Does Femoral Neck to Cup Impingement Affect Metal Ion Levels in Hip Resurfacing?
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Impingement of the femoral neck with the acetabular component after metal-on-metal hip resurfacing arthroplasty (HRA) is a possible cause of edge loading and accelerated bearing wear. No attempt has been made to correlate radiographic impingement signs and blood metal ion levels.
We (1) compared serum cobalt (CoS) and chromium (CrS) concentrations between patients with and without radiographic impingement signs treated with unilateral HRA, (2) determined whether divot depth on the femoral neck correlated with CoS and CrS, and (3) assessed the predictive value of radiographic impingement signs for high levels of CoS and CrS.
A retrospective radiographic review of 141 patients with CoS and CrS analyses yielded 21 patients with and 120 without radiographic impingement signs (controls). Radiographic measurements included divot depth and orientation of the acetabular component to compute the contact patch to rim distance, a measure of functional head coverage. We defined a patient as having radiographic impingement signs if a remodeling of the femoral neck cortex showed a depression matching the predicted path of an impinging acetabular component. CoS and CrS were analyzed by inductively coupled plasma mass spectrometry and the radiographs were taken within 12 months of the last blood draw.
Median CoS and CrS were greater in the impingement group than in controls in patients with less than 10-mm contact patch to rim distances. Divot depth did not correlate with CoS or CrS. In predicting elevated ion levels (≥ 7 μg/L), the presence of a radiographic impingement sign showed a sensitivity of 50% for CoS and 33% for CrS and a specificity of 87% for both CoS and CrS.
Radiographic impingement signs influenced CoS and CrS only when the functional head coverage was insufficient due to poor socket positioning. Radiographic impingement signs alone were not a good predictor of elevated metal ion levels.
Level of Evidence
Level III, diagnostic study. See Instructions for Authors for a complete description of levels of evidence.
- Amstutz, HC (2010) “Top 10” technical pearls for successfully performing hip resurfacing arthroplasty. Tech Orthop. 25: pp. 73-79 CrossRef
- Amstutz, HC, Beaulé, PE, Dorey, FJ, Duff, MJ, Campbell, PA, Gruen, TA (2006) Metal-on-metal hybrid surface arthroplasty—surgical technique. J. Bone Joint Surg. Am. 88: pp. 234-249
- Amstutz, HC, Campbell, PA, Dorey, FJ, Johnson, AJ, Skipor, A, Jacobs, JJ (2013) Do ion concentrations after metal-on-metal hip resurfacing increase over time? A prospective study. J Arthroplasty. 28: pp. 695-700 CrossRef
- Amstutz, HC, Duff, MJ (2006) Background of metal-on-metal resurfacing. Proc Inst Mech Eng H. 220: pp. 85-94 CrossRef
- Amstutz, HC, Duff, MJ, Campbell, PA, Dorey, FJ (2007) The effects of technique changes on aseptic loosening of the femoral component in hip resurfacing: results of 600 Conserve Plus with a 3–9 year follow-up. J Arthroplasty. 22: pp. 481-489 CrossRef
- Amstutz, HC, Duff, MJ, Johnson, AJ (2012) Socket position determines hip resurfacing 10-year survivorship. Clin Orthop Relat Res. 470: pp. 3127-3133 CrossRef
- Back, DL, Young, DA, Shimmin, AJ (2005) How do serum cobalt and chromium levels change after metal-on-metal hip resurfacing?. Clin Orthop Relat Res. 438: pp. 177-181 CrossRef
- Ball, ST, Schmalzried, TP (2009) Posterior femoroacetabular impingement (PFAI)—after hip resurfacing arthroplasty. Bull NYU Hosp Jt Dis. 67: pp. 173-176
- Bergmann, G, Deuretzbacher, G, Heller, M, Graichen, F, Rohlmann, A, Strauss, J, Duda, GN (2001) Hip contact forces and gait patterns from routine activities. J Biomech. 34: pp. 859-871 CrossRef
- Biedermann, R, Tonin, A, Krismer, M, Rachbauer, F, Eibl, G, Stockl, B (2005) Reducing the risk of dislocation after total hip arthroplasty: the effect of orientation of the acetabular component. J Bone Joint Surg Br. 87: pp. 762-769 CrossRef
- Grigoris, P, Roberts, P, Panousis, K, Bosch, H (2005) The evolution of hip resurfacing arthroplasty. Orthop Clin North Am. 36: pp. 125-134 CrossRef
- Gruen, TA, Duff, MJ, Wisk, LE, Amstutz, HC (2011) Prevalence and clinical relevance of radiographic signs of impingement in metal-on-metal hybrid hip resurfacing. J Bone Joint Surg Am. 93: pp. 1519-1526 CrossRef
- Heisel, C, Streich, N, Krachler, M, Jakubowitz, E, Kretzer, JP (2008) Characterization of the running-in period in total hip resurfacing arthroplasty: an in vivo and in vitro metal ion analysis. J Bone Joint Surg Am. 90: pp. 125-133 CrossRef
- Johnson, CR (1932) A new method for roentgenographic examination of the upper end of the femur. J Bone Joint Surg. 14: pp. 859-866
- Langton, DJ, Joyce, TJ, Mangat, N, Lord, J, Orsouw, M, Smet, K, Nargol, AV (2011) Reducing metal ion release following hip resurfacing arthroplasty. Orthop Clin North Am. 42: pp. 169-180 CrossRef
- Langton, DJ, Sprowson, AP, Joyce, TJ, Reed, M, Carluke, I, Partington, P, Nargol, AV (2009) Blood metal ion concentrations after hip resurfacing arthroplasty: a comparative study of articular surface replacement and Birmingham hip resurfacing arthroplasties. J Bone Joint Surg Br. 91: pp. 1287-1295 CrossRef
- Langton, DJ, Sprowson, AP, Mahadeva, D, Bhatnagar, S, Holland, JP, Nargol, AV (2009) Cup anteversion in hip resurfacing: validation of EBRA and the presentation of a simple clinical grading system. J Arthroplasty. 25: pp. 607-613 CrossRef
- Leslie, IJ, Williams, S, Isaac, G, Ingham, E, Fisher, J (2009) High cup angle and microseparation increase the wear of hip surface replacements. Clin Orthop Relat Res. 467: pp. 2259-2265 CrossRef
- Lim, SJ, Kim, JH, Moon, YW, Park, YS (2012) Femoroacetabular cup impingement after resurfacing arthroplasty of the hip. J Arthroplasty. 27: pp. 60-65 CrossRef
- MacDonald, SJ, McCalden, RW, Chess, DG, Bourne, RB, Rorabeck, CH, Cleland, D, Leung, F (2003) Metal-on-metal versus polyethylene in hip arthroplasty: a randomized clinical trial. Clin Orthop Relat Res. 406: pp. 282-296 CrossRef
- Matthies, A, Underwood, R, Cann, P, Ilo, K, Nawaz, Z, Skinner, J, Hart, AJ (2011) Retrieval analysis of 240 metal-on-metal hip components, comparing modular total hip replacement with hip resurfacing. J Bone Joint Surg Br. 93: pp. 307-314 CrossRef
- Medicines and Healthcare products Regulatory Agency. Medical Device Alert. All metal-on-metal (MoM) hip replacements (MDA/2012/008). Available at: http://www.mhra.gov.uk/home/groups/dts-bs/documents/medicaldevicealert/con143787.pdf. Accessed October 12, 2012.
- Morlock, MM, Bishop, N, Zustin, J, Hahn, M, Ruther, W, Amling, M (2008) Modes of implant failure after hip resurfacing: morphological and wear analysis of 267 retrieval specimens. J Bone Joint Surg Am. 90: pp. 89-95 CrossRef
- Pulos, N, Tiberi, JV, Schmalzried, TP (2011) Measuring acetabular component position on lateral radiographs—ischio-lateral method. Bull NYU Hosp Jt Dis. 69: pp. S84-S89
- Savarino, L, Granchi, D, Ciapetti, G, Cenni, E, Nardi Pantoli, A, Rotini, R, Veronesi, C, Baldini, N, Giunti, A (2002) Ion release in patients with metal-on-metal hip bearings in total joint replacement: a comparison with metal-on-polyethylene bearings. J Biomed Mater Res. 63: pp. 467-474 CrossRef
- Skipor, AK, Campbell, PA, Paterson, LM, Amstutz, HC, Schmalzried, TP, Jacobs, JJ (2002) Serum and urine metal levels in patients with metal-on-metal surface arthroplasty. J Mater Sci Mater Med. 13: pp. 1227-1234 CrossRef
- Tiberi, JV, Pulos, N, Kertzner, M, Schmalzried, TP (2012) A more reliable method to assess acetabular component position. Clin Orthop Relat Res. 470: pp. 471-476 CrossRef
- Underwood, RJ, Zografos, A, Sayles, RS, Hart, AJ, Cann, P (2012) Edge loading in metal-on-metal hips: low clearance is a new risk factor. Proc Inst Mech Eng H. 226: pp. 217-226 CrossRef
- Straeten, C, Grammatopoulos, G, Gill, HS, Calistri, A, Campbell, P, Smet, KA (2013) The 2012 Otto Aufranc Award. The interpretation of metal ion levels in unilateral and bilateral hip resurfacing. Clin Orthop Relat Res. 471: pp. 377-385 CrossRef
- Yoo, MC, Cho, YJ, Chun, YS, Rhyu, KH (2011) Impingement between the acetabular cup and the femoral neck after hip resurfacing arthroplasty. J Bone Joint Surg Am. 93: pp. 99-106 CrossRef
- Yoon, JP, Duff, MJ, Johnson, AJ, Takamura, KM, Ebramzadeh, E, Amstutz, HC (2013) Contact patch to rim distance predicts metal ion levels in hip resurfacing. Clin Orthop Relat Res. 471: pp. 1615-1621 CrossRef
- Does Femoral Neck to Cup Impingement Affect Metal Ion Levels in Hip Resurfacing?
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