Metal Ion Levels Not Sufficient as a Screening Measure for Adverse Reactions in Metal-on-Metal Hip Arthroplasties

Macnair, R; Wynn-Jones, Henry; Wimhurst, J.A.; Toms, Andoni P.; Cahir, John

doi:10.1016/j.arth.2012.05.029

Cited by 67 publications

(36 citation statements)

References 28 publications

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“…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.…”

Section: Accepted Manuscriptmentioning

confidence: 85%

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

Sutphen

MacLaughlin²,

Madsen

et al. 2016

The Journal of Arthroplasty

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Section: Accepted Manuscriptmentioning

confidence: 85%

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

Sutphen

MacLaughlin²,

Madsen

et al. 2016

The Journal of Arthroplasty

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“…116 Monitoring can be done clinically by assessing patient symptoms or by measuring serum cobalt and chromium levels, although neither of these methods has proven reliable in diagnosis of ARMD. 117,118 More direct visualization with MRI optimized to reduce susceptibility from prosthetic metal is perhaps the best and least invasive method of determining whether ARMD has developed and to monitor for its progression in initially mild cases. 116 The MR imaging protocols to reduce the degree of susceptibility artifact produced by metal implants revolve around common principles.…”

Section: Metal-on-metal Thamentioning

confidence: 99%

Magnetic Resonance Imaging of the Hip

Omar

Blount²

2015

Topics in Magnetic Resonance Imaging

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Hip pain is common in all age groups, and osteoarthritis of this joint is an increasingly recognized problem particularly in aging populations. One of the primary goals in the diagnostic evaluation in patients with hip pain is to identify and correct pathologies that could progress to osteoarthritis. Magnetic resonance imaging (MRI) has become an important noninvasive method for characterizing hip anatomy and pathology in these patients. Improvements in MRI hardware and techniques have allowed high spatial and contrast resolution imaging to detect subtle abnormalities, such as acetabular labral and articular cartilage injuries, which often contribute to patient symptoms. Newer MRI techniques, such as delayed gadolinium-enhanced MRI of cartilage and T2 mapping, can give insight into the biochemical structure of tissues such as the articular cartilage. In turn, these can allow quantitative assessment and enable imagers to more directly compare the findings of patients at earlier stages of disease. It is important to understand the fundamental principles of various MRI techniques and their limitations to know when these techniques can best be applied. In addition, understanding of normal hip anatomy and common anatomic variants is useful for being able to accurately detect and localize areas of pathology and to prevent misinterpreting normal structures as diseased. The aims of this work were to briefly review normal hip anatomy and common anatomic variants seen on routine MRI examination, to discuss principles often used in high-resolution hip MRI and newer techniques for biochemical evaluation, and to examine several intra-articular pathologic conditions of the hip joint that are of current clinical interest.

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“…Serum values are commonly reported and are most representative of extracellular fluid levels. However, some suggest that whole blood values more accurately measure systemic exposure [41]. A conversion equation for serum and whole blood values may prove clinically useful after independent validation [42].…”

Section: Clinical Features Of Suspected Phactmentioning

confidence: 99%

Clinical Features, Testing, and Management of Patients with Suspected Prosthetic Hip-Associated Cobalt Toxicity: a Systematic Review of Cases

et al. 2013

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Safety concerns regarding cobalt-containing metal alloy hip prosthetics (Co-HP) have resulted in product recalls, a medical device alert, and issuance of guidance for clinicians. Recently, cases of suspected prosthetic hip-associated cobalt toxicity (PHACT) from Co-HP have been reported. Although little is known about suspected PHACT, these patients may be referred to medical toxicologists for evaluation and management recommendations. We searched MEDLINE, EMBASE, and unpublished abstracts from toxicology scientific meetings for references relevant to PHACT. Authors independently screened publications for inclusion criteria: publication in English, human study population, subject(s) are symptomatic (except for isolated hip pain), and cobalt values in any matrix (blood, serum, urine, CSF, synovial fluid) available for review. Data from 10 cases are reviewed. Patients with suspected PHACT had findings consistent with cobalt toxicity, including thyroid, cardiac, and neurologic dysfunction.Signs and symptoms appeared between 3 and 72 months after arthroplasty (median 19 months). Neurologic symptoms were most common. Ancillary testing varied considerably. All patients had elevated cobalt levels in one or more matrices. Enhanced elimination was attempted in 27 % of patients. At this time, the information currently available regarding patients with suspected PHACT is inadequate to guide clinical decision making. No consensus has been reached regarding the management of Co-HP patients with systemic symptoms. Indications for chelation have not been established and require further study. Improved case definitions, improved surveillance, and controlled studies are needed to elucidate the scope of this problem and guide future investigations.

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Metal Ion Levels Not Sufficient as a Screening Measure for Adverse Reactions in Metal-on-Metal Hip Arthroplasties

Cited by 67 publications

References 28 publications

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

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

Magnetic Resonance Imaging of the Hip

Clinical Features, Testing, and Management of Patients with Suspected Prosthetic Hip-Associated Cobalt Toxicity: a Systematic Review of Cases

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