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. 2018 Dec 17:18:74-83.
doi: 10.1016/j.jot.2018.11.001. eCollection 2019 Jul.

The correlation between activity level, serum-ion concentrations and pseudotumours in patients with metal-on-metal hip articulations and metal-on-polyethylene total hip articulations

Mette Holm Hjorth  1   2 , Inger Mechlenburg  1   2 , Kjeld Soballe  1   2 , Lone Roemer  3 , Maiken Stilling  1   2
Affiliations

The correlation between activity level, serum-ion concentrations and pseudotumours in patients with metal-on-metal hip articulations and metal-on-polyethylene total hip articulations

Mette Holm Hjorth et al. J Orthop Translat. .

Abstract

Purpose: Young and physically active patients have mainly received metal-on-metal (MoM) total hip arthroplasty (THA) and resurfacing hip arthroplasty (RHA). However, the correlation between daily physical activity (PA) levels, serum-ion concentrations of chromium and cobalt and pseudotumours formation of patients who underwent MoM THA/RHA is insufficiently explored.

Methods: Ninety-nine patients with 134 hip articulations, 71 MoM THA/RHA and 63 MoP THA participated in a cross-sectional study at XXX University Hospital, Denmark, at mean 7.3 (range: 0.4-21.7) years after surgery. Patients' daily PA was monitored during a two-week period using a triaxial accelerometer. Metal artefact reduction sequence magnetic resonance imaging scans, estimation of serum-ion concentrations of chromium and cobalt and the Copenhagen Hip and Groin Outcome Score (HAGOS) questionnaire were completed on Day 14.

Results: Patients with a pseudotumour who underwent MoM THA/RHA had a higher average cadence of median 101.4 [interquartile range (IQR: 95.5-105)] steps/min than patients without a pseudotumor, median 96.7 (IQR: 92.2-103) steps/min (p = 0.02). Serum-ion concentrations of chromium and cobalt were higher in patients with a pseudotumour who underwent MoM THA/RHA, median 2.57 (IQR: 1.4-3.4) μg/L and 1.80 (IQR: 1.2-2.6) μg/L, respectively, than in patients without a pseudotumour, median 1.85 (IQR: 1.1-3.2) μg/L and 1.34 (IQR: 0.9-2.2) μg/L in MoM THA/RHA (p = 0.04 and p = 0.03). There was no statistical difference in these parameters between patients with and without a pseudotumour who underwent MoP THA. Daily PA levels of patients who underwent MoM THA/RHA were significantly correlated with serum-ion concentrations of chromium (p = 0.0002, r = 0.44) and cobalt (p = 0.005, r = 0.34), whereas no correlations were seen among patients who underwent MoP THA (p > 0.12).

Conclusion: The daily PA level of patients who underwent MoM THA/RHA influences the serum-ion concentrations of chromium and cobalt and the risk of pseudotumour formation.

Translational potential of this article: Results of this article add important knowledge on potential recommendations of prosthesis selection for patients with a high level of physical activity.

Keywords: 3D accelerometer; Clinical outcome measures; Magnetic resonance imaging; Metal-ion concentrations; Metal-on-metal; Resurfacing hip arthroplasty; Total hip arthroplasty.

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Figures

Figure 1
Figure 1
Presentation of the different types and brands of hip articulations included in the study.
Figure 2
Figure 2
(A) Coronal and (B) axial MARS MRIs of a 54-year-old male with right-side MoM THA (M2a-Magnum, BiMetric Stem) and a mixed pseudotumour located at the iliopsoas bursa. His serum metal-ion levels of chromium and cobalt were 1.4 μg/L and 2.8 μg/L, respectively. MARS = Metal artefact reduction sequence; MoM = metal-on-metal; MRI = magnetic resonance imaging; RHA = resurfacing hip arthroplasty; THA = total hip arthroplasty.
Figure 3
Figure 3
(A) Coronal and (B) axial MARS MRIs of a 64-year-old male with bilateral MoP THA (Right side: Mallory Head, Exeeter Stem, and left side: Pinnacle cup, Corail stem). The pseudotumour on the right side is of mixed type, and on the left side, it is of cystic type. MARS = Metal artefact reduction sequence; MoP = metal-on-polyethylene; MRI = magnetic resonance imaging; RHA = resurfacing hip arthroplasty; THA = total hip arthroplasty.
See this image and copyright information in PMC

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