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Do cobalt and chromium blood metal ion levels normalize after revision of failed metal-on-metal total hip replacements?

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

Abstract

Introduction

Increased cobalt (Co) and chromium (Cr) serum levels are one reason for revision surgery in metal on metal (MoM) total hip arthroplasty (THA) patients. Dual mobility liners are a simple revision option; however, they preserve the metal shell and stem and it is therefore not clear if metal ion levels will fully normalize after revision surgery.

Material and methods

Between April 2013 and December 2017 25 hips (24 patients) underwent revision from a MoM THA to an off-label dual mobility liner. Five patients were lost to follow-up and one patient refused leaving 18 patients (11 men, 7 female, average age 63.9 years) for pre- and postoperative metal ion level blood tests at a minimum follow-up of 2 years.

Results

Fourteen patients were revised for osteolysis, two for elevated metal ion levels and two for fluid or cysts around the femoral or acetabular component. The average preoperative Co and Cr levels were 8.3 µg/l and 5.0 µg/l, respectively. At a minimum follow-up of 2 years (30–95 months), metal ions dropped to 0.8 µg/l. Harris Hip Score (HHS), Hip Osteoarthritis Outcome Score (HOOS), Visual Analog Scale (VAS) and the UCLA activity score improved non-significantly from pre- to postoperative. There was one postoperative complication in the study cohort. One patient with persisting pain required revision surgery to a standard acetabular component during the follow-up period.

Conclusion

The off-label use of a dual-mobility liner in the current study resulted in normalization of the metal ion levels suggesting that preserving the cobalt-chromium acetabular component has little impact on ion levels. In addition, dual mobility liners have a low complication and revision rate.

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Funding

No funding was received to assist with the preparation of this manuscript.

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Authors and Affiliations

  1. Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Anna Jungwirth-Weinberger, Carola Hanreich & Friedrich Boettner

  2. Kantonsspital Baden, Im Ergel 1, 5404, Baden, Switzerland

    Anna Jungwirth-Weinberger

  3. Evangelisches Krankenhaus, Hans-Sachs-Gasse 10-12, 1180, Vienna, Austria

    Maximilian F. Kasparek

  4. Charite, Chariteplatz 1, 10117, Berlin, Germany

    Lisa Renner

  5. AKH Wien, Währinger Gürtel 18-20, 1090, Vienna, Austria

    Wenzel Waldstein

Authors
  1. Anna Jungwirth-Weinberger
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  2. Carola Hanreich
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  3. Maximilian F. Kasparek
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  4. Lisa Renner
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  5. Wenzel Waldstein
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  6. Friedrich Boettner
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by AJ-W. The first draft of the manuscript was written by AJ-W and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Friedrich Boettner.

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Conflict of interest

FB receives royalties from Orthodevelopment Inc. and Smith and Nephew and compensation from Orthodevelopment Inc., Smith and Nephew, JNJ Depuy and Medtronic, unrelated to this research.

Ethical approval

The study was approved by the institutional review board.

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Jungwirth-Weinberger, A., Hanreich, C., Kasparek, M.F. et al. Do cobalt and chromium blood metal ion levels normalize after revision of failed metal-on-metal total hip replacements?. Arch Orthop Trauma Surg 143, 1217–1221 (2023). https://doi.org/10.1007/s00402-021-04206-2

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  • DOI: https://doi.org/10.1007/s00402-021-04206-2

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