Modular junction may be more problematic than bearing wear in metal-on-metal total hip arthroplasty

Introduction: In total hip arthroplasty (THA), local adverse reaction to metal debris (ARMD) may be caused by abnormal metal ion release from a metal-on-metal (MoM) bearing, or by wear and corrosion of the implant’s modular junction. The aim of this study was to compare ion levels and rate of ARMD between patients sharing the same MoM bearing but 1 group having monoblock stems versus another having modular stems. Materials and methods: Whole blood cobalt (Co) and chromium (Cr) ion concentrations, ARMD rate, revision rate, and function measured by UCLA and WOMAC scores were compared between groups. Results: ARMD rate was significantly higher in the modular group (46%) compared with the monoblock group (16%, p = 0.031). Revision for ARMD was performed at 52.8 ± 8.1 months in the modular group versus 98.2 ± 15.5 months after primary THA in the monoblock group. ARMD originated from wear and corrosion of the junction between stem and femoral head adapter sleeve in all monoblock cases, and the junction between stem and modular neck in all the modular ones. Cr and Co ions levels were significantly higher in the modular stem group ( p < 0.001 for both). Conclusions: Although both groups had MoM bearings, corrosion at stem/neck or neck/head junctions combining dissimilar metal (Ti and Cr-Co) was seen as the source of excess metal ions release leading to ARMD. Poor performance of the modular junction may be more deleterious than wear of the bearing. To avoid such complications, THA femoral stem modular junctions should be eliminated (return to a full monoblock implant) or have improved junction design.

Download Full-text

Metal Ion Release after a Metal-on-Metal Hip Arthroplasty: Comparison between Resurfacing Arthroplasty and Total Hip Arthroplasty

The Journal of the Korean Orthopaedic Association ◽

10.4055/jkoa.2004.39.6.686 ◽

2004 ◽

Vol 39 (6) ◽

pp. 686

Author(s):

Soo Ho Lee ◽

Su Hyun Cho ◽

Tae Seok Nam

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Metal Ion ◽

Ion Release ◽

Total Hip ◽

Resurfacing Arthroplasty ◽

Metal On Metal ◽

Metal Ion Release

Download Full-text

Metal Ion Release, Clinical and Radiological Outcomes in Large Diameter Metal-on-Metal Total Hip Arthroplasty at Long-Term Follow-Up

Diagnostics ◽

10.3390/diagnostics10110941 ◽

2020 ◽

Vol 10 (11) ◽

pp. 941

Author(s):

Assunta Pozzuoli ◽

Antonio Berizzi ◽

Alberto Crimì ◽

Elisa Belluzzi ◽

Anna Chiara Frigo ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Metal Ion ◽

Local Level ◽

Harris Hip Score ◽

Control Group ◽

Ion Release ◽

Total Hip ◽

Metal On Metal ◽

Metal Ion Release

Total hip arthroplasty (THA) with metal-on-metal (MoM) bearings have shown problems of biocompatibility linked to metal ion release at the local level causing an adverse reaction to metal debris (ARMD) and at a systemic level. The aim of this study was to evaluate clinical and radiological outcomes, and metal ion concentrations in the blood and urine of patients who underwent THA with the LIMA Met-Met hip system. Patients with ceramic-on-ceramic (CoC) bearings were included as a control group. In this study, 68 patients were enrolled: 34 with MoM THAs and 34 with CoC THAs. Patients were evaluated clinically (Harris Hip Score, SF-36) and radiologically at a median of 7.4 years after surgery. Whole blood and urinary cobalt and chromium levels were also assessed. Both types of implants were comparable in terms of clinical and functional results. Ion levels were significantly higher in the MoM group compared with CoC group 7 years after surgery. No correlations were found between metal ion levels and patient demographics, functional and radiological outcomes, and prosthesis features. Patient monitoring is thus advised to establish if prosthesis revision is necessary, especially in the case of MoM THA.

Download Full-text

Abstract 17269: Incidence of Atrial Fibrillation in Patients With Cobalt and Chromium Containing Hip Arthroplasty

Circulation ◽

10.1161/circ.138.suppl_1.17269 ◽

2018 ◽

Vol 138 (Suppl_1) ◽

Author(s):

Sunita Sharma ◽

Shiva Ponamgi ◽

Christopher Desimone ◽

Cody Wyles ◽

Philip Sun ◽

...

Keyword(s):

Atrial Fibrillation ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Group Versus ◽

True Incidence ◽

Total Hip ◽

Metal On Metal ◽

All Cause Mortality ◽

Metal Group ◽

Serum Cobalt

Background: Worldwide, approximately one million patients have had total hip arthroplasty with 35% being cobalt and chromium Metal-on-Metal (MoM) or Metal-on-Polythelene (MoP) implants. Animal models have suggested that cobalt and chromium can affect all chambers, but there seems to be an atrial predilection. There are several case reports of metal containing hip arthroplasty causing atrial arrhythmias but the true incidence of atrial fibrillation associated with metal hip arthroplasty remains undefined. Objective: We sought to determine the incidence of atrial fibrillation in patients with metal containing hip arthroplasty. We also examined the association between serum cobalt and chromium levels and arrhythmias in this cohort and all cause mortality. Methods: We retrospectively examined the records of patients from the Mayo Clinic total hip arthroplasty registry (Metal group - Metal-on-Metal: MoM and Metal-on-Polyethylene: MoP, Non-Metal group - Ceramic-on-Ceramic: CoC and Ceramic-on-Polyethylne: CoP) to obtain demographic data, comorbidities, laboratory, ECG, and echocardiographic data. Out of a total of 1756 patients, Cobalt and Chromium levels were available in 138 patients. Results: The mean age of patients with metal containing hip replacement was 50 years and were predominantly male. During a follow up period of 10 years, the incidence of atrial fibrillation in our study population was 8% in metal group compared to 2% (p=0.11) in non-metal group. There was no association between cobalt or chromium levels with the incidence of atrial fibrillation. All-cause mortality was significantly higher in metal group versus non-metal group (p=0.005). Conclusion: The incidence of atrial fibrillation was relatively more in patients with metal versus non-metal hip arthroplasty but there was no association of serum cobalt or chromium levels with incidence of atrial fibrillation in the subset of patients. In addition, all-cause mortality was significantly higher in the metal group suggesting potential toxic effects of metal containing hip arthroplasty.

Download Full-text