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Wan Y, You J, Jiang W, Wang P, Xia Q. Metal ion levels after metal-on-metal hip resurfacing: A single-center longitudinal study of Chinese patients. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2024; 58:196-202. [PMID: 39320036 PMCID: PMC11448754 DOI: 10.5152/j.aott.2024.23096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2024]
Abstract
This study aimed to investigate the long-term serum metal ion levels of patients who received metal-on-metal hip resurfacing arthroplasty (MoM HRA). We conducted a retrospective study of 99 patients (110 hips) from March 2006 to May 2017 who underwent MoM HRA. The Harris Hip Score (HHS) and the University of California at Los Angeles (UCLA) activity score were measured, and the patients underwent clinical and radiological management. Serum levels of cobalt (Co), chromium (Cr), and molybdenum (Mo) were measured using inductively coupled plasma mass spectrometry (ICPMS) at 1, 6, and 12 months, and each year follow-up after prosthesis implantation. Patients were followed up from 1 to 156 months, with a mean of 98 months. No complications occurred. Metal ion analysis revealed significantly elevated levels compared to preoperative levels. The metal ions levels increased and reached a peak after surgery, and then the levels began to decline gradually. Approximately 84-108 months after surgery, the metal ion levels increased again to approximately peak levels. Then, up to 156 months after surgery, the metal ions levels will drop approximately to preoperative levels. The serum levels of Cr in women were higher than those in men, with the difference being statistically significant. Patients with a body mass index (BMI) of ≥24.9 kg/m2 Co levels were significantly higher than those of normal-weight patients. The serum levels of metal ions showed no significant differences between the prostheses. The use of the MoM HRA was clinically effective, and the Co, Cr, and Mo levels increased significantly after HRA; however, upon long-term follow-up, serum metal ion levels tended to decrease to preoperative levels. Longer follow-up periods and larger study samples are needed to establish the long-term outcome of patients undergoing HRA with MoM bearings. Level IV, Therapeutic Study.
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Affiliation(s)
- Yanlin Wan
- Department of Orthopedics, Tianjin First Central Hospital, Tianjin, China
| | - Jia You
- Department of Orthopedics, Tianjin First Central Hospital, Tianjin, China
| | - Wenxue Jiang
- The Third People's Hospital of Shenzhen, Guangdong, China
| | - Pengfei Wang
- Department of Orthopedics, Tianjin First Central Hospital, Tianjin, China
| | - Qun Xia
- Department of Orthopedics, Tianjin First Central Hospital, Tianjin, China
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Min M, Xing C, Xu P, Wei X, Fan L. Case report: Formation and recurrence of inflammatory pseudotumor after metal-on-metal hip arthroplasty. Front Med (Lausanne) 2024; 11:1422230. [PMID: 39055697 PMCID: PMC11269118 DOI: 10.3389/fmed.2024.1422230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 06/17/2024] [Indexed: 07/27/2024] Open
Abstract
The metal-on-metal (MoM) artificial hip joint is a prosthesis used in early hip arthroplasty, particularly for hip resurfacing and total hip arthroplasty. However, abrasion and corrosion of MoM bearings result in the production of metal ions, such as cobalt and chromium, thereby inducing several complications such as inflammatory pseudotumor, aseptic inflammation, and allergy to metal ions (delayed type IV hypersensitivity). In this case report, we present a patient who was hospitalized for recurrence of a mass in the right inguinal area. In 2010, the patient underwent right MoM total hip arthroplasty for right femoral head necrosis and exhibited a good postoperative recovery. In 2019, the patient experienced pain in the right hip with activity limitation without any evident triggers, and a palpable mass was observed in the right inguinal area. A large periprosthetic mass was resected under general anesthesia, and the patient recovered well after the operation. Based on post-surgery imaging and pathological examinations, the mass was diagnosed as a periprosthetic inflammatory pseudotumor. In 2021, the inflammatory pseudotumor recurred at the same site. He then underwent right total hip revision surgery under epidural anesthesia and recovered well after surgery. No recurrence was noted at moderate follow-up. The incidence of inflammatory pseudotumors is high in MoM hip arthroplasty. Early revision is necessary in patients who meet the indications for revision, while regular postoperative follow-up is crucial.
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Affiliation(s)
| | | | | | | | - Lei Fan
- Department of Orthopedics, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Abdel Hamid OI, Attia ME, Hirshon JM, El-Shinawi M, El-Hussaini M, El-Setouhy M. Psychiatric Disorders and Genotoxicity Following Primary Metal on Polyethylene Total Hip Arthroplasty and Their Correlation to Cobalt/Chromium Levels. Drug Healthc Patient Saf 2022; 14:97-111. [PMID: 35880007 PMCID: PMC9308046 DOI: 10.2147/dhps.s360643] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 07/04/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Hip arthroplasty (HA) using implantable metal components is among the commonest orthopedic interventions. However, it can be followed by several complications following corrosion and the release of metal ions. Several studies proved that damaged genomic DNA may contribute to the pathophysiology of mental disorders. Aim The current work aims to evaluate the psychiatric disorders in metal on polyethylene hip arthroplasty (MOP-HA) patients and its correlation to cobalt/chromium (Co/Cr) levels and genotoxicity. Methods The work was a longitudinal follow-up study including 34 adults with unilateral primary MOP-HA meeting the inclusion and exclusion criteria. Preoperatively, 6, 12-months-postoperatively, patients were examined for cognitive impairment using mini-mental-state-examination (MMSE), depression using major-depressive-inventory (MDI), and blood samples were collected for estimation of Co/Cr, detection of genotoxicity by single-cell-gel-electrophoresis (comet assay) and serum 8-hydroxy-2'-deoxyguanosine (8-OHdG). Results Cognitive impairment was reported in 18.5% and 14.8% at 6-months, and 12-months postoperative, respectively. Depressive disorder was recorded in 22.2% at 6-months and 14.8% at 12-months postoperative. The marginal homogeneity tests proved a non-significant difference. There was a non-significant difference in preoperative, 6-months, 12-months postoperative MMSE, and MDI scores. There were significantly increased Co/Cr levels at 6-months postoperative. The levels decreased at 12-months postoperative, however, still significantly higher than preoperative values. There was a significant increase in serum 8-OHdG and the levels were positively correlated to cobalt levels at both 6 and 12-months-postoperative. There was a non-significant difference among preoperative, 6-months, and 12-months postoperative comet assay measurements. Conclusion From previous findings, we can conclude that will-functioning MOP hip arthroplasty can induce increased ion levels and positively correlated increase in biochemical markers of genotoxicity (8-OHdG).
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Affiliation(s)
- Omaima I Abdel Hamid
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed E Attia
- Orthopedics Departments, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Jon M Hirshon
- Department of Emergency Medicine, University of Maryland, School of Medicine, Baltimore, MD, USA
- Department of Epidemiology and Public Health, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Mohamed El-Shinawi
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Galala University, Galala City, Suez, Egypt
| | - Moustafa El-Hussaini
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Maged El-Setouhy
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Department of Family and Community Medicine, Faculty of Medince, Jazan University, Jazan, Kingdom of Saudi Arabia
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Ray GS, Laaksonen I, Galea VP, Madanat R, Muratoglu O, Malchau H. Obesity is not associated with hip failure in patients with articular surface replacement of the hip. Hip Int 2020; 30:78-86. [PMID: 30821180 DOI: 10.1177/1120700019828705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Our main aim was to investigate whether obese patients were at increased risk of elevated metal ion levels and/or adverse local tissue reaction (ALTR) after being treated with articular surface replacement (ASR) hip arthroplasty. METHODS This study included 360 patients who underwent metal-on-metal (MoM) hip resurfacing (HRA) or total hip arthroplasty (THA). 95 patients (26%) were underweight/normal weight (BMI < 25 kg/m2), 139 (39%) were overweight (BMI 25-30 kg/m2), and 126 (36%) were obese (BMI ⩾ 30 kg/m2). Blood metal ion levels and patient-reported outcome measures (PROMs) were obtained, and a sub-cohort of 85 patients had MARS MRI performed. Logistic regression analyses were used to assess the associations between obesity and metal ions, as well as ALTR. RESULTS BMI was not associated with either elevated metal ion levels or ALTR. In HRA patients, female gender (OR 3.0; p = 0.019) and pain (OR 2.3; p = 0.046) were associated with elevated Co levels. Female patients had increased risk of elevated Cr levels (OR 3.0; p = 0.02). In THA patients, female gender (OR 2.2; p = 0.004) and VAS satisfaction (OR 2.1; p = 0.01) were associated with elevated Co levels. Female gender (OR 3.6; p = 0.001) and time from surgery (OR 1.4; p = 0.005) were associated with Cr levels. In the sub-cohort, ALTR was associated with Co levels (OR 16.1; p = 0.002) in HRA patients. CONCLUSION Patients with BMI ⩾ 30 kg/m2 present no increased risk for elevated metal ion levels or development of ALTR.
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Affiliation(s)
- Gabrielle S Ray
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA
| | - Inari Laaksonen
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA
| | - Vincent P Galea
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA
| | - Rami Madanat
- Harvard Medical School, Department of Orthopaedic Surgery, Boston, MA, USA
| | - Orhun Muratoglu
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Department of Orthopaedic Surgery, Boston, MA, USA
| | - Henrik Malchau
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Department of Orthopaedic Surgery, Boston, MA, USA
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Uchihara Y, Grammatopoulos G, Munemoto M, Matharu G, Inagaki Y, Pandit H, Tanaka Y, Athanasou NA. Implant failure in bilateral metal-on-metal hip resurfacing arthroplasties: a clinical and pathological study. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2018; 29:28. [PMID: 29516273 PMCID: PMC5842269 DOI: 10.1007/s10856-018-6037-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 02/22/2018] [Indexed: 06/13/2023]
Abstract
Metal-on-metal hip resurfacing arthroplasties (MoMHRAs) have a high failure rate due to pseudotumour formation. It is not certain whether pseudotumours in bilateral MoMHRAs form on the basis of an adverse reaction to metal debris (ARMD) that is entirely due to a local innate and adaptive immune response to Cobalt-Chrome (Co-Cr) wear particles. To determine if there is a systemic component to ARMD in bilateral MoMHRAs, we examined the histology of ARMD in unilateral and bilateral MoMHRAs revised for pseudotumour and determined whether implant survival differed between these two groups. Periprosthetic tissue specimens from 119 hips revised for pseudotumour were examined. These were derived from 109 patients including 10 patients with bilateral MoMHRAs and 99 with sunilateral MoMHRAs including a cohort of 20 patients with bilateral MoMHRAs that had undergone only one MoMHRA revision for pseudotumour. The mean time to revision for pseudotumour of unilateral and bilateral MoMHRAs was determined. The histology of periprosthetic tissue was examined for evidence of the innate and adaptive immune response and scored semi-quantitatively. There was no significant difference in histological features of the innate / adaptive response between Group 1 bilateral pseudotumours and Group 2 and Group 3 unilateral pseudotumours. Histological features, including ALVAL scores, were similar in the periprosthetic tissues of right and left hips in Group 1 bilateral MoMHRAs. The mean time to first revision for pseudotumour of bilateral MoMHRAs (6.59 years) was not decreased compared with unilateral MoMHRAs (5.66 years) or bilateral MoMHRAs that had only one revision (7.05 years). Right and left hip pseudotumours in bilateral MoMHRAs exhibit similar histological features of the innate and adaptive immune response. Mean implant survival is not decreased in bilateral compared with unilateral MoMHRA cases. The findings suggest that pseudotumour formation is due more to a local than a systemic innate /adaptive immune response to components of metal wear.
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Affiliation(s)
- Yoshinubo Uchihara
- Department of Orthopaedic Surgery, Nara Medical University, Shijocho 840, Kashihara, Nara, 634-8522, Japan
| | - George Grammatopoulos
- Nuffield Department of Orthopaedics, Rheumatology and Surgery, Nuffield Orthopaedic Centre, University of Oxford, Headington, Oxford, OX3 7HE, UK.
| | - Mitsuru Munemoto
- Department of Orthopaedic Surgery, Nara Medical University, Shijocho 840, Kashihara, Nara, 634-8522, Japan
| | - Gulraj Matharu
- Nuffield Department of Orthopaedics, Rheumatology and Surgery, Nuffield Orthopaedic Centre, University of Oxford, Headington, Oxford, OX3 7HE, UK
| | - Yusuke Inagaki
- Department of Orthopaedic Surgery, Nara Medical University, Shijocho 840, Kashihara, Nara, 634-8522, Japan
| | - Hemant Pandit
- Nuffield Department of Orthopaedics, Rheumatology and Surgery, Nuffield Orthopaedic Centre, University of Oxford, Headington, Oxford, OX3 7HE, UK
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Shijocho 840, Kashihara, Nara, 634-8522, Japan
| | - Nick A Athanasou
- Nuffield Department of Orthopaedics, Rheumatology and Surgery, Nuffield Orthopaedic Centre, University of Oxford, Headington, Oxford, OX3 7HE, UK.
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