Accumulation in liver and spleen of metal particles generated at nonbearing surfaces in hip arthroplasty

Urban, Robert M.; Tomlinson, Michael J.; Hall, Deborah A.; Jacobs, Joshua J.

doi:10.1016/j.arth.2004.09.013

Cited by 120 publications

(76 citation statements)

References 15 publications

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“…International and national working groups are discussing the reference values to be set for hazardous occupational toxicants in body fluids and biologic tolerance values for occupational exposure [13,23,26]. Studies reporting local or systemic damage caused by metal ion elevation are scarce [12,30,37]. Some authors have suggested a possible sensitizing effect of Cr and Co ions, but without evidence of a correlation between ion concentrations and exposure [14,15].…”

Section: Discussionmentioning

confidence: 99%

Do Ion Levels In Hip Resurfacing Differ From Metal-on-metal THA at Midterm?

Moroni

Savarino

Hoque

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Metal-on-metal Birmingham hip resurfacing (MOM-BHR) is an alternative to metal-on-metal total hip arthroplasty (MOM-THA), especially for young and/or active patients. However, wear resulting in increased serum ion levels is a concern. Questions/purposes We asked whether (1) serum chromium (Cr), cobalt (Co), and molybdenum (Mo) concentrations would differ between patients with either MOM-BHR or MOM-THA at 5 years, (2) confounding factors such as gender would influence ion levels; and (3) ion levels would differ at 2 and 5 years for each implant type. Patients and Methods Ions were measured in two groups with either MOM-BHR (n = 20) or MOM-THA (n = 35) and a mean 5-year followup, and two groups with either MOM-BHR (n = 15) or MOM-THA (n = 25) and a mean 2-year followup. Forty-eight healthy blood donors were recruited for reference values. Results At 5 years, there were no differences in ion levels between patients with MOM-BHR or MOM-THA. Gender was a confounding factor, and in the MOM-BHR group at 5 years, Cr concentrations were greater in females compared with those of males. Mean ion levels were similar in patients with 2 and 5 years of followup for each implant type. Ion levels in patients were sevenfold to 10-fold higher than in controls. Conclusions As the metal ion concentrations in the serum at 5 years were in the range reported in the literature, we do not believe concerns regarding excessive metal ion levels after MOM-BHR are justified. Level of Evidence Level III, therapeutic study. See the Guidelines for Authors for a complete description of level of evidence.

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Section: Discussionmentioning

confidence: 99%

Do Ion Levels In Hip Resurfacing Differ From Metal-on-metal THA at Midterm?

Moroni

Savarino

Hoque

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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“…Early retrieval analyses of femoral components attempted to identify the cause of corrosion, and although initially thought to be galvanic [7], an increasing body of literature points toward a mechanical etiology secondary to fretting and crevice-associated mechanisms of corrosion at the head-neck junction [4,22]. Concerns regarding the potential local and systemic effects of soluble and particulate debris from corrosion at the head-neck interface were expressed as these modular implants became available [23][24][25]37]. Because of early reports of corrosion, fretting, and implant fracture at the modular interface [8,19] with associated biologic reactions [35], improvements in manufacturing and design subsequently were made, including making the femoral trunnions larger and more rigid.…”

Section: Introductionmentioning

confidence: 99%

Modern Trunnions Are More Flexible: A Mechanical Analysis of THA Taper Designs

Porter

Urban

Jacobs

et al. 2014

Clin Orthop Relat Res

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Background There is renewed concern surrounding the potential for corrosion at the modular head-neck junction to cause early failure in contemporary THAs. Although taper corrosion involves a complex interplay of many factors, a previous study suggested that a decrease in flexural rigidity of the femoral trunnion may be associated with an increased likelihood of corrosion at retrieval. Questions/purposes By analyzing a large revision retrieval database of femoral stems released during a span of three decades, we asked: (1) how much does flexural rigidity vary among different taper designs; (2) what is the contribution of taper geometry alone to flexural rigidity of the femoral trunnion; and (3) how have flexural rigidity and taper length changed with time in this group of revised retrievals? Methods A dual-center retrieval analysis of 85 modular femoral stems released between 1983 and 2012 was performed, and the flexural rigidity and length of the femoral trunnions were determined. These stems were implanted between 1991 and 2012 and retrieved at revision or removal surgery between 2004 and 2012. There were 10 different taper designs made from five different metal alloys from 16 manufacturers. Digital calipers were used to measure taper geometries by two independent observers. Results Median flexural rigidity was 228 N-m 2 ; however, there was a wide range of values among the various stems spanning nearly an order of magnitude between the most

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“…Clinical concerns for ceramic components include chips or particles entering the bearing surface as third bodies and catastrophic fracture [2]. For impingement of metal-metal implants, impingement and rim egress sites obviously constitute a plausible source of accelerated particle and ion liberation [18], and there is a possibility for local material failure (yield) to compromise the highly precise bearing surface clearances necessary for successful function of fluid film lubrication. For traditional Mo(C)P designs, the stress concentrations accompanying THA impingement events have been extensively documented [12,15].…”

Section: Introductionmentioning

confidence: 99%

Hard-on-Hard Total Hip Impingement Causes Extreme Contact Stress Concentrations

Elkins

O’Brien

Stroud

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Impingement events, in addition to their role immediately proximate to frank dislocation, hold the potential to damage new-generation hard-on-hard bearings as a result of the relatively unforgiving nature of the materials and designs. Because of the higher stiffness and tighter design tolerances of metal-on-metal and ceramic implants, surgical positioning plausibly has become even more important. Questions/purposes We asked (1) whether, and under what cup orientation conditions, hard-on-hard impingements might challenge implant material failure strength; and (2) whether particle generation propensity at impingement and egress sites would show similar dependence on cup orientation. Methods Realistic computational simulations were enabled by multistage finite element analyses, addressing both global construct motion and loading, and focal stress concentrations at neck impingement and rim egress sites. The global model, validated by a cadaveric simulation in a servohydraulic hip simulator, included both hardware components and advanced anisotropic capsule characterization. Parametric computational runs explored the effect of cup orientation for both ceramic-on-ceramic and metalon-metal bearing couples for two distinct motion sequences associated with dislocation.

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Accumulation in liver and spleen of metal particles generated at nonbearing surfaces in hip arthroplasty

Cited by 120 publications

References 15 publications

Do Ion Levels In Hip Resurfacing Differ From Metal-on-metal THA at Midterm?

Do Ion Levels In Hip Resurfacing Differ From Metal-on-metal THA at Midterm?

Modern Trunnions Are More Flexible: A Mechanical Analysis of THA Taper Designs

Hard-on-Hard Total Hip Impingement Causes Extreme Contact Stress Concentrations

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