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Case Reports
. 2018 Jan-Feb;8(1):44-47.
doi: 10.13107/jocr.2250-0685.992.

Activity-related Changes in Cobalt Levels in a Total Hip with a Modular Femoral Stem: A Case Report

Michael S Reich  1 , Richard H Walker  1
Affiliations
Case Reports

Activity-related Changes in Cobalt Levels in a Total Hip with a Modular Femoral Stem: A Case Report

Michael S Reich et al. J Orthop Case Rep. 2018 Jan-Feb.

Abstract

Introduction: Femoral neck modularity in total hip arthroplasty (THA) affords the surgeon the ability to optimize femoral neck length, offset, and version, thereby theoretically improving restoration of patient anatomy and biomechanics. The effect of activity on serum metal ion levels in patients with a THA with a mixed-metal modular neck design has not yet been described.

Case report: A 63-year-old male underwent THA utilizing a femoral stem with a mixed-metal modular femoral neck. After the stem was voluntarily recalled, he was indicated to be monitored for manifestations ofmodular junction corrosion and development of adverse local tissue reactions (ALTR). An association between activity levels and serial serum cobalt levels was demonstrated.

Conclusion: In this patient with a THA incorporating a mixed-metal modular femoral neck, modification of activity intensity may have played a role in altered corrosion generation, as indicated by serum metal ion levels. In turn, this may play a role in the progression of ALTR.

Keywords: Activity; adverse local tissue reactions; cobalt; modular femoral stem; total hip arthroplasty.

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Conflict of interest statement

Conflict of Interest: Nil

Figures

Figure 1
Figure 1
Immediate post-operative anteroposterior pelvis X-ray; anteroposterior pelvis X-ray obtained immediately postoperatively after total hip arthroplasty.
Figure 2
Figure 2
2-year follow-up anteroposterior pelvis X-ray; anteroposterior pelvis X-ray obtained at 2-year follow-up demonstrating stable total hip arthroplasty with the development ofheterotopic ossification.
Figure 3
Figure 3
Metal artifact reduction sequence (MARS) magnetic resonance imaging with adverse local tissue reaction lesion; axial T2-weighted MARS magnetic resonance imaging demonstrating adverse local tissue reaction lesion.
See this image and copyright information in PMC

References

    1. Stryker Initiates Voluntary Product Recall of Modular-Neck Stems. Action Specific to Rejuvenate and ABG II Modular-Neck Stems: Food and Drug Administration. New York, NY: US Department of Health and Human Services; 2012.
    1. Nawabi DH, Do HT, Ruel A, Lurie B, Elpers ME, Wright T, et al. Comprehensive analysis of a recalled modular total hip system and recommendations for management. J Bone Joint Surg Am. 2016;98:40–7. - PubMed
    1. Liow MH, Urish KL, Preffer FI, Nielson GP, Kwon YM. Metal ion levels are not correlated with histopathology of adverse local tissue reactions in taper corrosion of total hip arthroplasty. J Arthroplasty. 2016;31:1797–802. - PubMed
    1. Walsh CP, Hubbard JC, Nessler JP, Markel DC. Revision of recalled modular neck Rejuvenate and ABG femoral implants. J Arthroplasty. 2015;30:822–6. - PubMed
    1. Cooper HJ, Urban RM, Wixson RL, Meneghini RM, Jacobs JJ. Adverse local tissue reaction arising from corrosion at the femoral neck-body junction in a dual-taper stem with a cobalt-chromium modular neck. J Bone Joint Surg Am. 2013;95:865–72. - PMC - PubMed

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