Comparison of synovial fluid, urine, and serum ion levels in metal-on-metal total hip arthroplasty at a minimum follow-up of 18 years.
Diagnosis of adverse reactions to metal debris in metal-on-metal hip arthroplasty is a multifactorial process. Systemic ion levels are just one factor in the evaluation and should not be relied upon solely to determine the need for revision surgery. Furthermore, the correlation between cobalt or chromium serum, urine, or synovial fluid levels and adverse local tissue reactions is still incompletely understood. The hypothesis was that elevated serum and urine metal-ion concentrations are associated with elevated local metal-ion concentrations in primary total hip arthroplasties (THA) and with failure of metal-on-metal articulations in the long-term. In our present study, we evaluated these concentrations in 105 cementless THA with metal-on-metal articulating surfaces with small head diameter at a minimum of 18 years postoperatively. Spearman correlation showed a high correlation between the joint fluid aspirate concentration of cobalt and chromium with the serum cobalt (r = 0.81) and chromium level (r = 0.77) in patients with the THA as the only source of metal-ions. In these patients serum metal-ion analysis is a valuable method for screening. In patients with more than one source of metal or renal insufficiency additional investigations, like joint aspirations are an important tool for evaluation of wear and adverse tissue reactions in metal-on-metal THA.
Department of Orthopaedics, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria.
Richard
R
Lass
Alexander
A
Grübl
Alexander
A
Kolb
David
D
Stelzeneder
Alexander
A
Pilger
Bernd
B
Kubista
Alexander
A
Giurea
Reinhard
R
Windhager
D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation*; D002857:Chromium / Q000097:blood / Q000378:metabolism* / Q000652:urine; D003035:Cobalt / Q000097:blood / Q000378:metabolism* / Q000652:urine; D003430:Cross-Sectional Studies; D019544:Equipment Failure Analysis; D005260:Female; D005500:Follow-Up Studies; D006621:Hip Joint / Q000601:surgery; D006622:Hip Prosthesis; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D013582:Synovial Fluid / Q000378:metabolism*; D016896:Treatment Outcome
D002857:Chromium; D003035:Cobalt
joint fluid ion concentration; long-term results; metal-on-metal bearings; serum ion concentration; total hip replacement