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Influence of implant design on blood metal ion concentrations in metal-on-metal total hip replacement patients

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Abstract

Purpose

Most factors considered to affect blood metal ions following metal-on-metal hip replacement are based on hip resurfacing patients. The study aims were to determine which factors affect blood metal ion concentrations following metal-on-metal total hip replacement (MoM THR).

Methods

All unilateral MoM THR patients at one centre with whole-blood cobalt (Co) and chromium (Cr) concentrations measured up to May 2013 were included. Blood sampling was at a mean of 4.5 years (range 1.1–11.8 years) postoperatively.

Results

Of 496 patients (mean age 59.1 years; 52.8 % male), blood metal ions >7 μg/l were observed in 9.7 % (n = 48). Large femoral head sizes (≥38 mm) had significantly higher (p < 0.0001) blood metal ions than smaller sizes (28/36 mm). Corail–Pinnacle implants produced significantly lower blood metal ions compared to other implant designs (p < 0.01 Co and Cr). Univariate linear regression demonstrated the only significant predictors of both blood Co and Cr concentrations were femoral head size (R 2 = 8.6 % Co and R 2 = 3.3 % Cr, both p < 0.0001) and implant design (R 2 = 8.8 %, p = 0.005 Co and R2 = 5.1 %, p = 0.003 Cr). When the three THR implant design groups (Corail–Pinnacle, Synergy, Other) were analysed separately, femoral head size no longer significantly affected blood metal ions in any of the three implant design groups.

Conclusions

Implant design was the most important factor affecting blood metal ion concentrations. We recommend the regularity of follow-up be tailored to survival rates of various MoM THR designs rather than according to femoral head size.

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Acknowledgments

The authors thank the Royal College of Surgeons of England and the Arthritis Research Trust for providing one of the authors with funding in the form of a Surgical Research Fellowship.

Conflict of interest

The author or one or more of the authors have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this article. In addition, benefits have been or will be directed to a research fund, foundation, educational institution or other nonprofit organisation with which one or more of the authors are associated.

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  1. The Royal Orthopaedic Hospital, Birmingham, UK, B31 2AP

    Gulraj S. Matharu, Fiona Berryman, Lesley Brash, Paul B. Pynsent, Ronan B. Treacy & David J. Dunlop

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  1. Gulraj S. Matharu
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Correspondence to Gulraj S. Matharu.

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Matharu, G.S., Berryman, F., Brash, L. et al. Influence of implant design on blood metal ion concentrations in metal-on-metal total hip replacement patients. International Orthopaedics (SICOT) 39, 1803–1811 (2015). https://doi.org/10.1007/s00264-014-2644-z

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