Systemic effects of implanted prostheses made of cobalt-chromium alloys

Michel, R.; Nolte, M.; Reich, Michael S.; Löer, F.

doi:10.1007/bf00393876

Cited by 129 publications

(49 citation statements)

References 21 publications

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“…Elevation of serum metal levels after primary total hip arthroplasty is well-documented 4,12,[14][15][16][17] , and several studies have investigated the serum levels of cobalt and chromium after joint arthroplasty [14][15][16]18,19 . However, there is limited information available regarding the long-term impact of primary metal-onpolyethylene total hip replacements on the serum concentrations of metals, particularly for serum titanium in titanium-containing implants 4,12,20,21 .…”

Section: Discussionmentioning

confidence: 99%

“…One of the general limitations in the literature regarding metal ion concentrations is the wide variability in how measurements are gathered, analyzed, and reported, thus making comparisons between studies difficult 18 . Even within studies there is substantial technical difficulty in ensuring that samples are drawn, processed, and analyzed in the exact same manner for consistency of results.…”

Section: Discussionmentioning

confidence: 99%

“…Even within studies there is substantial technical difficulty in ensuring that samples are drawn, processed, and analyzed in the exact same manner for consistency of results. Detecting differences between groups is challenging due to small detection limits, variations among individuals, and potential outside interferences 18 . An advantage of the present study was that all study samples were drawn and analyzed with identical technique within a single laboratory at our institution, which has expertise in analyzing serum metal ion concentrations, thus allowing more subtle differences between groups to be detected.…”

Section: Discussionmentioning

confidence: 99%

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Ten-Year Outcome of Serum Metal Ion Levels After Primary Total Hip Arthroplasty

Levine

Hsu

Skipor

et al. 2013

The Journal of Bone and Joint Surgery

101

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We previously reported on the metal ion concentrations of cobalt, chromium, and titanium that were found in the serum of patients three years after they had undergone primary total hip arthroplasty as compared with the concentrations found in the serum of control patients who did not have an implant. This study is a concise update on the serum metal levels found in a cohort of these patients ten years after the time of hip implantation. Of the original seventy-five subjects, metal ion levels were available for forty patients (53%). Ten patients (hybrid group) had received a hybrid total hip replacement that consisted of a modular cobalt-alloy femoral stem with a cobalt-alloy femoral head that had been inserted with cement and a titanium acetabular socket that had been inserted without cement. Nine patients (cobalt-chromium [CoCr] group) had received an implant with an extensively porous-coated modular cobalt-alloy femoral stem and femoral head along with a titanium acetabular socket; the femoral and acetabular components had each been inserted without cement. Eight patients (titanium group) had undergone insertion of a proximally porous-coated modular titanium-alloy femoral stem with a cobaltalloy femoral head and a titanium acetabular socket; the femoral and acetabular components had each been inserted without cement. Thirteen patients (control group) from the original control group of patients who had not received an implant served as control subjects. Serum metal levels were measured with use of high-resolution sector field inductively coupled plasma mass spectrometry. The hybrid total hip arthroplasty group had mean cobalt levels that were 3.2 times higher at 120 months than they were at baseline, and the cobalt levels in that group were significantly higher than those in the titanium total hip arthroplasty group at thirty-six, sixty, eighty-four, ninety-six, and 120 months (p < 0.01). The hybrid group had mean chromium levels that were 3.9 times higher at 120 months than they were at baseline, and the CoCr total hip arthroplasty group had chromium levels that were 3.6 times higher at 120 months than they were at baseline. The serum titanium levels were higher in the titanium group at all follow-up time intervals as compared with the levels in all other groups, and the level in the titanium group at 120 months was eighteen times higher than it was at baseline (p < 0.01). Patients with well-functioning primary metal-on-polyethylene total hip replacements had elevated serum metal levels for as many as ten years postoperatively. Furthermore, metal release at the modular femoral head-neck junctions, rather than passive dissolution from porous ingrowth surfaces, was likely the dominant source of serum cobalt and chromium.continued

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Ten-Year Outcome of Serum Metal Ion Levels After Primary Total Hip Arthroplasty

Levine

Hsu

Skipor

et al. 2013

The Journal of Bone and Joint Surgery

101

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“…Although the cause-and-effect relationship between metal wear debris and local or systemic disease has not been conclusively proved, complications from metal wear products are a subject for concern [18,31,35]. Any metal-on-metal bearing combination used in joint replacements must, therefore, be designed and manufactured in such a way as to produce minimal debris.…”

Section: Discussionmentioning

confidence: 99%

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

Lhotka

Szekeres

Steffan

et al. 2003

Journal Orthopaedic Research

218

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Buckground: Metal-on-metal total hip prostheses will produce a certain amount of wear debris. This results in increased wholeblood metal levels, which may cause adverse effects. It is not known to what extent the problem has been overcome by advances in alloy technology.Methods: In 259 patients who with total hip replacement, blood cobalt and chromium concentrations were measured with atomic absorption spectrophotometry over a period of four years after arthroplasty. Of the patients enrolled in the study, 131 had been managed with a METASUL@ cobalt-chromium alloy metal-on-metal bearing combination, while 128 had been given a SIKO-METO-SM2 1 @ cobalt-chromium alloy metal-on-metal combination. The control group consisted of 3 1 age-and gender-matched subjects.Resu1t.s: Compared with the controls, all the patients had higher cobalt and chromium levels. Cobalt concentrations were up to 50 times higher, while chromium concentrations were up to 100 times higher.Conclusions: Both systems showed evidence, in the whole-blood samples, of wear debris production by the implants. Therefore, patients managed with metal-on-metal bearing combinations should be carefully monitored in order to ensure that any local or systemic complications are detected early on.

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“…Gradual mobilization of metals from CoCrMo prostheses has also been documented in patients, based upon analyses of Co or Cr concentrations in serum or urine (Coleman et al 1973, Miehlke et al 1981, Pazzaglia et al 1986 and detection of Co or Cr in periprosthetic soft tissues and distant organs (Emn6us et al 1961, Michel et al 1984, 1991. The release of metals from implanted prostheses metal has been attributed to corrosion, wear, or a combination of these Factors.…”

Section: Discussionmentioning

confidence: 99%

Cobalt in periprosthetic soft tissue: Observations in 6 revision cases

Hopfer

et al. 1991

Acta Orthopaedica Scandinavica

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Systemic effects of implanted prostheses made of cobalt-chromium alloys

Cited by 129 publications

References 21 publications

Ten-Year Outcome of Serum Metal Ion Levels After Primary Total Hip Arthroplasty

Ten-Year Outcome of Serum Metal Ion Levels After Primary Total Hip Arthroplasty

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

Cobalt in periprosthetic soft tissue: Observations in 6 revision cases

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