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Do Survival Rate and Serum Ion Concentrations 10 Years After Metal-on-Metal Hip Resurfacing Provide Evidence for Continued Use?

  • Symposium: Papers Presented at the 2011 Meeting of the International Hip Society
  • Published:
Clinical Orthopaedics and Related Research®

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Abstract

Background

Owing to concerns attributable to problems associated with metal-on-metal bearing surfaces, current evidence for the use of hip resurfacing is unclear. Survival rates reported from registries and individual studies are controversial and the limited long-term studies do not conclusively allow one to judge whether hip resurfacing is still a reasonable alternative to conventional THA.

Questions/purposes

We asked whether the long-term survival rate of hip resurfacing is comparable to that of conventional THA and certain factors can be identified that influence serum ion concentration 10 years postoperatively. We specifically assessed (1) the 10-year survivorship in the whole cohort and in male and female patients, (2) serum concentrations of metal ions in patients with hip resurfacing who had not undergone revision surgery, and (3) potential influencing factors on the serum ion concentration.

Methods

We retrospectively reviewed our first 95 patients who had 100 hip resurfacings performed from 1998 to 2001. The median age of the patients at surgery was 52 years (range, 28–69 years); 49% were men. We assessed the survival rate (revision for any reason as the end point), radiographic changes, and serum ion concentrations for cobalt, chromium, and molybdenum. The correlations between serum ion concentration and patient-related factors (age, sex, BMI, activity) and implant-related factors (implant size, cup inclination, stem-shaft angle) were investigated. The minimum followup was 9.3 years (mean, 10 years; range, 9.3–10.5 years).

Results

The 10-year survivorship was 88% for the total cohort. The overall survival rate was greater in men (93%) than in women (84%). Median serum ion levels were 1.9 μg/L for chromium, 1.3 μg/L for cobalt, and 1.6 μg/L for molybdenum. Radiolucent lines around acetabular implants were observed in 4% and femoral neck thinning in 5%.

Conclusions

Although our overall failure rate was greater than anticipated, the relatively low serum ion levels and no revisions for pseudotumors in young male patients up to 10 years postoperatively provide some evidence of the suitability of hip resurfacing in this subgroup.

Level of Evidence

Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank our medical documentation assistants, Heike Voigt, Brit Brethfeld, and Susann Pohle, for assistance in collecting data. We also thank Gerd Dinnebier MD for his methodologic support with serum ion measurement.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University Hospital Carl Gustav Carus Dresden, Fetscherstr 74, 01307, Dresden, Germany

    Albrecht Hartmann MD, Jörg Lützner MD, Stephan Kirschner MD & Klaus-Peter Günther MD

  2. Forum Gesundheit Dresden, Dresden, Germany

    Wolf-Christoph Witzleb MD

Authors
  1. Albrecht Hartmann MD
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  2. Jörg Lützner MD
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  3. Stephan Kirschner MD
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  4. Wolf-Christoph Witzleb MD
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  5. Klaus-Peter Günther MD
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Corresponding author

Correspondence to Klaus-Peter Günther MD.

Additional information

The institution of one or more of the authors has received, in any 1 year, funding from Aesculap AG & Co KG, Tuttlingen, Germany (JL), Mathys AG, Bettlach, Switzerland (JL, SK), Smith & Nephew GmbH, Marl, Germany (JL, KPG, WCW), Stryker GmbH & Co KG, Freiburg, Germany (JL, SK, KPG), Zimmer GmbH, Winterthur, Switzerland (KPG, SK), and Deutsche Arthrose-Hilfe, Frankfurt/Main, Germany (KPG, SK).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

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 the University Hospital Carl Gustav Carus Dresden, Dresden, Germany.

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Hartmann, A., Lützner, J., Kirschner, S. et al. Do Survival Rate and Serum Ion Concentrations 10 Years After Metal-on-Metal Hip Resurfacing Provide Evidence for Continued Use?. Clin Orthop Relat Res 470, 3118–3126 (2012). https://doi.org/10.1007/s11999-012-2329-0

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  • DOI: https://doi.org/10.1007/s11999-012-2329-0

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