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Qi X, Liu J, Liu W, Qiao X, Fu J, Gao J. Association between metal implants and urinary chromium levels in US adults: a cross-sectional study from NHANES. Sci Rep 2024; 14:17111. [PMID: 39048613 PMCID: PMC11269588 DOI: 10.1038/s41598-024-68049-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 07/18/2024] [Indexed: 07/27/2024] Open
Abstract
Metal implants play a significant role in orthopedics, commonly used for treating fractures, joint replacement surgeries, spinal procedures, and more. Chromium (Cr), crucial in these implants, may raises health concerns. However, the relationship between metal implants and urine Cr levels remains uncertain. We aimed to evaluate this relationship. We conducted a cross-sectional study on 1419 individuals aged 40 years or older using data from the National Health and Nutrition Examination Survey (NHANES) spanning the years 2017 to 2020. Multivariate linear regression models and subgroup analysis were applied to assess associations between metal implants and urine Cr levels. Among the 1419 participants, 402 [28.3%] self-reported having metal objects in their bodies. After adjusting for potential confounding factors, metal implants were positively correlated with the accumulation of urine Cr (β = 0.41, 95% CI 0.04-0.77, p = 0.028). However, the positive correlation of metal implants with urine Cr was only present in females (β = 0.81, 95% CI 0.08-1.53, p = 0.029), but not in males. Our study revealed higher urine Cr levels in individuals with metal implants, with noticeable gender differences. Additionally, those with metal implants exhibited a more pronounced elevation in urine Cr levels with increasing age compared to individuals without implants.
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Affiliation(s)
- Xiaogang Qi
- Department of Orthopedics, Yangquan First People's Hospital, Yangquan, 045000, China
| | - Jiaming Liu
- Department of Pain Treatment, Yangquan First People's Hospital, Yangquan, 045000, China
| | - Wenhai Liu
- Department of Anesthesiology, Yangquan First People's Hospital, Yangquan, 045000, China
| | - Xiaodong Qiao
- Department of General Surgery, Yangquan First People's Hospital, Yangquan, 045000, China
| | - Junwen Fu
- Department of Orthopedics, Yangquan Coal Group General Hospital, Yangquan, 045000, China.
| | - Jiankang Gao
- Department of Endocrinology, Yangquan First People's Hospital, Yangquan, 045000, China.
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Langton DJ, Natu S, Harrington CF, Bowsher JG, Nargol AVF. Is the synovial fluid cobalt-to-chromium ratio related to the serum partitioning of metal debris following metal-on-metal hip arthroplasty? Bone Joint Res 2019; 8:146-155. [PMID: 30997040 PMCID: PMC6444018 DOI: 10.1302/2046-3758.83.bjr-2018-0049.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives We investigated the reliability of the cobalt-chromium (CoCr) synovial joint fluid ratio (JFR) in identifying the presence of a severe aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL) response and/or suboptimal taper performance (SOTP) following metal-on-metal (MoM) hip arthroplasty. We then examined the possibility that the CoCr JFR may influence the serum partitioning of Co and Cr. Methods For part A, we included all revision surgeries carried out at our unit with the relevant data, including volumetric wear analysis, joint fluid (JF) Co and Cr concentrations, and ALVAL grade (n = 315). Receiver operating characteristic curves were constructed to assess the reliability of the CoCr JFR in identifying severe ALVAL and/or SOTP. For part B, we included only patients with unilateral prostheses who had given matched serum and whole blood samples for Co and Cr analysis (n = 155). Multiple regression was used to examine the influence of JF concentrations on the serum partitioning of Co and Cr in the blood. Results A CoCr JFR > 1 showed a specificity of 83% (77% to 88%) and sensitivity of 63% (55% to 70%) for the detection of severe ALVAL and/or SOTP. In patients with CoCr JFRs > 1, the median blood Cr to serum Cr ratio was 0.99, compared with 0.71 in patients with CoCr JFRs < 1 (p < 0.001). Regression analysis demonstrated that the blood Cr to serum Cr value was positively associated with the JF Co concentration (p = 0.011) and inversely related to the JF Cr concentration (p < 0.001). Conclusion Elevations in CoCr JFRs are associated with adverse biological (severe ALVAL) or tribocorrosive processes (SOTP). Comparison of serum Cr with blood Cr concentrations may be a useful additional clinical tool to help to identify these conditions.Cite this article: D. J. Langton, S. Natu, C. F. Harrington, J. G. Bowsher, A. V. F. Nargol. Is the synovial fluid cobalt-to-chromium ratio related to the serum partitioning of metal debris following metal-on-metal hip arthroplasty? Bone Joint Res 2019;8:146-155. DOI: 10.1302/2046-3758.83.BJR-2018-0049.R1.
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Affiliation(s)
- D J Langton
- Northern Retrieval Registry, The Biosphere, Newcastle Helix, Newcastle upon Tyne, UK
| | - S Natu
- University Hospital of North Tees, Stockton-on-Tees, UK
| | - C F Harrington
- Supra-Regional Assay Service (SAS), Trace Element Centre, Guildford, UK
| | - J G Bowsher
- Food and Drugs Administration, Silver Spring, Maryland, USA
| | - A V F Nargol
- University Hospital of North Tees, Stockton-on-Tees, UK
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3
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Bravo D, Wagner ER, Larson DR, Davis MP, Pagnano MW, Sierra RJ. No Increased Risk of Knee Arthroplasty Failure in Patients With Positive Skin Patch Testing for Metal Hypersensitivity: A Matched Cohort Study. J Arthroplasty 2016; 31:1717-21. [PMID: 26869063 DOI: 10.1016/j.arth.2016.01.024] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 12/10/2015] [Accepted: 01/08/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND It is unclear whether a positive skin patch test for metal allergy in patients with skin hypersensitivity to metals is associated with an increased risk of total knee arthroplasty (TKA) failure. Our aim was to determine whether patients with a history of metal allergy who had a positive skin patch test (SPT+) had worse outcomes after primary TKA compared with those with a negative skin patch test and compared with controls. METHODS Over 12 years, 127 patients underwent 161 TKA after skin patch testing (SPT; 56 were positive). Cases were matched by age, gender, body mass index, American Society of Anesthesiologists score, implant type, and implant manufacturer to 161 control knee arthroplasties without any prior history of metal allergy and no SPT. Median follow-up was 5.3 years. Differences in outcome measures were assessed between groups. RESULTS Patients with a SPT+ to metal did not have a higher complication, reoperation, or revision rates compared with patients with a SPT- and matched controls. Survivorship free of revision at 5 years was 98.1% for SPT+; 100% for SPT-; 97.6% for SPT+ controls, 99.0% for SPT- controls. There was no statistically significant difference in postoperative pain between SPT+ and SPT- patients and matched controls. CONCLUSION This study was designed to evaluate the effect of metal hypersensitivity on TKA outcomes and the role of SPT in patients before TKA. In this study, a SPT+ for metals was of little practical value in predicting the midterm outcome after TKA and cannot be strongly recommended as a method to guide the selection of implant type.
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Affiliation(s)
- Dalibel Bravo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota; Department of Pediatric Infectious Disease, Mayo Clinic, Rochester, Minnesota; Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York, New York
| | - Eric R Wagner
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota; Department of Pediatric Infectious Disease, Mayo Clinic, Rochester, Minnesota
| | - Dirk R Larson
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota; Department of Pediatric Infectious Disease, Mayo Clinic, Rochester, Minnesota
| | - Mark P Davis
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota; Department of Pediatric Infectious Disease, Mayo Clinic, Rochester, Minnesota
| | - Mark W Pagnano
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota; Department of Pediatric Infectious Disease, Mayo Clinic, Rochester, Minnesota
| | - Rafael J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota; Department of Pediatric Infectious Disease, Mayo Clinic, Rochester, Minnesota
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Briggs TWR, Hanna SA, Kayani B, Tai S, Pollock RC, Cannon SR, Blunn GW, Carrington RWJ. Metal-on-polyethylene versus metal-on-metal bearing surfaces in total hip arthroplasty. Bone Joint J 2015; 97-B:1183-91. [DOI: 10.1302/0301-620x.97b9.34824] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The long term biological effects of wear products following total hip arthroplasty (THA) are unclear. However, the indications for THA are expanding, with increasingly younger patients undergoing the procedure. This prospective, randomised study compared two groups of patients undergoing THA after being randomised to receive one of two different bearing surfaces: metal-on-polyethylene (MoP) n = 22 and metal-on-metal (MoM) n = 23. We investigated the relationship between three variables: bearing surface (MoP vs MoM), whole blood levels of chromium (Cr) and cobalt (Co) and chromosomal aberrations in peripheral lymphocyte pre-operatively and at one, two and five years post-surgery. Our results demonstrated significantly higher mean cobalt and chromium (Co and Cr) blood levels in the MoM group at all follow-up points following surgery (p < 0.01), but there were no significant differences in the chromosomal aberration indices between MoM and MoP at two or five years (two years: p = 0.56, p = 0.08, p = 0.91, p = 0.51 and five years: p = 0.086, p = 0.73, p = 0.06, p = 0.34) for translocations, breaks, loss and gain of chromosomes respectively. Regression analysis showed a strong linear relationship between Cr levels and the total chromosomal aberration indices in the MoM group (R2 = 0.90016), but this was not as strong for Co (R2 = 0.68991). In the MoP group, the analysis revealed a poor relationship between Cr levels and the total chromosomal aberration indices (R2 = 0.23908) but a slightly stronger relationship for Co (R2 = 0.64292). Across both groups, Spearman’s correlation detected no overall association between Co and Cr levels and each of the studied chromosomal aberrations. There remains no clear indication which THA bearing couple is the most biocompatible, especially in young active patients. While THA continues to be very successful at alleviating pain and restoring function, the long-term biological implications of the procedure still require further scrutiny. Cite this article: Bone Joint J 2015;97-B:1183–91.
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Affiliation(s)
- T. W. R. Briggs
- Royal National Orthopaedic Hospital, Brockley
Hill, Stanmore, Middlesex, HA7
4LP, UK
| | - S. A. Hanna
- Joint Replacement Institute, University
of Western Ontario, London, Ontario, N6G
2V4, Canada
| | - B. Kayani
- Royal National Orthopaedic Hospital, Brockley
Hill, Stanmore, Middlesex, HA7
4LP, UK
| | - S. Tai
- East and North Hertfordshire NHS Trust, Coreys
Mill Lane, Stevenage, SG1
4AB, UK
| | - R. C. Pollock
- Royal National Orthopaedic Hospital, Brockley
Hill, Stanmore, Middlesex, HA7
4LP, UK
| | - S. R. Cannon
- Royal National Orthopaedic Hospital, Brockley
Hill, Stanmore, Middlesex, HA7
4LP, UK
| | - G. W. Blunn
- Institute of Orthopaedics and Musculoskeletal
Science, Royal National Orthopaedic Hospital, Brockley
Hill, Stanmore, Middlesex, HA7
4LP, UK
| | - R. W. J. Carrington
- Royal National Orthopaedic Hospital, Brockley
Hill, Stanmore, Middlesex, HA7
4LP, UK
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5
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Affiliation(s)
- P Gopinathan
- Department of Orthopaedics, Gopinath Orthopaedic Centre, Calicut, Kerala 673305, India
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Jebahi S, Saleh GB, Saoudi M, Besaleh S, Oudadesse H, Mhadbi M, Rebai T, Keskes H, Feki AE. Genotoxicity effect, antioxidant and biomechanical correlation: Experimental study of agarose–chitosan bone graft substitute in New Zealand white rabbit model. Proc Inst Mech Eng H 2014; 228:800-9. [DOI: 10.1177/0954411914547247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Bone loss associated with skeletal trauma or metabolic diseases often requires bone grafting. In such situations, a biomaterial is necessary for migrated cells to produce new tissue. In this study, agarose–chitosan was implanted in the femoral condyle of New Zealand White rabbits that were divided into three groups: Group I was used as control; Groups II and III were used as implanted tissue with agarose–chitosan and presenting empty defects, respectively. This study evaluated the agarose–chitosan biocompatibility by determining the in vivo genotoxicity, oxidative stress balance that correlated with the hardness mechanical property. Moreover, the histopathological and quantitative elements analyzed by using inductively coupled plasma optical emission spectrometry were determined. After 30 days of implantation, the in vivo analysis of genotoxicity showed that agarose–chitosan did not induce chromosome aberration or micronucleus damage. A significant decrease in thiobarbituric and acid-reactive substance was observed after agarose–chitosan implantation in the bone tissue. Superoxide dismutase, catalase and glutathione peroxidase were significantly enhanced in agarose–chitosan–treated group compared with that of control group. A negative correlation coefficient of the mechanical property with malonyldialdehyde level was detected (R = −0.998). The histological study exhibited a significantly increased angiogenesis and newly formed tissue. No presence of inflammatory process, necrotic or fibrous tissue was detected. Major and trace elements such as Ca, P, Zn, Mg and Fe were increased significantly in the newly formed bone. These findings show that agarose–chitosan biomaterial implantation might be effective for treating trauma and bone regeneration.
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Affiliation(s)
- Samira Jebahi
- UMR CNRS 6226, University of Rennes 1, Rennes, France
- Histology, Orthopaedic and Traumatology Laboratory, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Animal Ecophysiology Laboratory, Department of Life Sciences, Faculty of Sciences of Sfax, University of Sfax, Sfax, Tunisia
| | - Ghada Ben Saleh
- Laboratory of Human Molecular Genetics, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Mongi Saoudi
- Animal Ecophysiology Laboratory, Department of Life Sciences, Faculty of Sciences of Sfax, University of Sfax, Sfax, Tunisia
| | - Salma Besaleh
- Histology, Orthopaedic and Traumatology Laboratory, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | | | - Moufida Mhadbi
- Histology, Orthopaedic and Traumatology Laboratory, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Tarek Rebai
- Histology, Orthopaedic and Traumatology Laboratory, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Hassib Keskes
- Histology, Orthopaedic and Traumatology Laboratory, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Abdelfattah El Feki
- Animal Ecophysiology Laboratory, Department of Life Sciences, Faculty of Sciences of Sfax, University of Sfax, Sfax, Tunisia
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7
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Incidence of adverse wear reactions in hip resurfacing arthroplasty: a single surgeon series of 2,600 cases. Hip Int 2014; 23:250-8. [PMID: 23760745 DOI: 10.5301/hipint.5000030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2013] [Indexed: 02/04/2023]
Abstract
A single surgeon performed 2,559 metal-on-metal hip resurfacing arthroplasties in
2,109 patients. The Corin Cormet 2000 (393 cases) and Biomet Recap implants (2,166 cases) were used in our series. In this study, the adverse wear failure (AWF) rate was 0.27%. At 10 years postoperatively, our Kaplan-Meier cumulative revision rate for AWF was 1% for all patients, 0.2% for men, 2.6% for women, and 9% for patients with a diagnosis of dysplasia. All AWF failures had component sizes ≤48 mm. All had metal ion levels above 15 ug/ml. All had acetabular inclination angles (AIA) ≥50° on standing pelvis radiographs. All had severe metallosis found at the time of revision. Six of the seven AWF cases were in women. There were no failures from pseudotumours without AWF (metallosis) in this series.
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8
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Hwang KT, Kim YH, Kim YS, Choi IY. Is second generation metal-on-metal primary total hip arthroplasty with a 28 mm head a worthy option?: a 12- to 18-year follow-up study. J Arthroplasty 2013; 28:1828-33. [PMID: 23890829 DOI: 10.1016/j.arth.2013.06.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 05/28/2013] [Accepted: 06/15/2013] [Indexed: 02/01/2023] Open
Abstract
To determine whether MoM THA with a small head is still worthy of use, we investigated survivorship, complications, and factors influencing failure. Of 149 consecutive patients (195 hips), 141 (180 hips) of mean age 43 (19-55) years were available for review at a mean of 14.4 years postoperatively. Survivorship for cup revision for any cause was 97.8% at 18.4 years postoperatively. Nine hips generated complaints of groin pain; six showed periacetabular osteolysis, one had pain without radiological change, and two were diagnosed as symptomatic pseudotumors. Four of six hips with periacetabular osteolysis or aseptic loosening were revised. Surgery- and patient-related factors had no effect in results. Our results are encouraging, however, further study will be necessary to determine the incidence and fates of pseudotumors after MoM THA with a small head.
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Affiliation(s)
- Kyu-Tae Hwang
- Department of Orthopaedic Surgery, Hanyang University Hospital, Seoul, South Korea
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9
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Newton AW, Ranganath L, Armstrong C, Peter V, Roberts NB. Differential distribution of cobalt, chromium, and nickel between whole blood, plasma and urine in patients after metal-on-metal (MoM) hip arthroplasty. J Orthop Res 2012; 30:1640-6. [PMID: 22447496 DOI: 10.1002/jor.22107] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 03/01/2012] [Indexed: 02/04/2023]
Abstract
Evidence shows that raised cobalt (Co), chromium (Cr), and nickel (Ni) whole blood concentrations correlate with poor device outcome in patients following metal-on-metal (MoM) hip arthroplasty. To understand the local and systemic pathological effects of these raised metal concentrations it is important to define their distribution between whole blood, plasma, and urine. The metals were measured by Inductively Coupled Plasma Mass Spectrometry (ICPMS). Two hundred and five plasma, 199 whole blood, and 24 sets of urine samples were analyzed from 202 patients with Co-Cr alloy MoM hip prostheses implanted between 8 months to 12 years (mean 6.0 years) prior to analysis. Plasma Co (median 39.1 nmol/L) showed significantly positive 1:1 correlation with whole blood Co (median 45.9 nmol/L; R(2) = 0.98, p < 0.001, slope = 1.0). Plasma Cr (median 53.8 nmol/L) and whole blood Cr (median 40.3 nmol/L) were also correlated; however, concentrations were significantly higher in plasma indicating relatively little blood cell uptake (R(2) = 0.96, p < 0.001, slope = 1.6). Urinary Co was up to threefold higher than Cr (median 334.0 vs. 97.3 nmol/L respectively). Nickel concentrations in whole blood, plasma, and urine were low relative to Co and Cr. The analysis shows fundamental differences in the physiological handling of these metals: Co is distributed approximately equally between blood cells and plasma, whereas Cr is mainly in plasma, despite which, Cr had far less renal excretion than Co.
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Affiliation(s)
- Ashley W Newton
- Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool University Hospital, University of Liverpool, Prescot Street, Liverpool L7 8XP, United Kingdom.
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10
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Metal-on-metal bearings, inflammatory pseudotumours and their neurological manifestations. Hip Int 2012; 22:129-36. [PMID: 22476931 DOI: 10.5301/hip.2012.9185] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2012] [Indexed: 02/04/2023]
Abstract
Metal-on-metal bearings have become more popular for hip arthroplasty in younger patients in the last 15 years. We present a review of the neurological consequences relating to such bearing surfaces illustrated by an appropriate case report. The mechanisms of increased metal ion production and pseudotumour formation are discussed. If unexplained neurology, hip/groin pain or a localised mass around the hip are present with a metal bearing hip then urgent referral to a specialist orthopaedic surgeon is warranted for consideration of exchange arthroplasty.
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11
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Minimum 5-year results of modular metal-on-metal total hip arthroplasty. J Arthroplasty 2012; 27:545-50. [PMID: 21908166 DOI: 10.1016/j.arth.2011.07.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Accepted: 07/05/2011] [Indexed: 02/01/2023] Open
Abstract
This study reports minimum 5-year results of 95 hips implanted with a Pinnacle (DePuy, Warsaw, Ind) modular metal-on-metal acetabular prosthesis. Clinical scores such as the Harris Hip and Western Ontario and McMaster Universities Arthritis Index revealed excellent clinical outcomes at mean 6-year follow-up. With the use of large-diameter femoral heads, dislocation was rare, occurring in only 1 hip. Moreover, no acetabular and only 3 femoral osteolytic lesions were detected. Kaplan-Meier survivorship at 7 years after arthroplasty was 97.8% for the total hip arthroplasty construct and 100% for the acetabular shell. No unexplained pain or other complication attributable to wear debris or the metal-on-metal articulation was observed. These findings indicate that total hip arthroplasty with this specific modular metal-on-metal bearing performed well in a high-demand population at midterm follow-up.
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12
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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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13
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Cousen PJ, Gawkrodger DJ. Metal allergy and second-generation metal-on-metal arthroplasties. Contact Dermatitis 2011; 66:55-62. [DOI: 10.1111/j.1600-0536.2011.01970.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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14
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Meng QE, Liu F, Fisher J, Jin ZM. Transient elastohydrodynamic lubrication analysis of a novel metal-on-metal hip prosthesis with a non-spherical femoral bearing surface. Proc Inst Mech Eng H 2011; 225:25-37. [PMID: 21381485 DOI: 10.1243/09544119jeim795] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Effective lubrication performance of metal-on-metal hip implants only requires optimum conformity within the main loaded area, while it is advantageous to increase the clearance in the equatorial region. Such a varying clearance can be achieved by using non-spherical bearing surfaces for either acetabular or femoral components. An elastohydrodynamic lubrication model of a novel metal-on-metal hip prosthesis using a non-spherical femoral bearing surface against a spherical cup was solved under loading and motion conditions specified by ISO standard. A full numerical methodology of considering the geometric variation in the rotating non-spherical head in elastohydrodynamic lubrication solution was presented, which is applicable to all non-spherical head designs. The lubrication performance of a hip prosthesis using a specific non-spherical femoral head, Alpharabola, was analysed and compared with those of spherical bearing surfaces and a non-spherical Alpharabola cup investigated in previous studies. The sensitivity of the lubrication performance to the anteversion angle of the Alpharabola head was also investigated. Results showed that the non-spherical head introduced a large squeeze-film action and also led to a large variation in clearance within the loaded area. With the same equatorial clearance, the lubrication performance of the metal-on-metal hip prosthesis using an Alpharabola head was better than that of the conventional spherical bearings but worse than that of the metal-on-metal hip prosthesis using an Alpharabola cup. The reduction in the lubrication performance caused by the initial anteversion angle of the non-spherical head was small, compared with the improvement resulted from the non-spherical geometry.
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Affiliation(s)
- Q E Meng
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK.
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15
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Abstract
BACKGROUND Despite the clinical success of modern metal-on-metal articulations, concerns with wear-related release of metal ions persist. Evidence suggests metal ion release is related to the effective coverage of the head in the metal shell (the cup's functional articular arc). A recent study suggests a reduced functional articular arc is associated with increased ion release and the arc is a function of component design, size, and the abduction angle. QUESTIONS/PURPOSES The purposes of this study were to (1) measure the functional articular arc in different sizes of currently available one-piece metal shells from several different manufacturers; and (2) compare the functional articular arc of these one-piece metal shells with the 180 masculine arc of conventional hip arthroplasty acetabular components. METHODS We calculated the available articular surface arc for 33 one-piece metal cups using measurements of cup depth and internal cup radius. RESULTS The arc of the articular surface varied among manufacturers and generally decreased with decreasing shell diameter. The mean functional articular arc was 160.5 degrees +/- 3.6 degrees (range, 151.8 degrees -165.8 degrees), which was less than the 180 degrees arc of a conventional acetabular component. CONCLUSIONS Our data show certain cup designs are at higher risk for failure as a result of the decreased articular surface arc. This, along with analysis of abduction angles, supports the recent findings of bearing failure with vertically placed implants. Care must be taken when implanting these shells to ensure they are placed in less abduction to avoid edge loading and the potential for early bearing failure.
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Abstract
The effects of elevated levels of metal ions in patients who have undergone metal-on-metal total hip arthroplasty are not fully understood. The effects of femoral head size on serum metal-ion levels have been the subject of conflicting reports, and further investigation is needed to evaluate the impact of acetabular and femoral component alignment. The conduct of clinical trials of metal-on-metal total hip arthroplasties has been inadequate as few investigators have used a randomized controlled design to compare metal-on-metal bearings with other bearing surfaces. Additional clinical research needs to include appropriate validated patient-reported outcome measures, activity monitoring, and health economics.
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Affiliation(s)
- Ajay Malviya
- Department of Orthopaedic Surgery, Freeman Hospital, Newcastle on Tyne NE7 7DN, United Kingdom
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Tkaczyk C, Petit A, Antoniou J, Zukor DJ, Tabrizian M, Huk OL. Significance of Elevated Blood Metal Ion Levels in Patients with Metal-on-Metal Prostheses: An Evaluation of Oxidative Stress Markers. Open Orthop J 2010; 4:221-7. [PMID: 21249162 PMCID: PMC3023063 DOI: 10.2174/1874325001004010221] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 03/24/2010] [Accepted: 04/10/2010] [Indexed: 11/22/2022] Open
Abstract
It is widely known that cobalt and chromium ions can enhance the production of reactive oxygen species, known to be damaging to cells by disturbing their redox status and then generating oxidative stress. The aim of the present study was to determine if increased metal ion levels induce a state of oxidative stress in patients with metal-on-metal (MM) hip arthroplasty. Results indicated that there was no significant difference in the concentration of oxidative stress markers (total antioxidants, peroxides, and nitrated proteins) in the patients with MM bearings compared to patients without prostheses. The activity antioxidant enzymes was stable (catalase and glutathione peroxidase) or slightly decreased (superoxide dismutase and heme oxygenase-1) over time. This work is the first to determine the biological effects of metal ions released from MM hip implants with regards to mid-term systemic oxidative stress and showed that the increased levels of Co and Cr ions are not associated with significant oxidative stress damage in the plasma of patients with these implants.
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Affiliation(s)
- Cathy Tkaczyk
- Department of Biomedical Engineering, McGill University, Duff Medical Building, 3775 University Street, Montreal, Quebec, H3A 2B4, Canada
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Lazennec JY, Boyer P, Poupon J, Rousseau MA, Roy C, Ravaud P, Catonné Y. Outcome and serum ion determination up to 11 years after implantation of a cemented metal-on-metal hip prosthesis. Acta Orthop 2009; 80:168-73. [PMID: 19404797 PMCID: PMC2823177 DOI: 10.3109/17453670902947408] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [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 Little is known about the long-term outcome of cemented metal-on-metal hip arthroplasties. We evaluated a consecutive series of metal-on-metal polyethylene-backed cemented hip arthroplasties implanted in patients under 60 years of age. METHODS 109 patients (134 joint replacements) were followed prospectively for mean 9 (7-11) years. The evaluation included clinical score, radiographic assessment, and blood sampling for ion level determination. RESULTS At the final review, 12 hips had been revised, mainly because of aseptic loosening of the socket. Using revision for aseptic loosening as the endpoint, the survival rate at 9 years was 91% for the cup and 99% for the stem. In addition, 35 hips showed radiolucent lines at the bone-cement interface of the acetabulum and some were associated with osteolysis. The median serum cobalt and chromium levels were relatively constant over time, and were much higher than the detection level throughout the study period. The cobalt level was 1.5 microg/L 1 year after implantation, and 1.44 microg/L 9 years after implantation. INTERPRETATION Revisions for aseptic loosening and radiographic findings in the sockets led us to halt metal-on-metal-backed polyethylene cemented hip arthroplasty procedures. If the rigidity of the cemented socket is a reason for loosening, excessive release of metal ions and particles may be involved. Further investigations are required to confirm this hypothesis and to determine whether subluxation, microseparation, and hypersensitivity also play a role.
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Affiliation(s)
- Jean-Yves Lazennec
- Department of Orthopaedic Surgery, Pitié-Salpétrière HospitalParisFrance
| | - Patrick Boyer
- Department of Orthopaedic Surgery, Bichat HospitalParisFrance
| | - Joel Poupon
- Laboratory of Toxicology, Lariboisière HospitalParisFrance
| | | | - Carine Roy
- Department of Statistics, Bichat Hospital, Université Paris Diderot, Asistance Publique-Hopitaux de ParisParisFrance
| | - Philippe Ravaud
- Department of Statistics, Bichat Hospital, Université Paris Diderot, Asistance Publique-Hopitaux de ParisParisFrance
| | - Yves Catonné
- Department of Orthopaedic Surgery, Pitié-Salpétrière HospitalParisFrance
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Bal BS, Khandkar A, Lakshminarayanan R, Clarke I, Hoffman AA, Rahaman MN. Testing of silicon nitride ceramic bearings for total hip arthroplasty. J Biomed Mater Res B Appl Biomater 2008; 87:447-54. [DOI: 10.1002/jbm.b.31123] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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