Does modularity of metal-on-metal hip implants increase cobalt: chromium ratio?

Background: Blood metal ion levels are used in the surveillance of metal-on-metal (MoM) hip implants. Modular implants contain an extra source of metal debris that may affect the ratio of metal ions in the blood. Methods: This was a retrospective study of 503 patients with hip replacements made by a single manufacturer (Smith & Nephew, Warwick, UK) with the same bearing surface. There were 54 total hip arthroplasties, 35 Birmingham Mid-Head Resections and 414 hip resurfacings. Whole blood metal ion levels and their ratios were analysed to investigate the effect of a modular junction. Results: The cobalt:chromium ratios were greater in the total hip arthroplasty group (mean 2.3:1) when compared to the resurfacings group (mean 1.3:1, p = <0.05) and Birmingham Mid-Head Resection group (mean 1.1:1, p = 0.11). Conclusions: This study demonstrated a trend for a higher cobalt:chromium ratio in patients with MoM total hip replacement that may be due to metal debris from the modular stem-head junction. Further work is required to correlate clinical data with retrieval analysis to confirm the effect of taper material loss on the cobalt:chromium ratio.

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Outcomes of a metal-on-metal total hip replacement system

Annals of The Royal College of Surgeons of England ◽

10.1308/003588414x14055925058030 ◽

2014 ◽

Vol 96 (7) ◽

pp. 530-535 ◽

Cited By ~ 21

Author(s):

GS Matharu ◽

K Theivendran ◽

PB Pynsent ◽

L Jeys ◽

AM Pearson ◽

...

Keyword(s):

Femoral Head ◽

Metal Ion ◽

Metal Debris ◽

Total Hip ◽

Metal On Metal ◽

Significant Difference ◽

Hip Replacements ◽

Specialist Centre ◽

Clinical Surveillance ◽

The Mean

Introduction High short-term failure rates have been reported for a variety of metal-on-metal (MoM) total hip replacements (THRs) owing to adverse reactions to metal debris (ARMD). This has led to the withdrawal of certain poorly performing THRs. This study analysed the outcomes of a MoM THR system. Methods Between 2004 and 2010, 578 uncemented MoM THRs (511 patients, mean age: 60.0 years) were implanted at one specialist centre. The THR system used consisted of the Corail® stem, Pinnacle® cup, Ultamet® liner and Articul/eze® femoral head (all DePuy, Leeds, UK). All patients were recalled for clinical review with imaging performed as necessary. Results The mean follow-up duration was 5.0 years (range: 1.0–9.1 years). Overall, 39 hips (6.7%) in 38 patients (all 36mm femoral head size) underwent revision at a mean time of 3.5 years (range: 0.01–8.3 years) from the index THR with 30 revisions (77%) performed in women. The cumulative eight-year survival rate for all THRs was 88.9% (95% confidence interval [CI]: 78.5–93.4%), with no difference (p=0.053) between male (95.2%, 95% CI: 84.2–98.7%) and female patients (85.3%, 95% CI: 70.2–92.1%) at eight years. Seventeen revisions (44%) were performed for ARMD. There was no significant difference in absolute postoperative Oxford hip scores between men and women (p=0.608). The mean acetabular inclination in unrevised THRs was 44.0°. Forty-seven non-revised THRs (8.7%) had blood metal ion concentrations above recommended thresholds (seven had periprosthetic effusions). Conclusions Although this MoM THR system has not failed as dramatically as other similar designs, we recommend against continued use and advise regular clinical surveillance to identify ARMD early.

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Incidence of Adverse Reactions to Metal Debris From 28-mm Metal-on-Metal Total Hip Arthroplasties With Minimum 10 Years of Follow-Up: Clinical, Laboratory, and Ultrasound Assessment of 44 Cases

The Journal of Arthroplasty ◽

10.1016/j.arth.2016.11.013 ◽

2017 ◽

Vol 32 (4) ◽

pp. 1206-1210 ◽

Cited By ~ 5

Author(s):

Béchir Ayoub ◽

Sophie Putman ◽

Pierre Cholewinski ◽

Amandine Paris ◽

Henri Migaud ◽

...

Keyword(s):

Adverse Reactions ◽

Clinical Laboratory ◽

Metal Debris ◽

Total Hip ◽

Metal On Metal ◽

Ultrasound Assessment ◽

Hip Arthroplasties

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Surface Characterization of Retrieved Metal-on-Metal Total Hip Implants from Patients with Adverse Reaction to Metal Debris

Materials ◽

10.3390/ma7031866 ◽

2014 ◽

Vol 7 (3) ◽

pp. 1866-1879 ◽

Cited By ~ 7

Author(s):

Maria Burbano ◽

Robert Russell ◽

Michael Huo ◽

Robert Welch ◽

Diana Roy ◽

...

Keyword(s):

Adverse Reaction ◽

Surface Characterization ◽

Hip Implants ◽

Metal Debris ◽

Total Hip ◽

Metal On Metal

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Blood Metal Ion Thresholds to Identify Patients with Metal-on-Metal Hip Implants at Risk of Adverse Reactions to Metal Debris

The Journal of Bone and Joint Surgery (American) ◽

10.2106/jbjs.16.01568 ◽

2017 ◽

Vol 99A (18) ◽

pp. 1532-1539 ◽

Cited By ~ 28

Author(s):

Gulraj S. Matharu ◽

Fiona Berryman ◽

Andrew Judge ◽

Aleksi Reito ◽

Jamie McConnell ◽

...

Keyword(s):

At Risk ◽

Metal Ion ◽

Adverse Reactions ◽

Hip Implants ◽

Metal Debris ◽

Metal On Metal

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Blood Metal Ion Levels Have Limited Utility in the Surveillance of Asymptomatic Large-Head Metal-on-Metal Total Hip Arthroplasties

The Journal of Arthroplasty ◽

10.1016/j.arth.2017.07.015 ◽

2017 ◽

Vol 32 (12) ◽

pp. 3685-3688 ◽

Cited By ~ 9

Author(s):

Manish Kiran ◽

Catherine Armstrong ◽

Deepak Shivarathre ◽

Viju K. Peter

Keyword(s):

Metal Ion ◽

Total Hip ◽

Large Head ◽

Metal On Metal ◽

Hip Arthroplasties

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Outcome of Revision Arthroplasty for Failed Metal-On-Metal Total Hip Replacements; is there a Relation with Metal Ions?

Hip International ◽

10.5301/hipint.5000460 ◽

2017 ◽

Vol 27 (3) ◽

pp. 235-240 ◽

Cited By ~ 2

Author(s):

Hafiz J. Iqbal ◽

Waheeb A.K. Al-Azzani ◽

Esther Jackson-Taylor ◽

Elizabeth Clatworthy ◽

Alun John

Keyword(s):

Metal Ions ◽

Revision Surgery ◽

Revision Arthroplasty ◽

Poor Correlation ◽

Metal Debris ◽

Total Hip ◽

Total Hip Replacements ◽

Metal On Metal ◽

Hip Replacements ◽

Oxford Hip Score

Purpose We aimed to assess the early outcome following revision arthroplasty for failed metal-on-metal (MoM) total hip replacements (THR) due to adverse reaction to metal debris (ARMD). Methods We reviewed 106 consecutive revision arthroplasties. Case notes and radiological investigations were reviewed to assess the complications. Oxford Hip Score (OHS) and Euroqol (EQ-5D-3L) scores were used to assess the functional outcome and improvement of quality of life. Results At a mean follow-up of 20 months (12-48 months), the mean OHS was 28.7. Pain improved in 61% patients. A majority of patients were in level 2 for all the EQ-5D-3L dimensions. The overall complication rate was 16%. Survivorship free from further revision for any cause was 94.3% at 48 months. There was no correlation between pre-revision blood metal ions and the final outcome. Conclusions Revision surgery for failed MoM hip replacement due to ARMD is associated with a relatively higher rate of complications and risk of chronic pain. There is poor correlation between serum metal ions and development of ARMD and outcome following revision surgery.

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Material loss at the taper junction of retrieved large head metal‐on‐metal total hip replacements

Journal of Orthopaedic Research® ◽

10.1002/jor.22431 ◽

2013 ◽

Vol 31 (11) ◽

pp. 1677-1685 ◽

Cited By ~ 104

Author(s):

Ashley K. Matthies ◽

Radu Racasan ◽

Paul Bills ◽

Liam Blunt ◽

Suzie Cro ◽

...

Keyword(s):

Material Loss ◽

Total Hip ◽

Total Hip Replacements ◽

Large Head ◽

Metal On Metal ◽

Hip Replacements

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Can We Improve Screening Costs in Asymptomatic Metal on Metal Total Hip Arthroplasties?

Reconstructive Review ◽

10.15438/rr.9.1.214 ◽

2019 ◽

Vol 9 ◽

Author(s):

J. Ryan Martin ◽

Jesse Otero ◽

Bryan Springer ◽

William Griffin

Keyword(s):

Metal Ion ◽

The United States ◽

Total Cost ◽

Total Hip ◽

Metal On Metal ◽

Annual Screening ◽

Screening Protocol ◽

Tissue Reactions ◽

The Cost ◽

Hip Arthroplasties

Introduction: Metal on Metal (MoM) total hip arthroplasty (THA) has been largely abandoned in the United States secondary to high failure rates. Many of the failures are attributed to adverse local tissue reactions (ALTR). Therefore, patients that have a MoM THA are routinely screened by checking serum metal ion levels every two years, as was recommended by the FDA. However, there is limited data on the costs of current screening protocols. Materials and Methods: 318 consecutive patients who underwent a MoM THA at a single institution were retrospectively enrolled. The average follow-up was 8.2 years. Clinical data, metal ion levels, revision and reoperation rates were prospectively collected. The costs of clinical screening for this patient population was calculated and compared to the cost of an annual screening protocol. Results: 12 patients had either an elevated Co or Cr level (>4.5 ppb). Eight patients were revised secondary to ALTR. The total cost of screening during the study was $612,250. Additionally, if annual screening had been performed, total screening costs would be approximately $1,719,200. Discussion: Eight patients in the following study were revised secondary to ALTR with a total cost of screening of $612,500. These costs are substantially less than the cost of annual screening ($1,719,200). Due to the considerable costs of screening asymptomatic MoM THA patients, we recommend both optimizing the frequency of screening and evaluating the specific risk of the implant being screened.

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