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International Orthopaedics

, Volume 39, Issue 4, pp 631–638 | Cite as

Large fixed-size metal-on-metal total hip arthroplasty: higher serum metal ion levels in patients with pain

  • Christiaan SmeekesEmail author
  • Bastiaan Ongkiehong
  • Bart van der Wal
  • Ron Wolterbeek
  • Jan-Ferdinand Henseler
  • Rob Nelissen
Original Paper

Abstract

Purpose

Recently, concerns have arisen about metal-on-metal (MoM) total hip arthroplasty (THA). Therefore, the purpose of this cross-sectional cohort study was to describe the incidence of pain, pseudotumours, revisions and the relation between elevated metal ion levels, functional outcome and quality of life after MoM THA.

Methods

In 351 patients, 377 MoM THA with a fixed-size 38-mm head were evaluated with a mean follow-up of 30 months (range 11–58). Evaluation included pain, serum metal ions, patient-reported questionnaires (Short Form-36 [SF-36], Hip disability and Osteoarthritis Outcome Score [HOOS] and the Oxford Hip Score [OHS]) and radiological imaging. Sixteen patients did not participate in the screening.

Results

One hundred and eighteen (35 %) patients reported pain and showed significantly higher cobalt and chromium levels compared to patients without pain. Median serum cobalt levels were 4.4 μg/l (interquartile range [IQR] 6.6) and chromium levels were 3.6 μg/l (IQR 4.8). Patients with cobalt levels of ≤5 μg/l reported significantly better outcome on the SF-36 and HOOS. Fifty-seven pseudotumours were identified in 227 THAs. A revision rate of 19 % was observed.

Conclusions

In conclusion, 35 % of the patients experienced pain after MoM THA. These patients showed significantly higher serum metal ion levels. The patient-reported questionnaires indicated significantly better outcome in patients with cobalt levels ≤5 μg/l.

Keywords

Total hip arthroplasty Quality of life Cobalt Chromium Pseudotumours Revisions 

Notes

Acknowledgments

We would like thank Ben Heggelman radiologist at the Meander Medical Centre.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Learmonth ID, Young C, Rorabeck C (2007) The operation of the century: total hip replacement. Lancet 9597:1508–1519. doi: 10.1016/S0140-6736(07)60457-7 CrossRefGoogle Scholar
  2. 2.
    Takenaga RK, Callaghan JJ, Bedard NA, Liu SS, Gao Y (2013) Which functional assessments predict long-term wear after total hip arthroplasty. Clin Orthop Relat Res 8:2586–2594. doi: 10.1007/s11999-013-2968-9 CrossRefGoogle Scholar
  3. 3.
    Burroughs BR, Hallstrom B, Golladay GJ, Hoeffel D, Harris WH (2005) Range of motion and stability in total hip arthroplasty with 28-, 32-, 38-, and 44-mm femoral head sizes. J Arthroplasty 1:11–19. doi: 10.1016/j.arth.2004.07.008 CrossRefGoogle Scholar
  4. 4.
    Goldsmith AA, Dowson D, Isaac GH, Lancaster JG (2000) A comparative joint simulator study of the wear of metal-on-metal and alternative material combinations in hip replacements. Proc Inst Mech Eng H 1:39–47CrossRefGoogle Scholar
  5. 5.
    Zijlstra WP, van den Akken-Scheek I, Zee MJ, van Raay JJ (2011) No clinical difference between large metal-on-metal total hip arthroplasty and 28-mm-head total hip arthroplasty. Int Orthop 12:1771–1776. doi: 10.1007/s00264-011-1233-7 CrossRefGoogle Scholar
  6. 6.
    Back DL, Dalziel R, Young D, Shimmin A (2005) Early results of primary Birmingham hip resurfacings. An independent prospective study of the first 230 hips. J Bone Joint Surg Br 3:324–329CrossRefGoogle Scholar
  7. 7.
    Innmann MM, Gotterbarm T, Kretzer JP, Merle C, Ewerbeck V, Weiss S et al (2014) Minimum ten-year results of a 28-mm metal-on-metal bearing in cementless total hip arthroplasty in patients fifty years of age and younger. Int Orthop 5:929–934. doi: 10.1007/s00264-013-2228-3 CrossRefGoogle Scholar
  8. 8.
    Bosker BH, Ettema HB, Boomsma MF, Kollen BJ, Maas M, Verheyen CC (2012) High incidence of pseudotumour formation after large-diameter metal-on-metal total hip replacement: a prospective cohort study. J Bone Joint Surg Br 6:755–761. doi: 10.1302/0301-620X.94B6.28373 CrossRefGoogle Scholar
  9. 9.
    Prentice JR, Clark MJ, Hoggard N, Morton AC, Tooth C, Paley MN et al (2013) Metal-on-metal hip prostheses and systemic health: a cross-sectional association study 8 years after implantation. PLoS One 6:e66186. doi: 10.1371/journal.pone.0066186 CrossRefGoogle Scholar
  10. 10.
    Fabi D, Levine B, Paprosky W, Della VC, Sporer S, Klein G et al (2012) Metal-on-metal total hip arthroplasty: causes and high incidence of early failure. Orthopedics 7:e1009–e1016. doi: 10.3928/01477447-20120621-12 CrossRefGoogle Scholar
  11. 11.
    Smith AJ, Dieppe P, Vernon K, Porter M, Blom AW (2012) Failure rates of stemmed metal-on-metal hip replacements: analysis of data from the National Joint Registry of England and Wales. Lancet 9822:1199–1204. doi: 10.1016/S0140-6736(12)60353-5 CrossRefGoogle Scholar
  12. 12.
    Meding JB, Meding LK, Keating EM, Berend ME (2012) Low incidence of groin pain and early failure with large metal articulation total hip arthroplasty. Clin Orthop Relat Res 2:388–394. doi: 10.1007/s11999-011-2069-6 CrossRefGoogle Scholar
  13. 13.
    Keurentjes JC, Blane D, Bartley M, Keurentjes JJ, Fiocco M, Nelissen RG (2013) Socio-economic position has no effect on improvement in health-related quality of life and patient satisfaction in total hip and knee replacement: a cohort study. PLoS One 3:e56785. doi: 10.1371/journal.pone.0056785 CrossRefGoogle Scholar
  14. 14.
    de Groot IB, Reijman M, Terwee CB, Bierma-Zeinstra S, Favejee MM, Roos E et al (2009) Validation of the Dutch version of the Hip disability and Osteoarthritis Outcome Score. Osteoarthritis Cartilage 1:132. doi: 10.1016/j.joca.2008.05.014 CrossRefGoogle Scholar
  15. 15.
    Ware JE Jr, Keller SD, Hatoum HT, Kong SX (1999) The SF-36 Arthritis-Specific Health Index (ASHI): I. Development and cross-validation of scoring algorithms. Med Care 5(Suppl):MS40–MS50Google Scholar
  16. 16.
    Gosens T, Hoefnagels NH, de Vet RC, Dhert WJ, van Langelaan EJ, Bulstra SK et al (2005) The “Oxford Heup Score”: the translation and validation of a questionnaire into Dutch to evaluate the results of total hip arthroplasty. Acta Orthop 2:204–211CrossRefGoogle Scholar
  17. 17.
    Hart AJ, Sabah SA, Bandi AS, Maggiore P, Tarassoli P, Sampson B et al (2011) Sensitivity and specificity of blood cobalt and chromium metal ions for predicting failure of metal-on-metal hip replacement. J Bone Joint Surg Br 10:1308–1313. doi: 10.1302/0301-620X.93B10.26249 CrossRefGoogle Scholar
  18. 18.
    Anderson H, Toms AP, Cahir JG, Goodwin RW, Wimhurst J, Nolan JF (2011) Grading the severity of soft tissue changes associated with metal-on-metal hip replacements: reliability of an MR grading system. Skeletal Radiol 3:303–307. doi: 10.1007/s00256-010-1000-7 CrossRefGoogle Scholar
  19. 19.
    Hauptfleisch J, Pandit H, Grammatopoulos G, Gill HS, Murray DW, Ostlere S (2012) A MRI classification of periprosthetic soft tissue masses (pseudotumours) associated with metal-on-metal resurfacing hip arthroplasty. Skeletal Radiol 2:149–155. doi: 10.1007/s00256-011-1329-6 CrossRefGoogle Scholar
  20. 20.
    Lavigne M, Laffosse JM, Ganapathi M, Girard J, Vendittoli P (2011) Residual groin pain at a minimum of two years after metal-on-metal THA with a twenty-eight-millimeter femoral head, THA with a large-diameter femoral head, and hip resurfacing. J Bone Joint Surg Am 93:93–98. doi: 10.2106/JBJS.J.01711 CrossRefPubMedGoogle Scholar
  21. 21.
    Nikolajsen L, Brandsborg B, Lucht U, Jensen TS, Kehlet H (2006) Chronic pain following total hip arthroplasty: a nationwide questionnaire study. Acta Anaesthesiol Scand 4:495–500. doi: 10.1111/j.1399-6576.2006.00976.x CrossRefGoogle Scholar
  22. 22.
    Hart AJ, Sabah S, Henckel J, Lewis A, Cobb J, Sampson B et al (2009) The painful metal-on-metal hip resurfacing. J Bone Joint Surg Br 6:738–744. doi: 10.1302/0301-620X.91B6.21682 CrossRefGoogle Scholar
  23. 23.
    Nilsdotter AK, Lohmander LS, Klassbo M, Roos EM (2003) Hip disability and osteoarthritis outcome score (HOOS)—validity and responsiveness in total hip replacement. BMC Musculoskelet Disord:10. doi: 10.1186/1471-2474-4-10
  24. 24.
    van der Weegen W, Smolders JM, Sijbesma T, Hoekstra HJ, Brakel K, van Susante JL (2012) High incidence of pseudotumours after hip resurfacing even in low risk patients; results from an intensified MRI screening protocol. Hip Int:0. doi: 10.5301/hipint.5000004
  25. 25.
    Keegan GM, Learmonth ID, Case CP (2008) A systematic comparison of the actual, potential, and theoretical health effects of cobalt and chromium exposures from industry and surgical implants. Crit Rev Toxicol 8:645–674. doi: 10.1080/10408440701845534 CrossRefGoogle Scholar
  26. 26.
    Zeng Y, Feng W, Li J, Lu L, Ma C, Zeng J et al (2014) A prospective study concerning the relationship between metal allergy and post-operative pain following total hip and knee arthroplasty. Int Orthop. doi: 10.1007/s00264-014-2367-1 Google Scholar
  27. 27.
    Australian Orthopaedic Association (2012) Hip and knee arthroplasty. Australian National Joint Replacement Registry, Adelaide. Available at: https://aoanjrr.dmac.adelaide.edu.au/annual-reports-2012
  28. 28.
    National Joint Registry for England, Wales and North Ireland (2014). Available at: www.njrcentre.org.uk
  29. 29.
    Wimmer MA, Fischer A, Buscher R, Pourzal R, Sprecher C, Hauert R et al (2010) Wear mechanisms in metal-on-metal bearings: the importance of tribochemical reaction layers. J Orthop Res 4:436–443. doi: 10.1002/jor.21020 Google Scholar
  30. 30.
    Langton DJ, Sidaginamale R, Lord JK, Nargol AV, Joyce TJ (2012) Taper junction failure in large-diameter metal-on-metal bearings. Bone Joint Res 4:56–63. doi: 10.1302/2046-3758.14.2000047 CrossRefGoogle Scholar
  31. 31.
    Kretzer JP, Jakubowitz E, Krachler M, Thomsen M, Heisel C (2009) Metal release and corrosion effects of modular neck total hip arthroplasty. Int Orthop 6:1531–1536. doi: 10.1007/s00264-009-0729-x CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2014

Authors and Affiliations

  • Christiaan Smeekes
    • 1
    • 2
    Email author
  • Bastiaan Ongkiehong
    • 2
  • Bart van der Wal
    • 2
  • Ron Wolterbeek
    • 1
  • Jan-Ferdinand Henseler
    • 1
  • Rob Nelissen
    • 1
  1. 1.Department of OrthopaedicsLeiden University Medical CentreLeidenThe Netherlands
  2. 2.Department of OrthopaedicsMeander Medical CentreAmersfoortThe Netherlands

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