MRI Findings Following Metal on Metal Hip Arthroplasty and Their Relationship With Metal Ion Levels and Acetabular Inclination Angles

Introduction: There have been reported adverse reactions in patients with large head metal-on-metal hip arthroplasty, therefore metal particle debris are a cause for concern. The aim of this study was to evaluate the release trend of metal ions and the correlated variables. Methods: 54 patients were prospectively enrolled into the study from 2004 to 2006. All patients had 36-mm metal head, Pinnacle acetabular component, Summit stem and Ultamet CoCr alloy liner (Depuy Inc.), and underwent clinical and radiological management. The haematic concentration of Cr-Co at 0, 6, 12, 24, 60 and 120 months after the implantation was analysed in a sub-cohort of 34 patients. Results: 10-year revision rate for each case was 8.9%. The average concentration of Co at 120 months was 3.12 μg/L (median 2.20) with 53% values >2 μg/L and 1 >7 μg/L. After 6 months the median levels of Cr and Co were higher than time 0 ( p < 0.0001); no significant differences were found between 6 and 24 months; while Co had significant increase between 60 and 120 months ( p = 0.002). Overweight, University of California at Los Angeles (UCLA) >9 and <50 years old patients have significantly higher circulating metal ions. Discussion: This is 1 of the few prospective studies on the argument. The revision rate is conforming to records. Our data shows ionic concentration is not predictive of revision or adverse reaction to metals. We described a 3-phase trend for Co probably due to the loss of integrity of the surfaces.

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2008 John Charnley Award: Metal Ion Levels After Metal-on-Metal Total Hip Arthroplasty: A Randomized Trial

Clinical Orthopaedics and Related Research ◽

10.1007/s11999-008-0540-9 ◽

2008 ◽

Vol 467 (1) ◽

pp. 101-111 ◽

Cited By ~ 77

Author(s):

C. Anderson Engh ◽

Steven J. MacDonald ◽

Supatra Sritulanondha ◽

Abigail Thompson ◽

Douglas Naudie ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Randomized Trial ◽

Hip Arthroplasty ◽

Metal Ion ◽

Total Hip ◽

Metal On Metal

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The Utility of Metal Ion Trends in Predicting Revision in Metal-on-Metal Total Hip Arthroplasty

The Journal of Arthroplasty ◽

10.1016/j.arth.2017.02.031 ◽

2017 ◽

Vol 32 (9) ◽

pp. S214-S219 ◽

Cited By ~ 9

Author(s):

Bayard C. Carlson ◽

Andrew J. Bryan ◽

Nazly T. Carrillo-Villamizar ◽

Rafael J. Sierra

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Metal Ion ◽

Total Hip ◽

Metal On Metal

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Metal Ion Levels After Metal-on-Metal Total Hip Arthroplasty

The Journal of Bone and Joint Surgery (American) ◽

10.2106/jbjs.m.00164 ◽

2014 ◽

Vol 96 (6) ◽

pp. 448-455 ◽

Cited By ~ 28

Author(s):

C.A. Engh ◽

S.J. MacDonald ◽

S. Sritulanondha ◽

A. Korczak ◽

D. Naudie ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Metal Ion ◽

Total Hip ◽

Metal On Metal

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

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-017-1931-y ◽

2017 ◽

Vol 27 (4) ◽

pp. 527-532 ◽

Cited By ~ 2

Author(s):

Tadahiko Ohtsuru ◽

Yuji Morita ◽

Yasuaki Murata ◽

Shuji Shimamoto ◽

Yutaro Munakata ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Metal Ion ◽

Ion Concentrations ◽

Total Hip ◽

Metal On Metal

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No association between pseudotumors, high serum metal-ion levels and metal hypersensitivity in large-head metal-on-metal total hip arthroplasty at 5–7-year follow-up

Skeletal Radiology ◽

10.1007/s00256-015-2264-8 ◽

2015 ◽

Vol 45 (1) ◽

pp. 115-125 ◽

Cited By ~ 17

Author(s):

Mette Holm Hjorth ◽

Maiken Stilling ◽

Kjeld Soballe ◽

Lars Hans Bolvig ◽

Jacob Pontoppidan Thyssen ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Metal Ion ◽

High Serum ◽

Metal Hypersensitivity ◽

Total Hip ◽

Large Head ◽

Metal On Metal

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Outcomes after the conversion of metal-on-metal hip resurfacing arthroplasty to ceramic-on-ceramic total hip arthroplasty: A retrospective observational study with a mean 10-year follow-up

10.21203/rs.2.21421/v1 ◽

2020 ◽

Author(s):

Weiguang Yu ◽

Mao Shuai ◽

Jinluan Lin ◽

Baomin Chen ◽

Mingdong Zhao ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Metal Ion ◽

Hip Resurfacing ◽

Hip Resurfacing Arthroplasty ◽

Resurfacing Arthroplasty ◽

Metal On Metal ◽

The Mean ◽

Ceramic On Ceramic

Abstract Background The purpose of this retrospective study was to assess clinical outcomes following failed metal-on-metal hip resurfacing arthroplasty (MoM-HRA) revised using ceramic-on-ceramic total hip arthroplasty (CoC-THA) via the direct anterior approach (DAA).Methods Data involving 112 patients (112 hips) with failed primary MoM-HRA that was revised using CoC-THA via the DAA during 2006 - 2018 were retrospectively analysed. The mean age was 54.6 years (45–63 years). Frequent surgical indications for conversion were aseptic loosening and femoral neck fracture. The primary endpoint was the Postel-Merle d’Aubigne functional score (PMA). Secondary endpoints were the major orthopaedic complication rate and serum metal ion levels (chromium and cobalt).Results The mean follow-up time was 10 years (range, 4 - 13 years). The mean PMA improved from 9 (4-14) to 16 (13-18) (p = 0.001). Six patients had undergone a re-revision intervention. Fourteen incidents of aseptic loosening and four periprosthetic fractures were observed. A consistent decline in mean serum metal ion levels was detected [chromium decreased from 36.6 μg/L (12.5-76.5 μg/L) prior to conversion to 2.6 μg/L (0.1-13.5 μg/L) at final follow-up (p = 0.001), cobalt decreased from 37.5 μg/L (6.7-93.2 μg/L) to 2.2 μg/L (1.2-18.4 μg/L) (p =0.003)].Conclusion Failed primary MoM-HRA converted to CoC-THA using the DAA yielded acceptable clinical outcomes.

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Limited need for screening of metal-on-metal hip resurfacing patients beyond 10 years of follow-up

Hip International ◽

10.1177/1120700020917939 ◽

2020 ◽

pp. 112070002091793

Author(s):

Walter van der Weegen ◽

Henk Hoekstra ◽

Koen Brakel ◽

Thea Sijbesma

Keyword(s):

Hip Arthroplasty ◽

Metal Ion ◽

Hip Resurfacing ◽

Implant Survival ◽

Long Term Outcomes ◽

Metal Debris ◽

Metal On Metal ◽

Further Development

Background: National and international guidelines lack consistency on how to screen metal-on-metal (MoM) hip arthroplasty patients for adverse reactions to metal debris (ARMD). Long-term outcomes of MoM hip arthroplasty are scarce, hindering further development of such guidelines. We present the clinical, radiological and ARMD status of 158 cases of hip resurfacing with >10 years follow-up. Methods: A prospective analysis of a cohort of 298 consecutive hip resurfacing procedures was performed at a single institution. All patients underwent MARS-MRI scanning for pseudotumour screening at least once, regardless of symptoms. Implant survival and reasons for revision were analysed for all patients. Clinical, radiological and MARS-MRI results were analysed for 158 unrevised procedures with >10 years follow-up. Results: The implant survival was 85.9% at 14.5 years (95% CI, 81.9–90.6) with revision for all causes as endpoint and 92.3% with MoM disease-related revisions excluded (95% CI, 88.2–95.0). Of the 158 cases with >10 years follow-up, 1 had elevated metal ion levels, 29 had a stable C1 pseudotumour and 6 a stable C2 pseudotumour. All pseudotumours were observed within 3 years after initiating our intensified ARMD screening (2011), with no new pseudotumours observed after that period. Conclusions: We suggest that follow-up of MoM hip resurfacing patients beyond 10 years after surgery can be done with large intervals (i.e. every 5 years), and only earlier if a patient becomes symptomatic.

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