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Insufficient Acetabular Version Increases Blood Metal Ion Levels after Metal-on-metal Hip Resurfacing

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Many factors affect the blood metal ion levels after metal-on-metal (MOM) hip arthroplasty. The main surgically adjustable variable is the amount of coverage of the head provided by the cup which is a function of the inclination and version angles. However, most studies have used plain radiographs which have questionable precision and accuracy, particularly for version and large diameter metal heads; further, these studies do not simultaneously assess version and inclination. Thus the relationship between version and blood metal ions levels has not been resolved.

Questions/purposes

We determined whether cup inclination and version influence blood metal ion levels while adjusting for age at assessment, gender, body mass index, horizontal femoral offset, head size, manufacturer hip type, and Oxford hip score.

Patients and Methods

We prospectively followed 100 individuals (51 females, 49 males) with unilateral MOM hip resurfacing who underwent clinical assessment, CT scanning, and blood metal ion measurement. Multiple regression analysis was used to determine which variables were predictors of blood metal ion levels and to model the effect of these variables.

Results

Only cup inclination, version angles, and gender influenced blood cobalt or chromium levels. Cobalt and chromium levels positively correlated with inclination angle and negatively correlated with version angle. The effect of changes in version angle was less than for inclination angle. Based on our observations, we developed a formula to predict the effect of these parameters on metal ion levels.

Conclusions

Our data suggest insufficient cup version can cause high blood metal ions after MOM hip arthroplasty. We were unable to show that excessive version caused high levels.

Level of Evidence

Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Gwynneth Lloyd for assistance in coordinating the additional investigations for the followup clinics, Prof. Justin Cobb for general support in the hospital for the study, and Prof. Jonathan Powell for assistance in data analysis.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Imperial College, Charing Cross Hospital Campus, London, SW7 2AZ, UK

    Alister J. Hart FRCSG(Orth) & Johann Henckel MRCS

  2. Department of Orthopaedic Surgery, Royal National Orthopaedic Hospital, University College London, London, UK

    John A. Skinner FRCS(Orth)

  3. Department of Clinical Chemistry, Imperial College and Imperial College Healthcare NHS Trust, Charing Cross Hospital Campus, London, UK

    Barry Sampson MRSC CChem

  4. Statistical Advisory Service, Imperial College, South Kensington Campus, London, UK

    Fabiana Gordon PhD

Authors
  1. Alister J. Hart FRCSG(Orth)
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  2. John A. Skinner FRCS(Orth)
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  3. Johann Henckel MRCS
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  4. Barry Sampson MRSC CChem
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  5. Fabiana Gordon PhD
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Corresponding author

Correspondence to Alister J. Hart FRCSG(Orth).

Additional information

The institution of one or more of the authors (AH and JS) has received funding from the British Orthopaedic Association (BOA) through an industry consortium of nine manufacturers: Depuy, Zimmer, Smith & Nephew, Biomet, JRI, Finsbury, Corin, Mathys and Stryker.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Imperial College London.

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Hart, A.J., Skinner, J.A., Henckel, J. et al. Insufficient Acetabular Version Increases Blood Metal Ion Levels after Metal-on-metal Hip Resurfacing. Clin Orthop Relat Res 469, 2590–2597 (2011). https://doi.org/10.1007/s11999-011-1930-y

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  • DOI: https://doi.org/10.1007/s11999-011-1930-y

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