One-year prospective comparative study of three large-diameter metal-on-metal total hip prostheses: serum metal ion levels and clinical outcomes.

نویسندگان

  • J-F Lardanchet
  • J Taviaux
  • D Arnalsteen
  • A Gabrion
  • P Mertl
چکیده

INTRODUCTION The good clinical outcomes and low wear obtained with 28-mm metal-on-metal implants for total hip replacement prompted the development of large-diameter heads that more closely replicated the normal hip anatomy, with the goal of improving prosthesis stability. However, the blood release of metal ions due to wear at the bearing surfaces and the high rate of groin pain seen with large-diameter implants are causing concern. To determine whether these events are related to the geometry and metal composition of the prosthesis components, we conducted a prospective study of clinical outcomes and serum chromium and cobalt levels 1 year after implantation of three different acetabular cups. HYPOTHESIS Serum levels of metal ions are comparable with different types of large-diameter metal-on-metal total hip prostheses. PATIENTS AND METHODS We compared 24 Durom™ cups (D), 23 M2a Magnum™ cups (M2a), and 20 Conserve Total™ (C) cups regarding serum chromium and cobalt levels, Postel-Merle d'Aubigné (PMA) scores and Oxford Hip Scores (OHS), as well as radiographic cup orientation and position at 1-year follow-up. Mean age was 66 years (45-85 years), mean body mass index was 28 Kg/m(2) (18-45), patients were almost equally divided between males and females, and the reason for hip replacement was primary hip osteoarthritis in 65 patients and avascular necrosis in two. Metal ions were assayed in serum from blood drawn through non-metallic catheters, using mass spectrometry. RESULTS Dislocation occurred in two patients (one D and one M2a) and revision to change the bearing couple was required in two patients in the D group. Serum cobalt levels in the C group were significantly higher (P=0. 0003) than in the two other groups (7.5 μg/L versus 2. 7 μg/L with D and 2. 2 μg/L with M2a). Clinical outcomes were better in the M2a group (PMA, 17.7 [16-18]; and OHS, 15.2 [12-30]; P<0.05). The PMA score and OHS were 17.5 (16-18) and 18.2 (12-42), respectively, with D; and 16.75 (10-18) and 22. 2 (12-42), respectively, with C cups. When all three cup models were pooled, serum ion levels were higher in patients with pain than without pain (chromium, 7.1 μg/L versus 2.1 μg/L [P=0.002], and cobalt, 8 μg/L versus 2.6 μg/L [P=0.0004]). DISCUSSION Serum chrome and cobalt levels increased after metal-on-metal total hip replacement, and the increase was greater with large-diameter implants than previously reported with 28-mm implants. Persistent pain was significantly associated with higher metal ion levels, with a probable cobalt cut-off of about 8 μg/L. Differences in modular head-neck concepts may explain the observed variations.

برای دانلود رایگان متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Metal ion levels in large-diameter total hip and resurfacing hip arthroplasty-Preliminary results of a prospective five year study after two years of follow-up

BACKGROUND Metal-on-metal hip resurfacing is an alternative to metal-on-metal total hip arthroplasty, especially for young and physically active patients. However, wear which might be detected by increased serum ion levels is a matter of concern. METHODS The aims of this preliminary study were to determine the raise of metal ion levels at 2-years follow-up in a prospective setting and to eval...

متن کامل

Metal ion levels decrease after revision for metallosis arising from large-diameter metal-on-metal hip arthroplasty.

Concerns have been renewed regarding the possible long-term effects of elevated circulating levels of cobalt and chromium as a direct result of implantation of large femoral head diameter metal-on-metal bearings. In order to establish whether metal ion levels remain persistently elevated, we compared metal ion levels before and after revision surgery in patients with large head diameter (greate...

متن کامل

Hip resurfacing versus metal-on-metal total hip arthroplasty - are metal ion levels different?

A systematic review and meta-analysis of trials comparing hip resurfacing to metal-on-metal total hip arthroplasty was conducted to determine if there is a difference in serum metal ion levels in patients receiving these implants. EMBASE and MEDLINE databases were searched from inception to December 2010 for all trials involving the use of these devices. Eligibility for inclusion in the review ...

متن کامل

Prevalence of Failure due to Adverse Reaction to Metal Debris in Modern, Medium and Large Diameter Metal-on-Metal Hip Replacements--The Effect of Novel Screening Methods: Systematic Review and Metaregression Analysis.

Metal-on-metal (MoM) hip replacements were used for almost a decade before adverse reactions to metal debris (ARMD) were found to be a true clinical problem. Currently, there is a paucity of evidence regarding the usefulness of systematic screening for ARMD. We implemented a systematic review and meta-analysis to establish the prevalence of revision confirmed ARMD stratified by the use of diffe...

متن کامل

Does bearing size influence metal ion levels in large-head metal-on-metal total hip arthroplasty? A comparison of three total hip systems

BACKGROUND The purpose of the study was twofold: first, to determine whether there is a statistically significant difference in the metal ion levels among three different large-head metal-on-metal (MOM) total hip systems. The second objective was to assess whether position of the implanted prostheses, patient demographics or factors such as activity levels influence overall blood metal ion leve...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

عنوان ژورنال:
  • Orthopaedics & traumatology, surgery & research : OTSR

دوره 98 3  شماره 

صفحات  -

تاریخ انتشار 2012