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Fa-Binefa M, Rojas-Sayol R, Peiró A, Trullols L, Machado P, Gracia I. Metal Ion Release in Cancer Patients Following Megaprosthesis Salvage Surgery. J Arthroplasty 2024; 39:2336-2340. [PMID: 38640965 DOI: 10.1016/j.arth.2024.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Megaprostheses contain many more modular components than conventional total hip and knee arthroplasty, which may lead to higher serum levels of metal ions. The aim of this study was to determine serum concentrations of titanium, chromium, and cobalt ions in cancer patients after limb salvage surgery with a megaprosthesis. METHODS A retrospective, descriptive cohort analysis consisting of patients who underwent cancer-related limb salvage surgery with a megaprosthesis at our hospital between 2010 and 2020 was conducted. Baseline and follow-up data were extracted from clinical and surgical records. Blood samples were prospectively obtained. Descriptive statistics were used for the analysis. RESULTS A total of 71 patients underwent limb salvage surgery during the study period. Of these, 22 (10 women, 12 men) were included in the study. The mean age was 52 years (range, 21 to 80). Most cases (n = 16; 72.7%) involved the femur. Most patients (n = 14, 63.6%) underwent total knee megaprosthesis surgery. Implant revision surgery was required in 45% of cases (n = 10), with a mean interval of 4.32 years between the initial and revision surgeries. The mean follow-up time after revision surgery was 4.05 years. High levels of chromium were observed in 22.7% of patients (n = 5). High cobalt levels were found in 68.2% (n = 15) of patients, with toxic levels in 9.1% (n = 2). Titanium levels were high in 77.3% (n = 17) of cases and toxic in 22.7% (n = 5). Postoperative chemotherapy was significantly associated with titanium levels (P = .017). No correlation was observed between metal ion levels and time from primary or revision surgery or time from the first to revision surgery. CONCLUSIONS This study shows that cancer-related limb salvage surgery with megaprosthesis is associated with metal ion levels that exceed established safe thresholds. Compared to conventional hip arthroplasty, a higher proportion of the patients in this cohort presented elevated levels of metal ions. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Manel Fa-Binefa
- Orthopaedic Surgery Department, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain; Oncology Orthopaedic Surgery Unit, Orthopaedic Surgery Department, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute IIB Sant Pau, Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Roger Rojas-Sayol
- Septic Surgery Unit, Orthopaedic Surgery Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Ana Peiró
- Orthopaedic Surgery Department, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain; Oncology Orthopaedic Surgery Unit, Orthopaedic Surgery Department, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute IIB Sant Pau, Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laura Trullols
- Orthopaedic Surgery Department, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain; Oncology Orthopaedic Surgery Unit, Orthopaedic Surgery Department, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute IIB Sant Pau, Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pau Machado
- Orthopaedic Surgery Department, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain; Oncology Orthopaedic Surgery Unit, Orthopaedic Surgery Department, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute IIB Sant Pau, Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Isidro Gracia
- Orthopaedic Surgery Department, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain; Oncology Orthopaedic Surgery Unit, Orthopaedic Surgery Department, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute IIB Sant Pau, Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
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Roh YH, Kang T, Lim C, Nam KW. METAL ION RELEASE ACCORDING TO LEG LENGTH DISCREPANCY IN CERAMIC-ON-METAL HIP ARTHROPLASTY. ACTA ORTOPEDICA BRASILEIRA 2023; 31:e265272. [PMID: 37323157 PMCID: PMC10263412 DOI: 10.1590/1413-785220233102e265272] [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: 05/24/2022] [Accepted: 07/19/2022] [Indexed: 06/17/2023]
Abstract
Objective The ceramic-on-metal (CoM) bearing has the theoretical advantages over ceramic-on-ceramic (CoC) and metal-on-metal bearings. This study aimed to analyze factors affecting the metal ion release of CoM bearings and compare clinical performance with CoC bearings. Methods The 147 patients were divided into 96 patients in group 1 (CoM group) and 51 patients in group 2 (CoC group). Additionally, within group1, 48 patients and 30 patients were sub-categorized into group 1-A with leg length discrepancy (LLD) less than 1cm and group 1-B greater than 1 cm. The level of serum metal ions, functional scores and plain radiographs were obtained for the analysis. Results The level of cobalt (Co) 2-years after surgery and chromium (Cr) 1-year after surgery showed significantly higher in the group1 than the group2. LLD indicated statistically significant positive correlation between serum metal ion levels among CoM bearing THAs. In comparison of the average metal ions level changes, group 1-B showed higher level of metal ion than group 1-A. Conclusion In patients underwent THA with CoM bearings, large LLD have a higher risk of complications associated to metal ions. Therefore, it is critical to reduce the LLD to 1 cm or less in using CoM bearing. Level of Evidence III; Case Control Study.
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Affiliation(s)
- Young-Ho Roh
- . Jeju National University Hospital, Department of Orthopaedic Surgery, 15 Aran 13-gil, Jeju-si, Jeju-do, South Korea
| | - Taehan Kang
- . Jeju National University Hospital, Department of Orthopaedic Surgery, 15 Aran 13-gil, Jeju-si, Jeju-do, South Korea
| | - Chaemoon Lim
- . Jeju National University Hospital, Department of Orthopaedic Surgery, 15 Aran 13-gil, Jeju-si, Jeju-do, South Korea
| | - Kwang Woo Nam
- Eulji University School of Medicine, Department of Orthopaedic Surgery, Uijeongbu Eulji University Hospital, Uijeongbu-si, Gyeonggi-do, South Korea
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Luo Q, Zhang H, Wang H, Ma L, Huang M, Niu J, Luo B, Yan J, Li X. The Effects of Lead and Cadmium Co-exposure on Serum Ions in Residents Living Near a Mining and Smelting Area in Northwest China. Biol Trace Elem Res 2022; 200:3932-3940. [PMID: 34713392 DOI: 10.1007/s12011-021-02991-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/23/2021] [Indexed: 10/20/2022]
Abstract
In this study, we investigated the associations between cadmium (Cd) and lead (Pb) co-exposure, and serum ion levels in two populations living near a mining/smelting area and a nature reserve (control area), respectively. A total of 445 participants were included in this study. Their blood cadmium (BCd), blood lead (BPb), and serum ion levels were determined, and the association between exposure levels and serum ion levels was analyzed. The exposure levels of subjects living in the polluted area were significantly higher (p < 0.001). Lower levels of potassium, inorganic phosphorus, and iron were observed in subjects from the polluted area, whereas their sodium and chloride levels were higher (p < 0.01). The anion gap in their serum was also significantly lower. We observed positive dose-effect relationships between Cd and/or Pb exposure and serum sodium and chloride, and negative dose-effect relationships between Cd and/or Pb exposure and serum inorganic phosphorus, iron, as well as the anion gap. High Cd-Pb, high Cd, and high Pb exposure led to modification effects in potassium, calcium, inorganic phosphorus, and iron levels, and the anion gap. No synergistic effects were observed in our results. In conclusion, our data demonstrate that Cd and Pb exposure, alone or in combination, can lead to serum ion imbalances.
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Affiliation(s)
- Qian Luo
- The First School of Clinical Medical, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
| | - Honglong Zhang
- The First School of Clinical Medical, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
| | - Haiping Wang
- The First School of Clinical Medical, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
- Key Laboratory of Biotherapy and Regenerative Medicine of Gansu Province, Lanzhou, 730000, Gansu, People's Republic of China
| | - Li Ma
- The First School of Clinical Medical, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
| | - Min Huang
- The First School of Clinical Medical, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
| | - Jingping Niu
- Institute of Occupational and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
| | - Bin Luo
- Institute of Occupational and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
| | - Jun Yan
- The First School of Clinical Medical, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China.
- Key Laboratory of Biotherapy and Regenerative Medicine of Gansu Province, Lanzhou, 730000, Gansu, People's Republic of China.
- Department of General Surgery, The First Hospital of Lanzhou University, No.1 Donggang West Road, Chengguan District, Lanzhou, 730000, Gansu, People's Republic of China.
| | - Xun Li
- The First School of Clinical Medical, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
- Key Laboratory of Biotherapy and Regenerative Medicine of Gansu Province, Lanzhou, 730000, Gansu, People's Republic of China
- Department of General Surgery, The First Hospital of Lanzhou University, No.1 Donggang West Road, Chengguan District, Lanzhou, 730000, Gansu, People's Republic of China
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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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Dover C, Kuiper JH, Craig P, Shaylor P. Ten years on: increased metal ion levels in a cohort of patients who underwent uncemented metal-on-polyethylene total hip arthroplasty. Bone Joint J 2020; 102-B:832-837. [DOI: 10.1302/0301-620x.102b7.bjj-2019-1372.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims We have previously demonstrated raised cobalt and chromium levels in patients with larger diameter femoral heads, following metal-on-polyethylene uncemented total hip arthroplasty. Further data have been collected, to see whether these associations have altered with time and to determine the long-term implications for these patients and our practice. Methods Patients from our previous study who underwent Trident-Accolade primary total hip arthroplasties using a metal-on-polyethylene bearing in 2009 were reviewed. Patients were invited to have their cobalt and chromium levels retested, and were provided an Oxford Hip Score. Serum ion levels were then compared between groups (28 mm, 36 mm, and 40 mm heads) and over time. Results Metal ion levels were repeated in 33 patients. When comparing the results of serum metal ion levels over time, regardless of head size, there was a significant increase in both cobalt and chromium levels (p < 0.001). Two patients with larger head sizes had undergone revision arthroplasty with evidence of trunnion damage at surgery. Two patients within the 40 mm subgroup had metal ion levels above the MHRA (Medicines and Healthcare Products Regulatory Agency) threshold for detailed investigation. The increase in cobalt and chromium, when comparing the 36 mm and 40 mm groups with those of the 28 mm group, was not significant (36 mm vs 28 mm; p = 0.092/p = 0.191; 40 mm vs 28 mm; p = 0.200/p = 0.091, respectively). There was no difference, between femoral head sizes, when comparing outcome as measured by the Oxford Hip Score. Conclusion This study shows an increase in cobalt and chromium levels over time for all modular femoral head sizes in patients with metal-on-polyethylene bearings, with two patients demonstrating ion levels above the MHRA threshold for failure, and a further two patients requiring revision surgery. These results may have clinical implications regarding longer term follow-up of patients and future implant choice, particularly among younger patients. Cite this article: Bone Joint J 2020;102-B(7):832–837.
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Affiliation(s)
- Caroline Dover
- The Robert Jones and Agnes Hunt Orthopaedic Hospital, UK
- University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Oswestry, UK
| | - Jan Herman Kuiper
- The Robert Jones and Agnes Hunt Orthopaedic Hospital, UK
- School of Pharmacy and Bioengineering, Keele University, Keele, UK
| | - Peter Craig
- The Holland Orthopaedic and Arthritic Centre, University of Toronto, Toronto, Canada
| | - Phillip Shaylor
- University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Oswestry, UK
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Shon WY, Park BY, R RN, Park PS, Im JT, Yun HH. Total Hip Arthroplasty: Past, Present, and Future. What Has Been Achieved? Hip Pelvis 2019; 31:179-189. [PMID: 31824872 PMCID: PMC6892902 DOI: 10.5371/hp.2019.31.4.179] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/03/2019] [Accepted: 09/16/2019] [Indexed: 01/27/2023] Open
Abstract
In the 1960s, Sir John Charnley introduced to clinical practice his concept of low-friction total hip arthroplasty (THA). Although early designs were plagued by poor performance and even failure, there have been steady advances in implant designs, biomaterials, surgical techniques and an understanding of the biomechanical restoration of the hip; these advances have contributed to improvements in implant survival and clinical outcomes of THA in the past three decades. With improved wear resistance and mechanical reliability, a potential to last for at least 25 to 30 years are now available for THA. In this review, we focus on the evolution of THA and review current controversies and future directions of this procedure based on a single surgeon's 29-year of experience at a single institution.
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Affiliation(s)
- Won Yong Shon
- Department of Orthopedic Surgery, Bumin Hospital, Busan, Korea
| | | | - Rajsankar N R
- Department of Orthopedic Surgery, Bumin Hospital, Busan, Korea
| | - Phil Sun Park
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Jung Taek Im
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Ho Hyun Yun
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
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[Total hip arthroplasty in young patients : Bearings and custom-made prostheses]. DER ORTHOPADE 2019; 48:292-299. [PMID: 30737518 DOI: 10.1007/s00132-019-03692-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Carefully and correctly implanted components are the prerequisite for the lifespan of a prosthesis. Whether higher levels of activity lead to prior failure of total hip arthroplasty in young patients is controversially discussed. The right choice of bearings is still of great relevance. BEARINGS Ceramic-on-ceramic as well as polyethylene-on-ceramic bearings achieve comparable results, although ceramic-on-ceramic bearings should be avoided in patients with high demands on their range of motion. Polyethylene-on-metal bearings also show good clinical results, if corrosion between head and stem is absent. Metal-on-metal bearings lead to adverse systemic effects due to metal wear and should be implanted in individual cases only, e. g. as hip resurfacing. Alternative bearings have to give proof of effectivity first. Custom-made prostheses constitute an option for young patients with special conditions of hip anatomy. Planning and study results of these prostheses are elucidated in this review article.
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