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Do Retrieval Analysis and Blood Metal Measurements Contribute to Our Understanding of Adverse Local Tissue Reactions?

  • Symposium: ABJS Carl T. Brighton Workshop on Implant Wear and Tribocorrosion of Total Joint Replacements
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Metal-on-metal (MoM) total hip arthroplasties (THAs) and the head-neck and neck-body junctions in modular THA are associated with a variety of local and systemic reactions to their related wear and corrosion products. Although laboratory testing is available, the relationship between laboratory values—including serum metal ion levels—and adverse local tissue reactions (ALTRs) remains controversial and incompletely characterized.

Questions/purposes

(1) What is the range of serum metal levels associated with ALTR in patients who have MoM THAs or corrosion at the head-neck and neck-body junctions in metal-on-polyethylene (or ceramic-on-polyethylene) THAs? (2) How much wear occurs in patients with MoM total hips? (3) Is there evidence of a dose-response relationship between wear and ALTR?

Methods

PubMed and Embase databases were reviewed for English-language studies assessing serum metal levels in the presence of ALTR and papers describing the results of wear measurements from revised MoM implants and ALTR histopathology were systematically reviewed. Reported linear wear data were separated into groups with ALTR and without ALTR as listed in individual papers and graphed to determine whether a dose-response relationship was present between wear and ALTR. Overall, 15 studies including 338 hips with ALTR with corresponding serum metal levels were identified and analyzed. Twelve studies reported the wear depth or volume of MoM components from patients with a variety of local reactions. Two studies investigated corrosion at the head-neck and neck-body junctions in metal-on-polyethylene THA. There was a high level of variability and study heterogeneity, and so data pooling (meta-analysis) could not be performed.

Results

Average reported metal concentrations were elevated above established normal values in patients with ALTR (cobalt concentrations ranged from 5 to 40 ppb, and chromium levels ranged from 5 to 54 ppb). Whereas several studies demonstrated that patients with ALTR had higher average linear wear of the bearing surfaces, this finding was not made in all studies that we identified in this systematic review. Because of this high degree of variability, no clear dose-response relationship between wear and ALTR could be established.

Conclusions

Serum metal level analysis and implant retrieval analysis both contribute to the understanding of ALTR. Serum metal levels generally are elevated in the presence of ALTR but should not be used in isolation for clinical decision-making. Many but not all patients with ALTR, including those with pseudotumors, demonstrate high wear, but more data and more systematic descriptions of the histopathology are needed to define the amount of wear that induces adverse reactions.

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Acknowledgments

We thank Dr Edward Ebramzadeh for his statistical advice related to the analysis of these papers.

Author information

Authors and Affiliations

  1. Orthopaedic Institute for Children, Los Angeles/UCLA Department of Orthopaedic Surgery, Los Angeles, CA, USA

    Patricia A. Campbell PhD & Michael S. Kung BA

  2. J Vernon Luck Research Center, UCLA/Orthopaedic Hospital, 403 W Adams Boulevard, Los Angeles, CA, 90007, USA

    Patricia A. Campbell PhD

  3. Rush University Medical Center, Chicago, IL, USA

    Andrew R. Hsu MD & Joshua J. Jacobs MD

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Corresponding author

Correspondence to Patricia A. Campbell PhD.

Additional information

One of the authors (JJJ) certifies that he has or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000 from Medtronics Sofamor Danek (Memphis, TN, USA), an amount of USD 10,000 to USD 100,000 from Nuvasive (San Diego, CA, USA), and an amount of USD 10,000 to USD 100,000 from Zimmer (Warsaw, IN, USA). One of the authors (PAC) certifies that she has or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000 from DePuy (Warsaw, IN, USA). The institution of one of the authors (PAC) has received, during the study period, funding from DePuy.

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.

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Campbell, P.A., Kung, M.S., Hsu, A.R. et al. Do Retrieval Analysis and Blood Metal Measurements Contribute to Our Understanding of Adverse Local Tissue Reactions?. Clin Orthop Relat Res 472, 3718–3727 (2014). https://doi.org/10.1007/s11999-014-3893-2

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  • DOI: https://doi.org/10.1007/s11999-014-3893-2

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