Early Markers of Nephrotoxicity in Patients With Metal-on-metal Hip Arthroplasty

Corradi, Massimo; Daniel, Joseph; Ziaee, Hena; Alinovi, Rossella; Mutti, Antonio; McMinn, Derek J. W.

doi:10.1007/s11999-010-1682-0

Cited by 29 publications

(14 citation statements)

References 28 publications

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“…Five studies [61], [62], [70], [71], [72] examined possible associations between metal ion concentrations and nephrotoxicity. Daniel et al [71] examined renal clearance and renal concentrating efficiency of cobalt.…”

Section: Resultsmentioning

confidence: 99%

Metal Ion Concentrations in Body Fluids after Implantation of Hip Replacements with Metal-on-Metal Bearing – Systematic Review of Clinical and Epidemiological Studies

et al. 2013

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IntroductionThe use of metal-on-metal (MoM) total hip arthroplasty (THA) increased in the last decades. A release of metal products (i.e. particles, ions, metallo-organic compounds) in these implants may cause local and/or systemic adverse reactions. Metal ion concentrations in body fluids are surrogate measures of metal exposure.ObjectiveTo systematically summarize and critically appraise published studies concerning metal ion concentrations after MoM THA.MethodsSystematic review of clinical trials (RCTs) and epidemiological studies with assessment of metal ion levels (cobalt, chromium, titanium, nickel, molybdenum) in body fluids after implantation of metalliferous hip replacements. Systematic search in PubMed and Embase in January 2012 supplemented by hand search. Standardized abstraction of pre- and postoperative metal ion concentrations stratified by type of bearing (primary explanatory factor), patient characteristics as well as study quality characteristics (secondary explanatory factors).ResultsOverall, 104 studies (11 RCTs, 93 epidemiological studies) totaling 9.957 patients with measurement of metal ions in body fluids were identified and analyzed. Consistently, median metal ion concentrations were persistently elevated after implantation of MoM-bearings in all investigated mediums (whole blood, serum, plasma, erythrocytes, urine) irrespective of patient characteristics and study characteristics. In several studies very high serum cobalt concentrations above 50 µg/L were measured (detection limit typically 0.3 µg/L). Highest metal ion concentrations were observed after treatment with stemmed large-head MoM-implants and hip resurfacing arthroplasty.DiscussionDue to the risk of local and systemic accumulation of metallic products after treatment with MoM-bearing, risk and benefits should be carefully balanced preoperatively. The authors support a proposed „time out“ for stemmed large-head MoM-THA and recommend a restricted indication for hip resurfacing arthroplasty. Patients with implanted MoM-bearing should receive regular and standardized monitoring of metal ion concentrations. Further research is indicated especially with regard to potential systemic reactions due to accumulation of metal products.

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Section: Resultsmentioning

confidence: 99%

Metal Ion Concentrations in Body Fluids after Implantation of Hip Replacements with Metal-on-Metal Bearing – Systematic Review of Clinical and Epidemiological Studies

et al. 2013

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“…In patients with MoM total hip arthroplasties, there is a progressive increase in cobalt clearance with increasing in-vivo wear of this bearing. Although for most MoM patients, elevated ion levels do not seem to be nephrotoxic [19], cobalt levels in particular may be dramatically increased in patients with renal failure compared to MoM patients with normal renal function [20]. Gastric excretion and hepatic storage may also play a lesser role in ion removal [21,22].…”

Section: Discussionmentioning

confidence: 99%

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

Fehring

Carter

Fehring

et al. 2015

The Journal of Arthroplasty

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“…Only a clinical study in Italy addressed this issue (126), which is still little discussed also at an international level (185,186).…”

Section: Discussionmentioning

confidence: 99%

“…To elucidate if the ion levels in hip arthroplasties were sufficient to cause renal damage, a retrospective study with a 10-year followup was performed on patients who underwent metal-onmetal hip resurfacings, without showing any elevation of renal markers. However, extended long-term, large-scale controlled trials are needed to monitor this arthroplastyinduced low-intensity but long-term trace element exposure to rule out potential nephrotoxicity (126).…”

Section: Hip Arthroplastymentioning

confidence: 99%

Orthopaedic Research in Italy: State of the Art

Cenni

Scioscia²,

Baldini

2011

Int J Immunopathol Pharmacol

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The most significant results in experimental and clinical orthopaedic research in Italy within the last three years have been primarily in major congenital diseases, bone tumors, regenerative medicine, joint replacements, spine, tendons and ligaments, The data presented in the following discussion is comparable with leading international results, highlighting Italian orthopaedic research excellemce as well as its shortcomings.There has been continued innovation in orthopaedic research over the past years. The advances in basic science, particularly in molecular and cell biology, in material science and in nanotechnology, has provided the tools for bone engineering, bone imaging and innovative methods for diagnosis and treatment of primitive and metastatic bone tumours. At this point, it seems necessary to examine to what extent are the limitations of these new orthopaedic techniques as well as the prevalent topics that should be explored and the position of the Italian orthopedic research on a global stage.

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Early Markers of Nephrotoxicity in Patients With Metal-on-metal Hip Arthroplasty

Cited by 29 publications

References 28 publications

Metal Ion Concentrations in Body Fluids after Implantation of Hip Replacements with Metal-on-Metal Bearing – Systematic Review of Clinical and Epidemiological Studies

Metal Ion Concentrations in Body Fluids after Implantation of Hip Replacements with Metal-on-Metal Bearing – Systematic Review of Clinical and Epidemiological Studies

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

Orthopaedic Research in Italy: State of the Art

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