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. 2014 Jul;38(7):1353-61.
doi: 10.1007/s00264-014-2300-7. Epub 2014 Mar 18.

Repeated metal ion measurements in patients with high risk metal-on-metal hip replacement

Aleksi Reito  1 , Teemu Moilanen, Timo Puolakka, Jorma Pajamäki, Antti Eskelinen
Affiliations

Repeated metal ion measurements in patients with high risk metal-on-metal hip replacement

Aleksi Reito et al. Int Orthop. 2014 Jul.

Abstract

Purpose: Conventional follow-up methods are not sufficient to identify adverse soft tissue reactions in patients with metal-on-metal hip replacements. The national guidelines regarding metal ion measurements are debatable. The aims of our study were to investigate (1) if there is a clinically significant change in whole blood (WB) cobalt (Co) or chrome (Cr) levels in repeated WB assessment in patients operated on with ASR hip replacements, and (2) what proportion of patients has WB Co or Cr level below the previously established safe upper limits (SUL) in the repeated WB metal ion assessment.

Methods: We identified all patients (n = 254) with unilateral ASR implants who had second blood sample taken eight to 16 months after the first.

Results: WB Co and Cr levels remained below SUL and within their initial values during a mean one-year measurement interval in the majority of patients with a high risk HR device. In contrast to this, 50 % of patients with THRs had metal ion levels exceeding the SUL in the first measurement. WB Co values significantly increased over the measurement interval in the THR group.

Conclusion: In patients with a high risk HR, repeated metal ion measurement did not provide useful information for clinical decision-making. In patients with a LD MoM THR repeated measurements revealed a large number of patients with metal ion levels exceeding SUL and might thus be clinically beneficial.

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Figures

Fig. 1
Fig. 1
Flow chart of the study
Fig 2
Fig 2
Median whole blood (WB) Co values divided across the follow-up time before initial measurement
Fig. 3
Fig. 3
Median whole blood (WB) Cr values divided across the follow-up time before initial measurement
Fig. 4
Fig. 4
Frequency distribution of change in whole blood (WB) Cr levels over one-year follow-up
Fig. 5
Fig. 5
Frequency distribution of change in whole blood (WB) Co levels over one-year follow-up
Fig. 6
Fig. 6
Proportion of HR patients having whole blood (WB) metal ion values below their safe upper limits (SUL)
Fig. 7
Fig. 7
Proportion of THR patients having whole blood (WB) metal ion values below their safe upper limits (SUL)
See this image and copyright information in PMC

Comment in

References

    1. Bosker BH, Ettema HB, Boomsma MF, Kollen BJ, Maas M, Verheyen CC. High incidence of pseudotumour formation after large-diameter metal-on-metal total hip replacement: a prospective cohort study. J Bone Joint Surg (Br) 2012;94(6):755–761. doi: 10.1302/0301-620X.94B6.28373. - DOI - PubMed
    1. Reito A, Puolakka T, Elo P, Pajamaki J, Eskelinen A. High prevalence of adverse reactions to metal debris in small-headed ASR hips. Clin Orthop Relat. 2013;471(9):2954–2961. doi: 10.1007/s11999-013-3023-6. - DOI - PMC - PubMed
    1. Bisschop R, Boomsma MF, Van Raay JJ, Tiebosch AT, Maas M, Gerritsma CL. High prevalence of pseudotumors in patients with a Birmingham hip resurfacing prosthesis: a prospective cohort study of one hundred and twenty-nine patients. J Bone Joint Surg Am. 2013;95(17):1554–1560. doi: 10.2106/JBJS.L.00716. - DOI - PubMed
    1. Donell ST, Darrah C, Nolan JF, Wimhurst J, Toms A, Barker TH. Early failure of the Ultima metal-on-metal total hip replacement in the presence of normal plain radiographs. J Bone Joint Surg (Br) 2010;92(11):1501–1508. doi: 10.1302/0301-620X.92B11.24504. - DOI - PubMed
    1. Anderson H, Toms AP, Cahir JG, Goodwin RW, Wimhurst J, Nolan JF. Grading the severity of soft tissue changes associated with metal-on-metal hip replacements: reliability of an MR grading system. Skelet Radiol. 2011;40(3):303–307. doi: 10.1007/s00256-010-1000-7. - DOI - PubMed