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. 2015 Dec 22:16:393.
doi: 10.1186/s12891-015-0851-4.

Diagnostic utility of joint fluid metal ion measurement for histopathological findings in metal-on-metal hip replacements

Aleksi Reito  1 , Jyrki Parkkinen  2 , Timo Puolakka  3 , Jorma Pajamäki  4 , Antti Eskelinen  5
Affiliations

Diagnostic utility of joint fluid metal ion measurement for histopathological findings in metal-on-metal hip replacements

Aleksi Reito et al. BMC Musculoskelet Disord. .

Abstract

Background: In vivo assessment of inflammatory responses in the synovia of patients with MoM hip replacements would be useful in the determination of the prognosis of the hip replacement. Aims of the study was to investigate the correlation between cobalt and chrome levels in joint fluid with histopathological findings and the predictive ability of metal ion levels for these findings.

Methods: In 163 revision surgeries (141 ASR THAs and 22 ASR hip resurfacings) joint fluid chrome and cobalt levels were assessed and histological analysis of synovial tissues was performed. Histological analysis included assessment of histiocytes, particle load, surface necrosis, lymphocyte cuffs and ALVAL-score.

Results: Surface necrosis correlated positively with cobalt levels both in both groups. Neither chrome nor cobalt level had even fair discriminative ability to predict the presence or severity of any histological finding in the THA group. In the hip resurfacing group, cobalt level had good discriminative ability to predict the presence of perivascular lymphocytes and ALVAL-score of ≥ 7 whereas chrome had good discriminative ability to predict surface necrosis, metal particle load and ALVAL-score of ≥ 7.

Conclusions: Measurement of metal ion levels following joint fluid aspirate offers no relevant information with regard to histopathological findings in patients with large-diameter MoM THAs. Limited information may be gained from assessment of joint fluid metal ion levels in patients with hip resurfacings, but disadvantages of an aspirate must be carefully reviewed.

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Figures

Fig. 1
Fig. 1
Flow chart of the study group selection
Fig. 2
Fig. 2
Interpretation of required sample size in order to have significant AUC at level .05 with power .80 with 141 hips in the THA group
Fig. 3
Fig. 3
Interpretation of required sample size in order to have significant AUC at level .05 with power .80 with 22 hips in the hip resurfacing group
Fig. 4
Fig. 4
Scatter plots of joint fluid versus WB metal ion levels. a Scatter plot of joint fluid cobalt versus WB cobalt in THAs. b Scatter plot of joint fluid chrome versus WB chrome in THRs. c Scatter plot of joint fluid cobalt versus WB cobalt in hip resurfacings. d Scatter plot of joint fluid chrome versus WB chrome in hip resurfacings
Fig. 5
Fig. 5
Scatter plot of ALVAL-score versus joint fluid metal ion levels. a Scatter plot of cobalt level in joint fluid versus ALVAL-score in the THA group. b Scatter plot of chrome level in joint fluid versus ALVAL-score in the hip resurfacing group
Fig. 6
Fig. 6
ROC curve and best threshold with corresponding value for sensitivity and specificity for each outcome with significant AUC of > .75 in the hip resurfacing group. a Joint fluid Co and Cr level predicting ALVAL-score of 7 or higher. b Joint fluid Co level predicting presence of lymphocyte cuffs. c Joint fluid Co predicting particle load graded 1–4. d Joint fluid Cr predicting grade III-IV surface necrosis
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References

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