Four‐year study of cobalt and chromium blood levels in patients managed with two different metal‐on‐metal total hip replacements

Lhotka, Christian; Szekeres, Thomas; Steffan, Ilse; K, Zhuber; Zweymüller, K.

doi:10.1016/s0736-0266(02)00152-3

Cited by 219 publications

(101 citation statements)

References 46 publications

(51 reference statements)

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“…This may also explain slow decline in cobalt levels for up to 2 years after revision of MOM-bearing hip joint prosthesis. 21 In this light, an interpretation of the data in Figure 1 would be that, in two of the Cormet prostheses, a high volume of insoluble cobalt had accumulated in the body during the period prior to our experiment, in one case because it had been in situ for a long period and in the other because the patient was very active. However, wear at the time of the experiment was low, presumably because most of the wear-in process had finished.…”

Section: Discussionmentioning

confidence: 81%

Current in vivo wear of metal‐on‐metal bearings assessed by exercise‐related rise in plasma cobalt level

Khan

Takahashi

Kuiper

et al. 2006

Journal Orthopaedic Research

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Baseline metal ion levels are elevated in patients with metal-on-metal (MOM) hip arthroplasty. Interpretation of baseline levels is difficult as measurements are influenced by wear, corrosion, and metal ion release from stored metal in the body. Schmalzried et al. demonstrated that ''wear is the function of use, not time.'' The specific research question we asked was: Does physiological exercise increase the wear of metal-on-metal articulation which can be measured from the plasma metal ion levels? Patients with three different well functioning MOM bearings [two types of resurfacing (BHR 46.8 mm and Cormet 48 mm) and Metasul 28 mm] were included. Blood samples were taken immediately before, immediately after, and 1 h after exercise to determine cobalt and chromium levels. A significant increase ( p < 0.005) in serum cobalt and chromium of 13% and 11%, respectively, was noticed after the exercise. Rise of cobalt levels in patients with a resurfacing MOM was 8.5 times (BHR group) or 6.5 times (Cormet group) larger than in those with a Metasul MOM ( p ¼ 0.021 and p ¼ 0.047). Neither rise of metal levels nor baseline levels correlated with any other factor ( p > 0.27). Exercise-related elevations of plasma cobalt level provides information on current in vivo wear production that cannot be inferred from a baseline measurement of cobalt levels. Chromium levels cannot provide reliable information on the in vivo wear of the devices. Diameter was the important feature of the implant in determining exercise-related elevations of plasma cobalt level. Exercise-related elevations of plasma cobalt level is a potential in vivo tool to understand and improve the tribology of metal-metal bearings. ß

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Section: Discussionmentioning

confidence: 81%

Current in vivo wear of metal‐on‐metal bearings assessed by exercise‐related rise in plasma cobalt level

Khan

Takahashi

Kuiper

et al. 2006

Journal Orthopaedic Research

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“…The local and systemic effects of these particles are not completely clear. Lymphatic dissemination of metallic wear particles has been observed [9], and there are numerous reports of increased serum levels of metal ions after metal-on-metal hip arthroplasty [10]. As reported in the literature, measurements of serum levels of metals might have been useful for initial diagnosis [11].…”

Section: Discussionmentioning

confidence: 99%

Catastrophic Wear in a Metal-On-Ceramic Total Hip Arthroplasty

Valentí

Rı́o

Amillo

2007

The Journal of Arthroplasty

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A 51-year-old woman came to our clinic 6 months after a right total hip arthroplasty. She had noticed a slowly growing mass in the proximal thigh and referred progressive pain in the right groin. Plain radiography revealed premature acetabular cup aseptic loosening, and in the computed tomography study, a 14-cm-diameter mass was observed. Revision surgery was performed, showing a metal-on-ceramic bearing surface. The histologic analysis of surrounding tissues was reported as massive metallosis. Although occasionally chosen for primary or revision hip arthroplasty, there is little information available about the in vivo wear behavior of this combination. This important fact should be taken into account before considering such a surface alternative.

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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.…”

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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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Four‐year study of cobalt and chromium blood levels in patients managed with two different metal‐on‐metal total hip replacements

Cited by 219 publications

References 46 publications

Current in vivo wear of metal‐on‐metal bearings assessed by exercise‐related rise in plasma cobalt level

Current in vivo wear of metal‐on‐metal bearings assessed by exercise‐related rise in plasma cobalt level

Catastrophic Wear in a Metal-On-Ceramic Total Hip Arthroplasty

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

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