Changes in Whole Blood Metal Ion Levels following Resurfacing: Serial Measurements in a Multi-Centre Study

Isaac, Graham; Siebel, Thomas; Oakeshott, R. D.; McLennan-Smith, R; Cobb, A. G.; Schmalzried, Thomas P.; Vail, Thomas P.

doi:10.1177/112070000901900406

Cited by 31 publications

(24 citation statements)

References 33 publications

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“…The RHA implant that we used (ASR) was later withdrawn from the market due to excessive failure rates, but despite the fact that it included a rather large proportion of females and of heads below 51 mm, the median ion concentrations measured in the present study were comparable to those in other prospective RHA studies involving implants known to have either a high degree or a suboptimal degree of survival (Allan et al 2007, Heisel et al 2008, Daniel et al 2009, Isaac et al 2009, deSouza et al 2010, Garbuz et al 2010, Beaule et al 2011, Pattyn et al 2011). We therefore believe that our results are not specific for the ASR implant, but that they can be generally applied to metal ion and lymphocyte levels.…”

Section: Discussionsupporting

confidence: 68%

Metal ion levels and lymphocyte counts: ASR hip resurfacing prosthesis vs. standard THA

et al. 2013

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Background and purpose Wear particles from metal–on–metal arthroplasties are under suspicion for adverse effects both locally and systemically, and the DePuy ASR Hip Resurfacing System (RHA) has above–average failure rates. We compared lymphocyte counts in RHA and total hip arthroplasty (THA) and investigated whether cobalt and chromium ions affected the lymphocyte counts.Method In a randomized controlled trial, we followed 19 RHA patients and 19 THA patients. Lymphocyte subsets and chromium and cobalt ion concentrations were measured at baseline, at 8 weeks, at 6 months, and at 1 and 2 years.Results The T–lymphocyte counts for both implant types declined over the 2–year period. This decline was statistically significant for CD3+CD8+ in the THA group, with a regression coefficient of –0.04 × 109cells/year (95% CI: –0.08 to –0.01). Regression analysis indicated a depressive effect of cobalt ions in particular on T–cells with 2–year whole–blood cobalt regression coefficients for CD3+ of –0.10 (95% CI: –0.16 to –0.04) × 109 cells/parts per billion (ppb), for CD3+CD4+ of –0.06 (–0.09 to –0.03) × 109 cells/ppb, and for CD3+CD8+ of –0.02 (–0.03 to –0.00) × 109 cells/ppb.Interpretation Circulating T–lymphocyte levels may decline after surgery, regardless of implant type. Metal ions—particularly cobalt—may have a general depressive effect on T– and B–lymphocyte levels.Registered with ClinicalTrials.gov under # NCT01113762

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Section: Discussionsupporting

confidence: 68%

Metal ion levels and lymphocyte counts: ASR hip resurfacing prosthesis vs. standard THA

et al. 2013

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“…One multicentre study involving a 24-month follow-up of 77 patients implanted with a unilateral resurfacing prosthesis found that ion levels were generally low and had stabilized by 3 months [15]. Six patients had abnormally high metal ion levels, and all of them also had a cup abduction angle above 55°.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Patients with a DePuy ASR Metal-on-Metal Hip Replacement: Results of Applying the Guidelines of the Spanish Society of Hip Surgery in a Tertiary Referral Hospital

Fernández-Valencia

Gallart

Bori

et al. 2014

Advances in Orthopedics

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The prognosis associated with the DePuy ASR hip cup is poor and varies according to the series. This implant was withdrawn from use in 2010 and all patients needed to be assessed. We present the results of the assessment of our patients treated with this device, according to the Spanish Society of Hip Surgery (SECCA) algorithm published in 2011. This retrospective study evaluates 83 consecutive ASR cups, followed up at a mean of 2.9 years. Serum levels of chromium and cobalt, as well as the acetabular abduction angle, were determined in order to assess their possible correlation with failure, defined as the need for revision surgery. The mean Harris Hip Score was 83.2 (range 42–97). Eight arthroplasties (13.3%) required revision due to persistent pain and/or elevated serum levels of chromium/cobalt. All the cups had a correct abduction angle, and there was no correlation between elevated serum levels of metal ions and implant failure. Since two previous ASR implants were exchanged previously to the recall, the revision rate for ASR cups in our centre is 18.2% at 2.9 years.

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“…These tend to stabilise three 55 to six months 54 after surgery. Research has shown that metal ion concentrations that are not directly cytotoxic to lymphocytes may affect events at a molecular level, thereby impeding lymphocyte proliferation 56 .…”

Section: Resultsmentioning

confidence: 96%

Have the media influenced the use of hip resurfacing arthroplasty? A review of UK print media

Malviya

Stafford²,

Villar³

et al. 2012

Ann R Coll Surg Engl

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INTRODUCTIONThe aim of this study was to look at the different claims made about hip resurfacing arthroplasty in the popular UK print media and how this relates to findings in the scientific literature.METHODSA review of UK popular print media from January 1992 to June 2011 was performed using the Lexis® Library online news database. Only articles discussing the clinical results of hip resurfacing arthroplasty were included. After excluding duplicates, 49 newspaper articles were found suitable for this study. The main outcome measure was the claims made in popular UK print media about hip resurfacing. These were compared with the scientific publication. We reviewed the trend of use of hip resurfacing prostheses during the same period as reported in the National Joint Registry.RESULTSA disparity was found between the claims in the newspapers and published scientific literature. The initial newspaper articles highlighted only the positive aspects of hip resurfacing arthroplasty, without definitive contemporary evidence backing the claims. Most of these claims were refuted by future scientific publications. The initial positive media reports coincided with an increase in the use of hip resurfacing but the decline coincided with negative reports in the scientific literature.CONCLUSIONSThe trend of the newspaper articles and that of the number of hip resurfacing prostheses implanted suggests that the media may have been partly responsible for the increased use of this prosthesis. The subsequent decrease was initiated by the scientific literature.

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Changes in Whole Blood Metal Ion Levels following Resurfacing: Serial Measurements in a Multi-Centre Study

Cited by 31 publications

References 33 publications

Metal ion levels and lymphocyte counts: ASR hip resurfacing prosthesis vs. standard THA

Metal ion levels and lymphocyte counts: ASR hip resurfacing prosthesis vs. standard THA

Assessment of Patients with a DePuy ASR Metal-on-Metal Hip Replacement: Results of Applying the Guidelines of the Spanish Society of Hip Surgery in a Tertiary Referral Hospital

Have the media influenced the use of hip resurfacing arthroplasty? A review of UK print media

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