Irish Journal of Medical Science (1971 -)

, Volume 188, Issue 1, pp 149–153 | Cite as

Femoral offset found not to affect metal ion levels in metal-on-metal total hip arthroplasty

  • Eoghan PomeroyEmail author
  • Fergal Macnamara
  • Evelyn Murphy
  • Niall McGoldrick
  • Anant Mahapatra
  • Nasir Awan
Original Article



Failure to restore femoral offset in metal on polyethylene total hip arthroplasty (THA) causes polyethylene wear and aseptic loosening. To our knowledge, no study to date has investigated the relationship between femoral offset and wear in metal-on-metal (MOM) THA.


In this study, we investigated the relationship between femoral offset and wear by measuring circulating metal ion levels in MOM THA.


In this retrospective study, we identified patients who had undergone MOM THA with the ASR XL system (DePuy International Ltd., Leeds, UK). Femoral offset was measured using anteroposterior radiographs, and circulating metal ion levels (cobalt and chromium) were recorded.


In total, 95 patients were included (68 males and 27 females). The mean age at the time of surgery was 64.9. Mean time from surgery to blood sampling was 15.4 months. No statistically significant relationship was found between femoral offset and cobalt (p = 0.313) or chromium (p = 0.401) ions.


It is known that failure to restore femoral offset during THA can lead to high rates of wear in metal-on-polyethylene articulations. In our study, no statistically significant relationship was found between femoral offset and serum cobalt or chromium ions. This study adds to the information available to surgeons regarding factors that increase wear in metal-on-metal total hip arthroplasty.


Chromium Cobalt Femoral offset Metal ions Metal-on-metal Total hip arthroplasty 



The authors would like to thank Paula Blake, orthopedic nurse at Our Lady’s Hospital, who worked tirelessly in assisting us with data collection and patient identification.

Compliance with ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Prior to undertaking this study, the local institutional review board was consulted. As it is a retrospective study, the decision was made that formal consent was not required.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Sieber HP, Rieker CB, Köttig P (1999) Analysis of 118 second-generation metal-on-metal retrieved hip implants. J Bone Joint Surg (Br) 81:46–50CrossRefGoogle Scholar
  2. 2.
    Cuckler JM (2005) The rationale for metal-on-metal total hip arthroplasty. Clin Orthop Relat Res 441:132–136CrossRefGoogle Scholar
  3. 3.
    Komistek RD, Dennis DA, Ochoa JA, Haas BD, Hammill C (2002) In vivo comparison of hip separation after metal-on-metal or metal-on-polyethylene total hip arthroplasty. J Bone Joint Surg Am 84–A:1836–1841CrossRefGoogle Scholar
  4. 4.
    Bozic KJ, Kurtz S, Lau E, Ong K, Chiu V, Vail TP, Rubash HE, Berry DJ (2009) The epidemiology of bearing surface usage in total hip arthroplasty in the United States. J Bone Joint Surg Am 91:1614–1620. CrossRefGoogle Scholar
  5. 5.
    de Steiger RN, Hang JR, Miller LN, Graves SE, Davidson DC (2011) Five-year results of the ASR XL acetabular system and the ASR hip resurfacing system: an analysis from the Australian Orthopaedic Association National Joint Replacement Registry. J Bone Joint Surg Am 93:2287–2293. CrossRefGoogle Scholar
  6. 6.
    Pandit H, Whitwell D, Gibbons CLM, Athanasou N, Gill HS, Murray DW (2008) Pseudotumours associated with metal-on- metal hip resurfacings. J Bone Joint Surg 90:847–851. CrossRefGoogle Scholar
  7. 7.
    Campbell P, Shimmin A, Walter L, Solomon M (2008) Metal sensitivity as a cause of groin pain in metal-on-metal hip resurfacing. J Arthroplast 23:1080–1085. CrossRefGoogle Scholar
  8. 8.
    Williams DH, Greidanus NV, Masri BA, Duncan CP, Garbuz DS (2011) Prevalence of pseudotumor in asymptomatic patients after metal-on-metal hip arthroplasty. J Bone Joint Surg Am 93:2164–2171. CrossRefGoogle Scholar
  9. 9.
    Kwon Y-M, Ostlere SJ, McLardy-Smith P, Athanasou NA, Gill HS, Murray DW (2016) “Asymptomatic” pseudotumors after metal-on-metal hip resurfacing arthroplasty. J Arthroplast 26:511–518. CrossRefGoogle Scholar
  10. 10.
    De Smet K, De Haan R, Calistri A, Campbell PA, Ebramzadeh E, Pattyn C 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):202–208. CrossRefGoogle Scholar
  11. 11.
    Langton DJ, Jameson SS, Joyce TJ, Webb J, Nargol AVF (2008) The effect of component size and orientation on the concentrations of metal ions after resurfacing arthroplasty of the hip. J Bone Joint Surg (Br) 90:1143–1151. CrossRefGoogle Scholar
  12. 12.
    Hart AJ, Ilo K, Underwood R, Cann P, Henckel J, Lewis A et al (2011) The relationship between the angle of version and rate of wear of retrieved metal-on-metal resurfacings. Bone Joint J 93–B:315–320Google Scholar
  13. 13.
    De Haan R, Pattyn C, Gill HS, Murray DW, Campbell PA, De Smet K (2008) Correlation between inclination of the acetabular component and metal ion levels in metal-on-metal hip resurfacing replacement. Bone Joint J 90–B:1291–1297Google Scholar
  14. 14.
    Langton DJ, Sprowson AP, Joyce TJ, Reed M, Carluke I, Partington P et al (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) 9191:1287–1295. CrossRefGoogle Scholar
  15. 15.
    Bayley N, Khan H, Grosso P, Hupel T, Stevens D, Snider M, Schemitsch E, Kuzyk P (2014) What are the predictors and prevalence of pseudotumor and elevated metal ions after large-diameter metal-on-metal THA? Clin Orthop Relat Res 473:477–484. CrossRefGoogle Scholar
  16. 16.
    Asayama I, Chamnongkich S, Simpson KJ, Kinsey TL, Mahoney OM (2016) Reconstructed hip joint position and abductor muscle strength after total hip arthroplasty. J Arthroplast 20:414–420. CrossRefGoogle Scholar
  17. 17.
    Devane PA, Robinson EJ, Bourne RB, Rorabeck CH, Nayak NN, Horne JG (1997) Measurement of polyethylene wear in acetabular components inserted with and without cement. A randomized trial. J Bone Joint Surg Am 79:682–689CrossRefGoogle Scholar
  18. 18.
    Bourne RB, Rorabeck CH (2002) Soft tissue balancing: the hip. J Arthroplast 17:17–22. CrossRefGoogle Scholar
  19. 19.
    McGrory BJ, Morrey BF, Cahalan TD, An KN, Cabanela ME (1995) Effect of femoral offset on range of motion and abductor muscle strength after total hip arthroplasty. Bone Joint J 77–B:865–869Google Scholar
  20. 20.
    Fackler CD, Poss R (1980) Dislocation in total hip arthroplasties. Clin Orthop Relat Res 151:169–178Google Scholar
  21. 21.
    Devane PA, Horne JG (1999) Assessment of polyethylene wear in total hip replacement. Clin Orthop Relat Res 369:59–72CrossRefGoogle Scholar
  22. 22.
    Little NJ, Busch CA, Gallagher JA, Rorabeck CH, Bourne RB (2009) Acetabular polyethylene wear and acetabular inclination and femoral offset. Clin Orthop Relat Res 467:2895–2900. CrossRefGoogle Scholar
  23. 23.
    Sakalkale DP, Sharkey PF, Eng K, Hozack WJ, Rothman RH (2001) Effect of femoral component offset on polyethylene wear in total hip arthroplasty. Clin Orthop Relat Res 388:125–134CrossRefGoogle Scholar
  24. 24.
    Bonin N, Jacquot L, Boulard L, Reynaud P, Saffarini M, Lustig S (2016) How to best measure femoral length and lateralisation after total hip arthroplasty on antero-posterior pelvic radiographs. Int Orthop 40:1–7. CrossRefGoogle Scholar
  25. 25.
    Craig P, Bancroft G, Burton A, Collier S, Shaylor P, Sinha A (2014) Raised levels of metal ions in the blood in patients who have undergone uncemented metal-on-polyethylene Trident-Accolade total hip replacement. Bone Joint J 96–B:43–47. CrossRefGoogle Scholar
  26. 26.
    White PB, Meftah M, Ranawat AS, Ranawat CS (2016) A comparison of blood metal ions in total hip arthroplasty using metal and ceramic heads. J Arthroplast 31:16–20. CrossRefGoogle Scholar
  27. 27.
    Cassidy KA, Noticewala MS, Macaulay W, Lee JH, Geller JA (2012) Effect of femoral offset on pain and function after total hip arthroplasty. J Arthroplast 27:1863–1869. CrossRefGoogle Scholar
  28. 28.
    Liebs TR, Nasser L, Herzberg W, Rüther W, Hassenpflug J (2014) The influence of femoral offset on health-related quality of life after total hip replacement. Bone Joint J 96–B:36–42CrossRefGoogle Scholar
  29. 29.
    Mri M (2012) Ref : No authors listed. Medicines and Healthcare products Regulatory Agency (MHRA). Medical device alert: all metal-on-metal (MOM) hip replacements, 2010 MDA/2010/033.–7
  30. 30.
    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) 93–B:1308–1313. CrossRefGoogle Scholar
  31. 31.
    Knight SR, Aujla R, Biswas SP (2011) Total Hip Arthroplasty - over 100 years of operative history. Orthop Rev (Pavia) 3:2–4CrossRefGoogle Scholar
  32. 32.
    Dobbs H (1980) Survivorship of total hip replacements. J Bone Joint Surg (Br) 62-B(2):168–173CrossRefGoogle Scholar
  33. 33.
    Vendittoli P-A, Lavigne M, Girard J, Roy AG (2006) A randomised study comparing resection of acetabular bone at resurfacing and total hip replacement. Bone Joint J 88–B:997–1002Google Scholar
  34. 34.
    Drummond J, Tran P, Fary C (2015) Metal-on-metal hip arthroplasty: a review of adverse reactions and patient management. J Funct Biomater 6:486–499. CrossRefGoogle Scholar
  35. 35.
    Hallab N, Merritt K, Jacobs JJ (2001) Metal sensitivity in patients with orthopaedic implants. J Bone Joint Surg Am 83:428–436CrossRefGoogle Scholar
  36. 36.
    MacDonald SJ (2004) Metal-on-metal total hip arthroplasty: the concerns. Clin Orthop Relat Res 429:86–93CrossRefGoogle Scholar
  37. 37.
    Emmanuel AR, Bergin KM, Kelly GE, McCoy GF, Wozniak AP, Quinlan JF (2014) The effect of acetabular inclination on metal ion levels following metal-on-metal hip arthroplasty. J Arthroplast 29:186–191. CrossRefGoogle Scholar
  38. 38.
    Langton DJ, Joyce TJ, Jameson SS, Lord J, Van Orsouw M, Holland JP et al (2011) Adverse reaction to metal debris following hip resurfacing. Bone Joint J 93–B:164–171Google Scholar
  39. 39.
    Engh CA, MacDonald SJ, Sritulanondha S, Korczak A, Naudie D, Engh C (2014) Metal ion levels after metal-on-metal total hip arthroplasty: a five-year, prospective randomized trial. J Bone Joint Surg Am 96:448–455. CrossRefGoogle Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2018

Authors and Affiliations

  • Eoghan Pomeroy
    • 1
    Email author
  • Fergal Macnamara
    • 2
  • Evelyn Murphy
    • 1
  • Niall McGoldrick
    • 1
  • Anant Mahapatra
    • 2
  • Nasir Awan
    • 2
  1. 1.Department of Trauma and OrthopaedicsCappagh National Orthopaedic HospitalDublinIreland
  2. 2.Department of Trauma and OrthopaedicsOur Lady’s HospitalNavanIreland

Personalised recommendations