Ion release and chromosomal damage from total hip prostheses with metal‐on‐metal articulation

Abstract

A prospective multicentric study was carried out in patients having metal-onmetal METASUL components (Sulzer Medica, Winterthur, Switzerland) in order to check the following null hypotheses: H1: The concentration of Co, Cr, Ni, and Mb in blood and urine is not modified by the implant of a hip prosthesis with METASUL components at 6 months. H2: The incidence of markers of chromosomal damage [sister chromatid exchanges (SCEs) and micronuclei (Mni)] in lymphocytes is not modified by the implant of METASUL components at 6 months. H3: The concentrations of Co, Cr, Ni, and Mb in blood and urine did not correlate with the incidence of the markers of chromosomal damage. The measurements showed a 2-fold increase of Co in blood, a 10-fold increase of Co in urine, a 1.5-fold increase of Cr in the blood, and a 3-fold increase of Cr in the urine at a follow-up of 6 months from the operation; there was also a significant increase in the Ni blood concentration at the 7 day checkup. The study cohort did not show any modification in the frequency of markers of chromosomal damage in the peripheral lymphocytes at any of the observation times. The amount of the SCEs and Mni recorded at all the observation times did not correlate with each other or with any of the ion levels measured in the blood and in the urine.

Prevalence of Pseudotumor in Patients After Metal-On-Metal Hip Arthroplasty Evaluated with Metal Ion Analysis and MARS-MRI

“…Our study demonstrated no significant difference in pseudotumor formation in regards to elevated serum cobalt or chromium ion levels. Therefore, it is a possibility that metal ion levels in the blood are only a small representation of the events taking place within the hip itself that leads to pseudotumor formation [21][22][23][24][25]. Consequently, as Macnair et al [26] noted, we feel metal ion levels are not independently sufficient as a screening measure for pseudotumor formation.…”

Release of Cobalt and Chromium Ions Into the Serum Following Implantation of the Metal-on-Metal Maverick-Type Artificial Lumbar Disc (Medtronic Sofamor Danek)

“…On the other hand, there are experimental proofs as well that cobalt/ chromium do not induce genetic deviations. 21,22 There are also controversial analyses regarding the local effects and induced local toxicity. 23,24 …”

Cancer after Total Joint Arthroplasty: A Meta-analysis

“…Urinary excretion of metals provides a possible mechanism for these site-specific cancers (41)(42)(43), although there may not be a relationship between urinary output of metals and markers of chromosomal damage (44).…”