Cobalt to Chromium Ratio is Not a Key Marker for Adverse Local Tissue Reaction (ALTR) in Metal on Metal Hips

Fehring, Thomas K.; Carter, Joshua L.; Fehring, Keith A.; Odum, Susan M.; Griffin, William L.

doi:10.1016/j.arth.2015.02.049

Cited by 20 publications

(19 citation statements)

References 22 publications

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“…There are, however, several studies showing that metal ion levels are not reliable predictors of ALTR [26,27]. One study consisting of patients with modular neck stems and metal-on-polyethylene bearings indicated Co/Cr ratio as a predictor of ALTR [28], but findings from a study considering MoM THA showed no association between the Co/Cr ratio and ALTR [29]. Only Co remained a significant predictor of ALTR in our multivariate analysis, although in our univariate Fig.…”

Section: Discussioncontrasting

confidence: 61%

Indications for MARS-MRI in Patients Treated With Articular Surface Replacement XL Total Hip Arthroplasty

Connelly

Galea

Laaksonen

et al. 2018

The Journal of Arthroplasty

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Section: Discussioncontrasting

confidence: 61%

Indications for MARS-MRI in Patients Treated With Articular Surface Replacement XL Total Hip Arthroplasty

Connelly

Galea

Laaksonen

et al. 2018

The Journal of Arthroplasty

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“…There are reports which have not shown Co:Cr to be useful, especially for diagnosing adverse local tissue reaction (ALTR). 14,15 This has been attributed to variabilities in alloy composition, solubility of metal ions and excretion. In this study, we have shown that well-functioning implants have lower blood metal ion levels than failed implants with the same bearing surface.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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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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“…Furthermore, Fehring et al. [9] have found that the Co:Cr ratio is not a predictive biomarker for ALTRs (they looked at MoM total hip replacement only.)…”

Section: Discussionmentioning

confidence: 99%

Custom titanium sleeve for surgical treatment of mechanically assisted crevice corrosion in the well-fixed, noncontemporary stem in total hip arthroplasty

Leibiger

McGrory

2015

Arthroplasty Today

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Adverse local tissue reaction associated with total hip replacement may occur when mechanically assisted crevice corrosion occurs at metal-metal modular junctions in which at least one of the components is fabricated from cobalt-chromium alloy. Complete removal of components may be associated with significant morbidity; when components are well fixed and in acceptable position, it may be appropriate to consider modular rather than complete revision. We have diagnosed mechanically assisted crevice corrosion in total hip arthroplasty patients with noncontemporary but well-fixed femoral components and found that modular conversion to a ceramic femoral head to remove a source of CoCr corrosion and fretting products was only possible by having a custom titanium sleeve manufactured. Surgical implantation with a revision style Biolox ceramic head (CeramTec, Plochingen, Germany) was then achieved.

show abstract

Cobalt to Chromium Ratio is Not a Key Marker for Adverse Local Tissue Reaction (ALTR) in Metal on Metal Hips

Cited by 20 publications

References 22 publications

Indications for MARS-MRI in Patients Treated With Articular Surface Replacement XL Total Hip Arthroplasty

Indications for MARS-MRI in Patients Treated With Articular Surface Replacement XL Total Hip Arthroplasty

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

Custom titanium sleeve for surgical treatment of mechanically assisted crevice corrosion in the well-fixed, noncontemporary stem in total hip arthroplasty

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