Urinary Cobalt Levels in Patients with Porous Austin-Moore Prostheses

Jorgensen, Timothy J.; Munno, F.J.; Mitchell, Thomas G.; Hungerford, David S.

doi:10.1097/00003086-198306000-00015

Cited by 28 publications

(7 citation statements)

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“…25 Elevation of urinary Co in patients with CoCr alloy implants has been reported to be between 5 and 22 µg/l for porous AustinMoore prostheses, but this was transient. 28 In comparing patients having a metal-on-metal implant with those with a ceramic-polyethylene prosthesis containing no cobalt, Brodner et al 29 found a mean level of Co of 1.1 µg/l after one year in the metal-on-metal group, which was significantly higher than that in the control group, which had a median below the detection limit of 0.3 µg/l. This was confirmed by Jacobs et al 30 who analysed the concentration of Co and Cr in the serum and urine of two groups of patients with metalon-metal implants followed up for over 20 years.…”

Section: Discussionmentioning

confidence: 99%

Analysis of 118 second-generation metal-on-metal retrieved hip implants

Sieber

Rieker

Köttig

1999

The Journal of Bone and Joint Surgery. British volume

182

134

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O steolysis is due to particulate wear debris and is responsible for the long-term failure of total hip replacements. It has stimulated the development of alternative joint surfaces such as metal-on-metal or ceramic-on-ceramic implants.Since 1988 the second-generation metal-on-metal implant Metasul has been used in over 60 000 hips. Analysis of 118 retrieved specimens of the head or cup showed rates of wear of approximately 25 µm for the whole articulation per year in the first year, decreasing to about 5 µm per year after the third. Metal surfaces have a 'self-polishing' capacity. Scratches are worn out by further joint movement. Volumetric wear was decreased some 60-fold compared with that of metal-on-polyethylene implants, suggesting that second-generation metal-on-metal prostheses may considerably reduce osteolysis. [Br] 1998;80-B:46-50. Received 20 April 1998; Accepted after revision 8 July 1998 Osteolysis is due to particulate wear debris 1,2 and is mainly responsible for the long-term failure of total hip replacement (THR). The Charnley THR has been shown to give satisfactory clinical results with a survival rate of 85% at 20 years. When radiological evidence of loosening was added to that seen at revision operations, 22% of the acetabular and 7% of the femoral components were considered to be unstable. Polyethylene wear was shown to be significantly related to acetabular loosening and resorption of the femoral neck in nearly two-thirds of cemented THRs in patients younger than 20 years at the time of operation. 4 About half a million polyethylene wear particles are produced at each step due mainly to abrasive wear. 5,6 Contact of particle-laden articular fluid with the surrounding bone could be a key factor in the development of osteolysis. Joint fluid under pressure invades soft tissues and bone and expands the effective joint pace. J Bone Joint Surg7 As a result, activated macrophages may be found in cysts around the prostheses. 8It is not only the concentration of accumulated polyethylene particles which affects the amount of osteolysis, but also their capacity for phagocytosis.9,10 Particles with a critical size of between 0.5 and 10 µm are needed to induce the secretion of interleukin-6 by macrophages in vitro. It is still unclear as to whether polyethylene or cement debris induces more osteolysis. Severe lysis around a stable uncemented press-fit titanium shell is a clear indication of polyethylene wear.11 Polymethylmethacrylate (PMMA) cement alone is less harmful if it does not contain radiopaque additives. In vitro, monocytes and macrophages responding to particles of bone cement are capable of differentiation into osteoclastic cells. Their capacity for bone resorption is activated only when radiopaque additives are introduced with the cement particles, with a doubling of the rate for Ba 2 SO 4 compared with ZrO 2 . 12Osteolysis therefore has a multifactorial pattern and the biological activity of all possible wear particles has to be considered when introducing new implants. 13There have bee...

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Section: Discussionmentioning

confidence: 99%

Analysis of 118 second-generation metal-on-metal retrieved hip implants

Sieber

Rieker

Köttig

1999

The Journal of Bone and Joint Surgery. British volume

182

134

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“…As observed both experimentally and clinically, small quantities of metal ions are released from the surface of Co-Cr-Mo alloy implants (Laing et al 1959, Emngus et al 1960, Ferguson et al 1960, 1962, Coleman et al 1973, Lord et al 1979, Dobbs & Minski 1980, Jorgensen et al 1983, and these quantities may increase dramatically in cases of failed prostheses (Evans et al 1974, Jones et al 1975. The importance of metal release from the implant is due to the risk of toxicity and of sensitivity to metals as a possible cause of Ioosening (Evans et al 1974, Elves et al 1975, Langlais et al 1980, Uchida et al 1980) and of carcinogenicity (Oppenheimer et al 1956, Heath et al 1971, Kazantzis 1981, Norseth 1981.…”

mentioning

confidence: 96%

Metal ions in body fluids after arthroplasty

Pazzaglia

Minoia

Gualtieri

et al. 1986

Acta Orthopaedica Scandinavica

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“…They include concerns about (a) diminished fatigue strength from the coating process, such as sintering (34,49,55) or plasma spraying (32,35,37); (b) morphology of the coatings for improved bone ingrowth, such as beads (4,10,12,31,42,52,53), sintered fiber metal (19,28), o r metal powders (6,37,44); (c) pore sizes of the coatings (4,10,12,33); (d) biocompatibility of the available materials, such as the harmful effects of released metal ions (1,5,7,24,26); (e) implant stability…”

Section: Discussionmentioning

confidence: 99%

“…A number of critical issues remain unresolved that are key to the success of porous-coated implants (7). They include concerns about (a) diminished fatigue strength from the coating process, such as sintering (34,49,55) or plasma spraying (32,35,37); (b) morphology of the coatings for improved bone ingrowth, such as beads (4,10,12, 31,42,52,53), sintered fiber metal (19,28), o r metal powders (6,37,44); (c) pore sizes of the coatings (4,10,12,33); (d) biocompatibility of the available materials, such as the harmful effects of released metal ions (1,5,7,24,26); (e) implant stability for bone ingrowth (8, 41,47); (f) enhancers for bone ingrowth, such as hydroxyapatite coatings (14,18,25), electrical stimulation (15, 45,51), or growth factors (17,29); (g) inhibitors of bone ingrowth (30,39,48); (h) adaptation of host bone to porous prostheses (22,50); (i) designs of porous-coated implants (7,42); and 6) analyses of retrieved implants (11,13,20).…”

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confidence: 99%

Influence of biomaterial surface texture on bone ingrowth in the rabbit femur

Friedman

Jing

et al. 1996

Journal Orthopaedic Research

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The purpose of this study was to examine both the histologic and the mechanical characteristics of bone apposition to an experimental surface, arc-deposited titanium, in a rabbit model and to compare them with those of four previously studied surfaces: one layer of cobalt-chromium beads, three layers of cobalt-chromium beads, plasma-sprayed cobalt-chromium, and uncoated titanium alloy. Bilateral cylindrical implants were press-fit into the lateral femoral condyles of 70 adult New Zealand White rabbits, which were allowed unrestricted activity and then killed at 6 or 12 weeks. The distal femora were harvested, radiographed, and prepared for either mechanical or histologic evaluation. All of the implants with coated surfaces had significantly greater shear strength than the implants of grit-blasted titanium alloy after both 6 and 12 weeks. After 6 weeks, maximum bone apposition occurred in the beaded surfaces. After 12 weeks, the shear strengths and bone apposition of implants of arc-deposited titanium and of one and three layers of cobalt-chromium beads were significantly greater than those of implants of plasma-sprayed cobalt-chromium and grit-blasted titanium alloy. The histologic studies correlated with the mechanical results. After 12 weeks, the bone apposition and mechanical stability of arc-deposited titanium were similar to those of a single layer of beads. There appeared to be no advantage to multiple layers of beads, and the plasma-sprayed cobalt-chromium and grit-blasted titanium surfaces showed lower shear strength and bone apposition than the other groups.

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Urinary Cobalt Levels in Patients with Porous Austin-Moore Prostheses

Cited by 28 publications

References 0 publications

Analysis of 118 second-generation metal-on-metal retrieved hip implants

Analysis of 118 second-generation metal-on-metal retrieved hip implants

Metal ions in body fluids after arthroplasty

Influence of biomaterial surface texture on bone ingrowth in the rabbit femur

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