Cobalt and chromium concentrations in patients with metal-on-metal and other cementless total hip arthroplasty

Maezawa, Katsuhiko; Nozawa, Masahiko; Hirose, Tomohiko; Matsuda, Keiji; Yasuma, Motoo; Shitoto, Katsuo; Kurosawa, Hisashi

doi:10.1007/s00402-001-0382-3

Cited by 42 publications

(27 citation statements)

References 9 publications

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“…Although the clinical use of MOM THA is increasing in popularity, concerns remain regarding wear and corrosion of the bearing surfaces and the consequent increase in metal ion serum levels [10,26,31,32,35]. It is certain that metal ions are released because of the combined effect of corrosion of the implant surface and wear particles.…”

Section: Discussionmentioning

confidence: 99%

Does Ion Release Differ Between Hip Resurfacing and Metal-on-metal THA?

Moroni

Savarino

Cadossi

et al. 2008

Clinical Orthopaedics &Amp; Related Research

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Modern metal-on-metal hip resurfacing was introduced as a bone-preserving method of joint reconstruction for young and active patients; however, the large diameter of the bearing surfaces is of concern for potential increased metal ion release. We hypothesized there were no differences in serum concentrations of chromium, cobalt, and molybdenum between patients who had metalon-metal hip resurfacing (Group A; average head diameter, 48 mm; median followup, 24 months) and patients who had 28-mm metal-on-metal THA (Group B; median followup, 25 months). Serum concentrations also were compared with concentrations in healthy subjects. We identified no differences in ion levels between Groups A and B. A distinction was made according to gender. Women showed a higher chromium release in Group A whereas men had a higher cobalt release in Group B. Values obtained from Group A were higher than those of the control subjects. Our data suggest metal-on-metal bearings for THA should not be rejected because of concern regarding potential increased metal ion release; however, patients with elevated ion levels, even without loosening or toxicity, could be at higher risk and should be followed up periodically. Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

Does Ion Release Differ Between Hip Resurfacing and Metal-on-metal THA?

Moroni

Savarino

Cadossi

et al. 2008

Clinical Orthopaedics &Amp; Related Research

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“…The serum levels of chromium and cobalt for the 28-mm Metasul bearing were similar to those found in previously reported investigations for the modern, second-generation metal-on-metal bearings. Investigations that have been conducted to date have uniformly shown substantial elevations in serum, blood, erythrocyte and/or urine serum levels relative to preoperative values, and/or relative to levels measured after implant of metal-onpolyethylene or ceramic-on-polyethylene bearings (Betts et al 1992, Basle et al 1996, Schaffer et al 1999, Prohaska et al 2000, Harding et al 2002, Maezawa et al 2002, Savarino et al 2002, Adami et al 2003, Clarke et al 2003, Lhotka et al 2003, MacDonald et al 2003.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to the corrosion potential of the implant itself, wear debris elevates the ion release due to the increased exposure of metal surface. In a number of studies, the release of metal ions from total hip arthroplasties (both locally and systemically) has been documented (Betts et al 1992, Basle et al 1996, Schaffer et al 1999, Prohaska et al 2000, Harding et al 2002, Maezawa et al 2002, Savarino et al 2002, Adami et al 2003, Clarke et al 2003, Lhotka et al 2003, MacDonald et al 2003.…”

mentioning

confidence: 99%

Exposure to chromium, cobalt and molybdenum from metal-on-metal total hip replacement and hip resurfacing arthroplasty

et al. 2006

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(2006) Exposure to chromium, cobalt and molybdenum from metal-onmetal total hip replacement and hip resurfacing arthroplasty, Acta Orthopaedica, 77:5, Background All metal implants-and metal-on-metal bearings in particular-corrode and cause a release of metal ions. Because cobalt and chromium have been shown to be carcinogenic and mutagenic in human and animal models, systemic toxicity and cancer risk are considered to be possible disadvantages of the metal-onmetal articulation.This study was designed to investigate the serum concentration profiles of chromium, cobalt and molybdenum after implantation of a Birmingham hip resurfacing arthroplasty (BHR) and a cementless total hip replacement with a 28-mm Metasul articulation (MTHR), over the first 2 years after implantation.Methods We analyzed profiles of metal ion serum levels in 111 patients implanted with a BHR, in 74 patients implanted with an MTHR, and in 130 implantfree probands control subjects using atomic absorption spectrophotometry.Results Chromium and cobalt concentrations (in µg/L) of all BHR and MTHR patients differed significantly from those of control subjects (chromium: < 0.25; cobalt: 0.25). The median chromium and cobalt concentrations in BHR patients had increased to 5.1 and 4.3 µg/ L 2 years after surgery. Concentrations in BHR patient exceeded those in the unilateral MTHR patients. Molybdenum serum concentrations hardly changed over time in either group and were not significantly different from the concentrations seen in the control subjects.Interpretation During the first 2 years after surgery, the Birmingham hip resurfacing arthroplasty leads to

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“…In general, the documented levels of metal ions in blood, plasma or urine of different types of implant [5][6][7][8][9][10][11][12][13] or correlated conditions like loosening [14,15] are not comparable with those observed in professionally exposed workers, due to the way of absorption (usually inhalation) and also the excretion rate is very different [16][17][18]. However, in both situations the risks connected with intoxication have been considered so far as potential.…”

Section: Introductionmentioning

confidence: 99%

“…The kinetics of metal ions in THR population, even if already studied [3,5,7,[9][10][11][12][13][14][15][19][20][21][22][23][24], remain a complicated topic because of the difficulty in determining the release rate and the active surface which includes both the metallic components of the prosthesis and the wear particles that are disseminated widely in the body through the lymphatics [22][23][24].…”

Section: Introductionmentioning

confidence: 99%

Cobalt, chromium and molybdenum ions kinetics in the human body: data gained from a total hip replacement with massive third body wear of the head and neuropathy by cobalt intoxication

Pazzaglia

Apostoli

Congiu

et al. 2011

Arch Orthop Trauma Surg

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Introduction A patient with a total hip replacement developed optic, acoustic and peripheral neuropathy from metal ions intoxication, due to the wear products released from the prosthesis. Subsequently the kinetics of the metal ions was studied. Materials and methods Massive wear and acute intoxication allowed a study of the metal ions kinetics and of EDTA treatment. Results Plasma and other organic fluids were saturated by each of the metal ions released from the exposed surface according to the solubility of each ion; a larger fraction of Co ions was bound within red cells, while the plasmatic fraction appeared more movable. In a patient with a prosthesis subjected to wear, the ions released are from the prosthetic and from the debris surface (spread in the body). The latter is a function of the number and size of particles. Discussion Revision of the prosthesis from the point of view of the metal ions kinetics corresponded to a reduction of the releasing surface because of debris washed out by irrigation and tissue excision; however, the metal particles spread by lymphatic circulation continued to release ions even though the source of wear had been removed. Early diagnosis of high metal wear can be ascertained with mass spectrometry and after revision high levels of metal ions can only be reduced with repeated chelating treatment. It is preferable not to revise fractured ceramic components with a polyethylene-metal articulation.

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Cobalt and chromium concentrations in patients with metal-on-metal and other cementless total hip arthroplasty

Cited by 42 publications

References 9 publications

Does Ion Release Differ Between Hip Resurfacing and Metal-on-metal THA?

Does Ion Release Differ Between Hip Resurfacing and Metal-on-metal THA?

Exposure to chromium, cobalt and molybdenum from metal-on-metal total hip replacement and hip resurfacing arthroplasty

Cobalt, chromium and molybdenum ions kinetics in the human body: data gained from a total hip replacement with massive third body wear of the head and neuropathy by cobalt intoxication

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