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



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.


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.


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.


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.


Total hip arthroplasty Quality of life Cobalt Chromium Pseudotumours Revisions 



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.


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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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