Blood metal ion concentrations in metal-on-metal total hip arthroplasty

  • Tadahiko OhtsuruEmail author
  • Yuji Morita
  • Yasuaki Murata
  • Shuji Shimamoto
  • Yutaro Munakata
  • Yoshiharu Kato
Original Article • HIP - ARTHROPLASTY



The hip placement with a metal-on-metal (MOM) bearing has been used for both surface replacement and total hip arthroplasty (THA). Use of MOM bearing for hip replacement reduces the wear compared to conventional bearings.


We prospectively assessed 30 patients who underwent unilateral MOM THA. A control group of 30 patients who underwent metal-on-polyethylene THA using the implants as the other group, except for bearing, were accessed. Blood samples were collected preoperatively and at 3- , 6- , 9- , 12- , 15- , 18- , and 24-month intervals. Changes in mean blood metal ion concentration were compared between the MOM and metal-on-polyethylene groups.


A statistically significant positive correlation was observed between blood cobalt and chromium concentrations in all of the patients. The mean blood ion concentrations of the MOM were significantly higher than those of the metal-on-polyethylene. A statistically significant negative correlation was found between maximum blood cobalt concentration and cup version angle. The maximum blood chromium concentrations in the patients who had larger cup version angles were more likely to decrease.


We considered that cup version angle is one of the factors that have the greatest effect on blood metal ion concentration, and the target cup version angle that did not induce an increase in blood metal ion concentrations was approximately 20°.


Angle Metal Ions Metal-on-metal Total hip arthroplasty Cup version angle 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Ethical Committee of Tokyo Women’s Medical University dated October 21, 2008 and approval number 1460. Written informed consent was obtained from all patients involved in the study.


  1. 1.
    Somers JF, Van Der Straeten C, De Coninck L (2016) High serum ion levels in Conserve Plus big femoral head cemented total hip arthroplasty. Hip Int 26:474–478CrossRefPubMedGoogle Scholar
  2. 2.
    McGrory BJ, Payson AM, MacKenzie JA (2016) Elevated intra-articular cobalt and chromium levels in mechanically assisted crevice corrosion in metal-on-polyethylene total hip arthroplasty. J Arthroplasty. doi: 10.1016/j.arth.2016.11.056 (Epub ahead of print) PubMedGoogle Scholar
  3. 3.
    De Pasquale D, Stea S, Squarzoni S, Bordini B, Amabile M, Catalani S, Apostoli P, Toni A (2014) Metal-on-metal hip prostheses: correlation between debris in the synovial fluid and levels of cobalt and chromium ions in the bloodstream. Int Orthop 38:469–475CrossRefPubMedGoogle Scholar
  4. 4.
    Hasegawa M, Iino T, Sudo A (2016) Immune response in adverse reactions to metal debris following metal-on-metal total hip arthroplasty. BMC Musculoskelet Disord 17:221. doi: 10.1186/s12891-01 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Nakamura M, Shimakawa T, Nakano S, Chikawa T, Yoshioka S, Kashima M, Toki S, Horiguchi H, Sairyo K (2016) Failure rates of Asian-type anatomic medullary locking stemmed metal-on-metal total hip replacement: a cause for adverse tissue reactions to metal debris (ARMD). J Orthop Sci 21:779–785. doi: 10.1016/j.jos.2016.07.020 CrossRefPubMedGoogle Scholar
  6. 6.
    Akrawi H, Hossain FS, Niculescu S, Hashim Z, Ng AB, Shetty A (2016) Midterm results of 36 mm metal-on-metal total hip arthroplasty. Indian J Orthop 50:256–262. doi: 10.4103/0019-5413.181786 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Goyal P, Howard JL, Yuan X, Teeter MG, Lanting BA (2016) Effect of acetabular position on polyethylene liner wear measured using simultaneous biplanar acquisition. J Arthroplasty. doi: 10.1016/j.arth.2016.11.057 (Epub ahead of print) Google Scholar
  8. 8.
    Lombardi AV Jr, Berend KR, Morris MJ, Adams JB, Snelle MA (2015) Large-diameter metal-on-metal total hip arthroplasty: dislocation infrequent but survivorship poor. Clin Orthop Relat Res 473:509–520. doi: 10.1007/s11999-014-3976-0 (Epub 2014 Nov 4) CrossRefPubMedGoogle Scholar
  9. 9.
    Patil S, Bergula A, Chen PC, Colwell CW Jr, D’Lima DD (2003) Polyethylene wear and acetabular component orientation. J Bone Joint Surg Am 85:56–63CrossRefPubMedGoogle Scholar
  10. 10.
    De Haan R, Pattyn C, Gill HS, Murray DW, Campbell PA, DeSmet K (2008) Correlation between inclination of the acetabular component and metal ion levels in metal-on-metal hip resurfacing replacement. J Bone Joint Surg Br 90:1291–1297CrossRefPubMedGoogle Scholar
  11. 11.
    Hart AJ, Buddhdev P, Winship P, Faria N, Powell JJ, Skinner JA (2008) Cup inclination angle of greater than 50 degrees increases whole blood concentrations of cobalt and chromium ions after metal-on-metal hip resurfacing. Hip Int 18:212–219CrossRefPubMedGoogle Scholar
  12. 12.
    Langton DJ, Sprowson AP, Joyce TJ, Reed M, Carluke I, Partington P, Nargol AV (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 91:1287–1295CrossRefPubMedGoogle Scholar
  13. 13.
    Desy NM, Bergeron SG, Petit A, Huk OL, Antoniou J (2011) Surgical variables influence metal ion levels after hip resurfacing. Clin Orthop Relat Res 469:1635–1641CrossRefPubMedGoogle Scholar
  14. 14.
    Hart AJ, Skinner JA, Henckel J, Sampson B, Gordon F (2011) Insufficient acetabular version increases blood metal ion levels after metal-on-metal hip resurfacing. Clin Orthop Relat Res 469:2590–2597CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Ohtsuru T, Morita Y, Munakata Y, Kato Y (2013) The relation of blood metal ion concentrations in a 3rd generation metal-on-metal THA, a component installation angle, an activity, and a patient background factor. Hip Jt 39:772–776 (in Japanese) Google Scholar
  16. 16.
    Pattyn CA, Lauwagie SN, Verdonk RC (2011) Whole blood metal ion concentrations in correlation with activity level in three different metal-on-metal bearings. J Arthroplasty 26:58–64CrossRefPubMedGoogle Scholar
  17. 17.
    Seki T, Hasegawa Y, Kanoh T, Matsuoka A, Ishiguro N, Tsuboi M, Kawabe K (2011) Relation between activity level and blood metal ion concentrations after metal-on-metal THA. Jpn J Replace Arthroplasty 41:336–337 (in Japanese) Google Scholar
  18. 18.
    Dowson D, Hardaker C, Flett M, Isaac GH (2004) A hip joint simulator study of the performance of metal-on-metal joints. J Arthroplasty 19:124–130PubMedGoogle Scholar
  19. 19.
    Williams S, Leslie I, Isaac G, Jin Z, Ingham E, Fisher J (2008) Tribology and wear of metal-on-metal hip prostheses: influence of cup angle and head position. J Bone Joint Surg Am 90:111–117CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag France 2017

Authors and Affiliations

  • Tadahiko Ohtsuru
    • 1
    Email author
  • Yuji Morita
    • 1
  • Yasuaki Murata
    • 1
  • Shuji Shimamoto
    • 1
  • Yutaro Munakata
    • 1
  • Yoshiharu Kato
    • 2
  1. 1.Department of Orthopedic SurgeryTokyo Women’s Medical UniversityTokyoJapan
  2. 2.Kita Shinagawa 3rd HospitalTokyoJapan

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