Archives of Orthopaedic and Trauma Surgery

, Volume 136, Issue 12, pp 1657–1662 | Cite as

Do cobalt and chromium levels predict osteolysis in metal-on-metal total hip arthroplasty?

  • Lisa Renner
  • Tom Schmidt-Braekling
  • Martin Faschingbauer
  • Friedrich BoettnerEmail author
Orthopaedic Surgery



Serum metal ions are part of the regular follow-up routine of patients with metal-on-metal total hip arthroplasties (MoM-THA). Increased cobalt levels have been suggested to indicate implant failure and corrosion.


(1) Is there a correlation between the size of the osteolysis measured on a CT scan and metal ion levels? (2) Can metal ion levels predict the presence of osteolysis in MoM-THA? (3) Are cobalt and chromium serum levels or the cobalt-chromium-ratio diagnostic for osteolysis?

Materials and methods

CT scans of patients (n = 75) with a unilateral MoM-THA (Birmingham Hip System, Smith & Nephew, TN, USA) implanted by a single surgeon were reviewed to determine the presence of osteolysis. Statistical analysis was performed to detect its association with metal ion levels at the time of the imaging exam.


The incidence of osteolysis was the same in men and women (35.6 vs 35.7 %). The cobalt-chromium-ratio correlates with the size of the osteolysis on the CT scan and the femoral component size in the overall study population (p = 0.050, p = 0.001) and in men (p = 0.002, p = 0.001) but not in women (p = 0.312, p = 0.344). The AUC for the cobalt-chromium-ratio to detect osteolysis was 0.613 (p = 0.112) for the overall population, 0.710 for men (p = 0.021) and 0.453 (p = 0.684) for women. The data suggest that a cut off level of 1.71 for the cobalt-chromium-ratio has a sensitivity of 62.5 % and specificity of 72.4 % to identify male patients with osteolysis.


The disproportional increase of cobalt over chromium, especially in male patients with large component sizes can not be explained by wear alone and suggests that other processes (corrosion) might contribute to metal ion levels and might be more pronounced in patients with larger component sizes.


Metal ions Total hip arthroplasty Osteolysis Metal-on-metal CT scan 


Compliance with ethical standards

Conflict of interest

We certify that we have not signed any agreement with commercial interest related to this study, which would in any way limit publication of any and all data generated for the study or to delay publication for any reason. The senior author reports personal fees from Smith & Nephew, personal fees from Ortho Development Corporation and personal fees form Depuy, outside the submitted work.


  1. 1.
    Bolland BJ et al (2011) High failure rates with a large-diameter hybrid metal-on-metal total hip replacement: clinical, radiological and retrieval analysis. J Bone Joint Surg Br 93(5):608–615CrossRefPubMedGoogle Scholar
  2. 2.
    Langton DJ et al (2011) Accelerating failure rate of the ASR total hip replacement. J Bone Joint Surg Br 93(8):1011–1016CrossRefPubMedGoogle Scholar
  3. 3.
    Daniel J et al (2014) Results of Birmingham hip resurfacing at 12 to 15 years: a single-surgeon series. Bone Joint J 96-B(10):1298–1306CrossRefPubMedGoogle Scholar
  4. 4.
    National Joint Replacement Registry Australian Orthopaedic Association, Metal on Metal Total Conventional Hip Arthroplasty Supplementary Report. 2014: AustraliaGoogle Scholar
  5. 5.
    De Smet K et al (2008) Metal ion measurement as a diagnostic tool to identify problems with metal-on-metal hip resurfacing. J Bone Joint Surg Am 90(Suppl 4):202–208CrossRefPubMedGoogle Scholar
  6. 6.
    Bosker BH et al (2015) Pseudotumor formation and serum ions after large head metal-on-metal stemmed total hip replacement. Risk factors, time course and revisions in 706 hips. Arch Orthop Trauma Surg 135(3):417–425CrossRefPubMedGoogle Scholar
  7. 7.
    Cooper HJ et al (2012) Corrosion at the head-neck taper as a cause for adverse local tissue reactions after total hip arthroplasty. J Bone Joint Surg Am 94(18):1655–1661CrossRefPubMedGoogle Scholar
  8. 8.
    Bayley N et al (2015) What are the predictors and prevalence of pseudotumor and elevated metal ions after large-diameter metal-on-metal THA? Clin Orthop Relat Res 473(2):477–484CrossRefPubMedGoogle Scholar
  9. 9.
    Latteier MJ et al (2011) Gender is a significant factor for failure of metal-on-metal total hip arthroplasty. J Arthroplasty 26(6 Suppl):19–23CrossRefPubMedGoogle Scholar
  10. 10.
    Carr AM, DeSteiger R (2008) Osteolysis in patients with a metal-on-metal hip arthroplasty. ANZ J Surg 78(3):144–147CrossRefPubMedGoogle Scholar
  11. 11.
    Lohmann CH et al (2014) Metallic debris from metal-on-metal total hip arthroplasty regulates periprosthetic tissues. World J Orthop 5(5):660–666CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Kurtz S et al (2005) Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am 87(7):1487–1497PubMedGoogle Scholar
  13. 13.
    Lombardi AV et al (2015) Large-diameter metal-on-metal total hip arthroplasty: dislocation infrequent but survivorship poor. Clin Orthop Relat Res 473(2):509–520CrossRefPubMedGoogle Scholar
  14. 14.
    Hayter CL et al (2012) MRI findings in painful metal-on-metal hip arthroplasty. AJR Am J Roentgenol 199(4):884–893CrossRefPubMedGoogle Scholar
  15. 15.
    Bosker BH et al (2012) High incidence of pseudotumour formation after large-diameter metal-on-metal total hip replacement: a prospective cohort study. J Bone Joint Surg Br 94(6):755–761CrossRefPubMedGoogle Scholar
  16. 16.
    Reito A et al (2013) High prevalence of adverse reactions to metal debris in small-headed ASR™ hips. Clin Orthop Relat Res 471(9):2954–2961CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Hart AJ et al (2014) Surveillance of patients with metal-on-metal hip resurfacing and total hip prostheses: a prospective cohort study to investigate the relationship between blood metal ion levels and implant failure. J Bone Joint Surg Am 96(13):1091–1099CrossRefPubMedGoogle Scholar
  18. 18.
    Matharu GS et al (2015) Influence of implant design on blood metal ion concentrations in metal-on-metal total hip replacement patients. Int Orthop. doi: 10.1007/s00264-014-2644-z Google Scholar
  19. 19.
    U.S. Food and Drug Administration, General Recommendation for Orthopaedic Sugeons after Metal-on-Metal Hip Replacment Surgery (Follow-up) (2015)Google Scholar
  20. 20.
    European Federation of National Associations of Orthopedics and Traumatology. Consensus statement “Current evidence on the management of metao-on-metal bearings” (2012). Accessed 18 June 2015
  21. 21.
    Matharu GS et al (2015) Follow-up of metal-on-metal hip arthroplasty patients is currently not evidence based or cost effective. J Arthroplasty. doi: 10.1016/j.arth.2015.03.009 Google Scholar
  22. 22.
    Robinson E et al (2014) Cross-sectional imaging of metal-on-metal hip arthroplasties. Can we substitute MARS MRI with CT? Acta Orthop 85(6):577–584CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Waldstein W, Schmidt-Braekling T, Boettner F (2014) MRI does not detect acetabular osteolysis around metal-on-metal Birmingham THA. Arch Orthop Trauma Surg 134(7):1009–1015CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Health Canada Government of Canada. Metal-on-metal hip implants-information for orthopaedic surgeons regarding patient management following surgery-for health professionals (2015). Accessed 19 June 2015
  25. 25.
    Therapeutic Goods Administration Department of Health Australian Government. Metal-on-metal hip replacement implants–information for general practitioners, orthopaedic surgeons and other health professtional (2012). Accessed19 June 2015 (recommend)
  26. 26.
    Fehring TK et al (2015) Cobalt to Chromium ratio is not a key marker for adverse local tissue reaction (ALTR) in metal on metal hips. J Arthroplasty 30(9 Suppl):107–109CrossRefPubMedGoogle Scholar
  27. 27.
    Reito A, Lainiala O, Eskelinen A (2015) Letter to Editor: cobalt to chromium ratio is not a key marker for adverse local tissue reaction in metal-on-metal hips. J Arthroplasty. doi: 10.1016/j.arth.2015.09.019 PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Lisa Renner
    • 1
    • 2
  • Tom Schmidt-Braekling
    • 3
  • Martin Faschingbauer
    • 1
    • 4
  • Friedrich Boettner
    • 1
    Email author
  1. 1.Hospital for Special SurgeryNew YorkUSA
  2. 2.Department of Orthopedic Surgery, Center for Musculosceletal SurgeryCharite UniversitaetsmedizinBerlinGermany
  3. 3.Department of OrthopedicsUniversity of MuensterMuensterGermany
  4. 4.Department of Orthopedics and Orthopedic SurgeryUniversity of UlmUlmGermany

Personalised recommendations