The Utility of Metal Ion Trends in Predicting Revision in Metal-on-Metal Total Hip Arthroplasty

Abstract

Background: There is a paucity of data examining metal ion levels over time.

Methods: We retrospectively reviewed 59 patients (69 hips) with an articular surface replacement total hip arthroplasty. We reviewed prerevision cobalt and chromium concentrations over time.

Results: Seventy-one percent of patients who were revised and had multiple ion measurements (12/17) demonstrated increasing cobalt ion levels or elevated ion levels over time. There was a trend toward an elevated risk of revision for increasing cobalt and chromium levels starting at 12 and 4 ppb, respectively; this was significant for chromium levels above 7 ppb (hazard ratio 22.35, P = .001). Similarly, there was a trend toward an elevated risk of pseudotumor formation for increasing cobalt and chromium levels starting at 5 and 2.5 ppb, respectively; this was significant for cobalt levels above 7 ppb (hazard ratio 6.88, P = .027).

Conclusion: In this paper, cobalt and chromium levels levels above 5 and 2.5 ppb started to demonstrate an increased risk of ARMD, and should be considered as a lower cutoff for discussion with patients about the potential for future revision.

Keywords: ASR; adverse reaction to metal debris; metal ion levels; metal-on-metal total hip arthroplasty; pseudotumor; trunnionosis.