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Predictive factors for metal ion levels in metal-on-metal total hip arthroplasty

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Although metal-on-metal (MoM) total hip arthroplasty (THA) and hip resurfacings (HR) have similar bearing surfaces and comparable wear rates, metal ion levels and risk of failure are higher for MoM–THA. The mechanism behind the increased metal ion levels in large head MoM–THA is not completely understood. The current study aims to identify predictive factors for increased metal ion levels in unilateral and bilateral large head MoM–THA.

Materials and methods

99 Birmingham modular MoM–THA in 87 patients with metal ion levels at least 36 months after index procedure were analyzed. Mean follow-up time was 61.3 months (range 37–108) and the relationship of the following variables (gender, age, BMI, follow-up time, UCLA Activity Score, cup inclination, femoral head size, bilateral surgery) on metal ion levels were analyzed with multivariate regression models.

Results

Multivariate regression analysis revealed that bilateral MoM–THA surgery (p < 0.001) had a positive predictive effect on cobalt serum levels, while BMI had a negative (p = 0.018). Female gender (p = 0.012), activity (p = 0.001) and bilateral MoM–THA (p = 0.004) were positively correlated with chromium levels. Positive independent predictors for the cobalt–chromium ratio in the multivariate analysis were overall follow-up time (p = 0.004), bilateral MoM–THA (p < 0.001) and femoral head size (p = 0.007).

Conclusions

The data of the current study suggest that bilateral MoM–THA, increased patient activity levels and female gender are associated with increased chromium levels. Patients with larger component size, longer follow-up time and bilateral MoM–THAs have an increased cobalt–chromium ratio. These patients might be at increased risk for adverse local soft tissue reactions secondary to corrosion. Continuous close monitoring is recommended and bearing-surface change should be discussed if local tissue reactions occur.

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References

  1. Jack CM, Walter WL, Shimmin AJ, Cashman K, de Steiger RN (2013) Large diameter metal on metal articulations. Comparison of total hip arthroplasty and hip resurfacing arthroplasty. J Arthroplasty 28:650–653. https://doi.org/10.1016/j.arth.2012.07.032

    Article  PubMed  Google Scholar 

  2. Hart AJ, Matthies A, Henckel J, Ilo K, Skinner J, Noble PC (2012) Understanding why metal-on-metal hip arthroplasties fail: a comparison between patients with well-functioning and revised birmingham hip resurfacing arthroplasties. AAOS exhibit selection. J Bone Joint Surg Am 94:e22. https://doi.org/10.2106/jbjs.k.01266

    Article  PubMed  Google Scholar 

  3. Renner L, Faschingbauer M, Schmidt-Braekling T, Boettner F (2016) Cobalt serum levels differ in well functioning Birmingham resurfacing and Birmingham modular THA. Arch Orthop Trauma Surg 136:715–721. https://doi.org/10.1007/s00402-016-2439-3

    Article  PubMed  Google Scholar 

  4. Garbuz DS, Tanzer M, Greidanus NV, Masri BA, Duncan CP (2010) The John Charnley Award: metal-on-metal hip resurfacing versus large-diameter head metal-on-metal total hip arthroplasty: a randomized clinical trial. Clin Orthop Relat Res 468:318–325. https://doi.org/10.1007/s11999-009-1029-x

    Article  PubMed  Google Scholar 

  5. Lainiala OS, Moilanen TP, Hart AJ, Huhtala HS, Sabah SA, Eskelinen AP (2016) Higher blood cobalt and chromium levels in patients with unilateral metal-on-metal total hip arthroplasties compared to hip resurfacings. J Arthroplasty 31:1261–1266. https://doi.org/10.1016/j.arth.2015.11.045

    Article  PubMed  Google Scholar 

  6. Vendittoli PA, Amzica T, Roy AG, Lusignan D, Girard J, Lavigne M (2011) Metal Ion release with large-diameter metal-on-metal hip arthroplasty. J Arthroplasty 26:282–288. https://doi.org/10.1016/j.arth.2009.12.013

    Article  PubMed  Google Scholar 

  7. Matthies A, Underwood R, Cann P, Ilo K, Nawaz Z, Skinner J, Hart AJ (2011) Retrieval analysis of 240 metal-on-metal hip components, comparing modular total hip replacement with hip resurfacing. J Bone Joint Surg Br 93:307–314. https://doi.org/10.1302/0301-620x.93b3.25551

    Article  CAS  PubMed  Google Scholar 

  8. Hothi HS, Berber R, Whittaker RK, Blunn GW, Skinner JA, Hart AJ (2016) The relationship between cobalt/chromium ratios and the high prevalence of head-stem junction corrosion in metal-on-metal total hip arthroplasty. J Arthroplasty 31:1123–1127. https://doi.org/10.1016/j.arth.2015.11.014

    Article  PubMed  Google Scholar 

  9. Meyer H, Mueller T, Goldau G, Chamaon K, Ruetschi M, Lohmann CH (2012) Corrosion at the cone/taper interface leads to failure of large-diameter metal-on-metal total hip arthroplasties. Clin Orthop Relat Res 470:3101–3108. https://doi.org/10.1007/s11999-012-2502-5

    Article  PubMed  PubMed Central  Google Scholar 

  10. Del Balso C, Teeter MG, Tan SC, Lanting BA, Howard JL (2015) Taperosis: does head length affect fretting and corrosion in total hip arthroplasty?. Bone Joint J 97-b:911–916. https://doi.org/10.1302/0301-620x.97b7.35149

    Article  PubMed  Google Scholar 

  11. Hart AJ, Muirhead-Allwood S, Porter M, Matthies A, Ilo K, Maggiore P, Underwood R, Cann P, Cobb J, Skinner JA (2013) Which factors determine the wear rate of large-diameter metal-on-metal hip replacements? Multivariate analysis of two hundred and seventy-six components. J Bone Joint Surg Am 95:678–685. https://doi.org/10.2106/jbjs.j.01447

    Article  CAS  PubMed  Google Scholar 

  12. Hutt J, Lavigne M, Lungu E, Belzile E, Morin F, Vendittoli PA (2016) Comparison of whole-blood metal ion levels among four types of large-head, metal-on-metal total hip arthroplasty implants: a concise follow-up, at five years, of a previous report. J Bone Joint Surg Am 98:257–266. https://doi.org/10.2106/jbjs.o.00201

    Article  PubMed  Google Scholar 

  13. Bottner F, Delgado S, Sculco TP (2006) Minimally invasive total hip replacement: the posterolateral approach. Am J Orthop (Belle Mead NJ) 35:218–224

    Google Scholar 

  14. Leslie I, Williams S, Brown C, Isaac G, Jin Z, Ingham E, Fisher J (2008) Effect of bearing size on the long-term wear, wear debris, and ion levels of large diameter metal-on-metal hip replacements—an in vitro study. J Biomed Mater Res B Appl Biomater 87:163–172. https://doi.org/10.1002/jbm.b.31087

    Article  PubMed  Google Scholar 

  15. Affatato S, Leardini W, Jedenmalm A, Ruggeri O, Toni A (2007) Larger diameter bearings reduce wear in metal-on-metal hip implants. Clin Orthop Relat Res 456:153–158. https://doi.org/10.1097/01.blo.0000246561.73338.68

    Article  CAS  PubMed  Google Scholar 

  16. Bowsher JG, Hussain A, Williams PA, Shelton JC (2006) Metal-on-metal hip simulator study of increased wear particle surface area due to ‘severe’ patient activity. Proc Inst Mech Eng H 220:279–287. https://doi.org/10.1243/09544119jeim93

    Article  CAS  PubMed  Google Scholar 

  17. Sawalha S, Ravikumar R, Chowdhury EA, Massraf A (2012) The effect of obesity on blood metal ion levels after hip resurfacing and metal-on-metal total hip replacement. Hip Int 22:107–112. https://doi.org/10.5301/hip.2012.9034

    Article  PubMed  Google Scholar 

  18. Nadler SB, Hidalgo JH, Bloch T (1962) Prediction of blood volume in normal human adults. Surgery 51:224–232

    PubMed  Google Scholar 

  19. Renner L, Schmidt-Braekling T, Faschingbauer M, Boettner F (2016) Do cobalt and chromium levels predict osteolysis in metal-on-metal total hip arthroplasty? Arch Orthop Trauma Surg 136:1657–1662. https://doi.org/10.1007/s00402-016-2565-y

    Article  PubMed  Google Scholar 

  20. Yan Y, Neville A, Dowson D (2006) Understanding the role of corrosion in the degradation of metal-on-metal implants. Proc Inst Mech Eng H 220:173–181

    Article  CAS  PubMed  Google Scholar 

  21. Urish KLHN, Giori NJ, Lavernia CJ, Plakseychuk A, Hamlin BR, Milhalko WM, Anderson P (2016) Trunnion corrosion in total hIp Arthroplasty: diagnosis, evaluation, and management. AAOS Annual Meeting 2016, March 1–5, Orlando, FL, USA

  22. Bolland BJ, Culliford DJ, Langton DJ, Millington JP, Arden NK, Latham JM (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 93:608–615. https://doi.org/10.1302/0301-620x.93b5.26309

    Article  CAS  PubMed  Google Scholar 

  23. Smith J, Lee D, Bali K, Railton P, Kinniburgh D, Faris P, Marshall D, Burkart B, Powell J (2014) Does bearing size influence metal ion levels in large-head metal-on-metal total hip arthroplasty? A comparison of three total hip systems. J Orthop Surg Res 9:3. https://doi.org/10.1186/1749-799x-9-3

    Article  PubMed  PubMed Central  Google Scholar 

  24. Magone K, Luckenbill D, Goswami T (2015) Metal ions as inflammatory initiators of osteolysis. Arch Orthop Trauma Surg 135:683–695. https://doi.org/10.1007/s00402-015-2196-8

    Article  PubMed  Google Scholar 

  25. Vendittoli PA, Roy A, Mottard S, Girard J, Lusignan D, Lavigne M (2010) Metal ion release from bearing wear and corrosion with 28 mm and large-diameter metal-on-metal bearing articulations: a follow-up study. J Bone Joint Surg Br 92:12–19. https://doi.org/10.1302/0301-620x.92b1.22226

    Article  PubMed  Google Scholar 

  26. Shahgaldi BF, Heatley FW, Dewar A, Corrin B (1995) In vivo corrosion of cobalt-chromium and titanium wear particles. J Bone Joint Surg Br 77:962–966

    CAS  PubMed  Google Scholar 

  27. Pelt CE, Bergeson AG, Anderson LA, Stoddard GJ, Peters CL (2011) Serum metal ion concentrations after unilateral vs bilateral large-head metal-on-metal primary total hip arthroplasty. J Arthroplasty 26:1494–1500. https://doi.org/10.1016/j.arth.2011.03.037

    Article  PubMed  Google Scholar 

  28. Langton DJ, Sidaginamale R, Lord JK, Nargol AV, Joyce TJ (2012) Taper junction failure in large-diameter metal-on-metal bearings. Bone Joint Res 1:56–63. https://doi.org/10.1302/2046-3758.14.2000047

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Lavigne M, Belzile EL, Roy A, Morin F, Amzica T, Vendittoli PA (2011) Comparison of whole-blood metal ion levels in four types of metal-on-metal large-diameter femoral head total hip arthroplasty: the potential influence of the adapter sleeve. J Bone Joint Surg Am 93 Suppl 2:128–136. https://doi.org/10.2106/jbjs.j.01885

  30. Witt F, Bosker BH, Bishop NE, Ettema HB, Verheyen CC, Morlock MM (2014) The relation between titanium taper corrosion and cobalt-chromium bearing wear in large-head metal-on-metal total hip prostheses: a retrieval study. J Bone Joint Surg Am 96:e157. https://doi.org/10.2106/jbjs.m.01199

    Article  CAS  PubMed  Google Scholar 

  31. Higgs GB, Hanzlik JA, MacDonald DW, Gilbert JL, Rimnac CM, Kurtz SM (2013) Is increased modularity associated with increased fretting and corrosion damage in metal-on-metal total hip arthroplasty devices?: a retrieval study. J Arthroplasty 28:2–6. https://doi.org/10.1016/j.arth.2013.05.040

    Article  PubMed  PubMed Central  Google Scholar 

  32. Matthies AK, Racasan R, Bills P, Blunt L, Cro S, Panagiotidou A, Blunn G, Skinner J, Hart AJ (2013) Material loss at the taper junction of retrieved large head metal-on-metal total hip replacements. J Orthop Res 31:1677–1685. https://doi.org/10.1002/jor.22431

    PubMed  Google Scholar 

  33. Waldstein W, Schmidt-Braekling T, Boettner F (2014) MRI does not detect acetabular osteolysis around metal-on-metal Birmingham THA. Arch Orthop Trauma Surg 134:1009–1015. https://doi.org/10.1007/s00402-014-2005-9

    Article  PubMed  PubMed Central  Google Scholar 

  34. Renner L, Faschingbauer M, Boettner F (2015) Is there a rationale to use a dual mobility poly insert for failed Birmingham metal-on-metal hip replacements? A retrieval analysis. Arch Orthop Trauma Surg 135:1177–1181. https://doi.org/10.1007/s00402-015-2256-0

    Article  PubMed  Google Scholar 

  35. Kasparek MF, Renner L, Faschingbauer M, Waldstein W, Rueckl K, Boettner F (2017) Salvage of a monoblock metal-on-metal cup using a dual mobility liner: a two-year MRI follow-up study. Int Orthop. https://doi.org/10.1007/s00264-017-3641-9

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Maximilian F. Kasparek & Friedrich Boettner

  2. Orthopaedic Department, Center for Musculoskeletal Surgery, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Lisa Renner

  3. Department of Orthopedic Surgery, University Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany

    Martin Faschingbauer

  4. Department of Orthopedics, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria

    Maximilian F. Kasparek & Wenzel Waldstein

  5. Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria

    Michael Weber

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I attest to the fact that all authors have participated in the research, read the manuscript, attest to the validity and legitimacy of the data and its interpretation, and agree to its submission.

Corresponding author

Correspondence to Friedrich Boettner.

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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. Dr. Boettner reports personal fees from Smith & Nephew, personal fees from Ortho Development Corporation and personal fees form Depuy, outside the submitted work. The senior author reports personal fees from Smith & Nephew, personal fees from Ortho Development Corporation and personal fees form Depuy, outside the submitted work.

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The study was approved by the institutional review board.

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Kasparek, M.F., Renner, L., Faschingbauer, M. et al. Predictive factors for metal ion levels in metal-on-metal total hip arthroplasty. Arch Orthop Trauma Surg 138, 281–286 (2018). https://doi.org/10.1007/s00402-017-2856-y

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