological studies) totaling 9.957 patients with measurement of metal ions in body fluids were identified and analyzed. Consistently, median metal ion concentrations were persistently elevated after implantation of MoM-bearings in all investigated mediums (whole blood, serum, plasma, erythrocytes, urine) irrespective of patient characteristics and study characteristics. In several studies very high serum cobalt concentrations above 50 µg/L were measured (detection limit typically 0.3 µg/L). Highest metal ion concentrations were observed after treatment with stemmed large-head MoM-implants and hip resurfacing arthroplasty. DISCUSSION Due to the risk of local and systemic accumulation of metallic products after treatment with MoM-bearing, risk and benefits should be carefully balanced preoperatively. The authors support a proposed "time out" for stemmed large-head MoM-THA and recommend a restricted indication for hip resurfacing arthroplasty. Patients with implanted MoM-bearing should receive regular and standardized monitoring of metal ion concentrations. Further research is indicated especially with regard to potential systemic reactions due to accumulation of metal products.
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Affiliation(s)
- Albrecht Hartmann
- University Hospital Carl Gustav Carus Dresden, University Centre for Orthopaedics and Trauma Surgery, Dresden, Germany
| | - Franziska Hannemann
- University Hospital Carl Gustav Carus Dresden, University Centre for Orthopaedics and Trauma Surgery, Dresden, Germany
- University Hospital Carl Gustav Carus Dresden, Centre for Evidence-Based Health Care, Dresden, Germany
| | - Jörg Lützner
- University Hospital Carl Gustav Carus Dresden, University Centre for Orthopaedics and Trauma Surgery, Dresden, Germany
| | - Andreas Seidler
- Dresden University of Technology, Occupational and Social Medicine, Dresden, Germany
| | - Hans Drexler
- University Erlangen-Nuremberg, Occupational, Social and Environmental Medicine, Erlangen, Germany
| | - Klaus-Peter Günther
- University Hospital Carl Gustav Carus Dresden, University Centre for Orthopaedics and Trauma Surgery, Dresden, Germany
| | - Jochen Schmitt
- University Hospital Carl Gustav Carus Dresden, Centre for Evidence-Based Health Care, Dresden, Germany
- Dresden University of Technology, Occupational and Social Medicine, Dresden, Germany
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In-vitro-Analyse des Einflusses von Metallionen auf humane Lymphozyten. DER ORTHOPADE 2013; 42:643-50. [DOI: 10.1007/s00132-012-2039-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Zhou Y, Sun C, Wang Y. New Method Addressing the Problem of Using Ceramic-on-Ceramic Bearing in Too Small Acetabulum of High-Riding DDH Patients with THA. ACTA ACUST UNITED AC 2012. [DOI: 10.1053/j.sart.2012.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bal BS, Rahaman MN. Orthopedic applications of silicon nitride ceramics. Acta Biomater 2012; 8:2889-98. [PMID: 22542731 DOI: 10.1016/j.actbio.2012.04.031] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 04/18/2012] [Accepted: 04/19/2012] [Indexed: 11/29/2022]
Abstract
Silicon nitride (Si(3)N(4)) is a ceramic material developed for industrial applications that demand high strength and fracture resistance under extreme operating conditions. Recently, Si(3)N(4) has been used as an orthopedic biomaterial, to promote bone fusion in spinal surgery and to develop bearings that can improve the wear and longevity of prosthetic hip and knee joints. Si(3)N(4) has been implanted in human patients for over 3 years now, and clinical trials with Si(3)N(4) femoral heads in prosthetic hip replacement are contemplated. This review will provide background information and data relating to Si(3)N(4) ceramics that will be of interest to engineering and medical professionals.
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Affiliation(s)
- B S Bal
- Department of Orthopaedic Surgery, School of Medicine, University of Missouri, Columbia, MO 65211, USA.
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Qu X, Huang X, Dai K. Metal-on-metal or metal-on-polyethylene for total hip arthroplasty: a meta-analysis of prospective randomized studies. Arch Orthop Trauma Surg 2011; 131:1573-83. [PMID: 21643799 DOI: 10.1007/s00402-011-1325-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND There has been recent concern regarding the increased use of metal-on-metal total hip arthroplasty (MOM-THA) as an alternative to contemporary metal-on-polyethylene total hip arthroplasty (MOP-THA), and the choice remains controversial. We performed a meta-analysis to evaluate and compare metal ion concentrations, complications, reoperation rates, clinical outcomes and radiographic outcomes of MOM-THA and MOP-THA. METHODS We performed a systematic review of English and non-English articles identified from MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, PreMEDLINE and HealthSTAR. Metal ion concentrations, complications, reoperation rates and other outcomes of MOM bearings were compared with MOP bearings in THA based on relative risks, mean differences and standardized mean difference statistics. RESULTS Eight prospective randomized trials were identified from 1,075 citations. Our results demonstrated significantly elevated erythrocyte, serum and urine levels of metal ions (cobalt and chromium) among patients who received MOM-THA. No significant differences in titanium concentrations or total complication or reoperation rates were found between MOM-THA and MOP-THA. Clinical function scores and radiographic evaluations were similar between the two groups. CONCLUSIONS This analysis found insufficient evidence to identify any clinical advantage of MOM-THA compared with MOP-THA. Although cobalt and chromium concentrations were elevated after MOM-THA, there were no significant differences in total complication rates (including all-case mortality) between the two groups in the short- to mid-term follow-up period. The MOM bearing option for THA should be used with caution.
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Affiliation(s)
- Xinhua Qu
- Shanghai Key Laboratory of Orthopaedic Implant, Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, People's Republic of China
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