title: Metal ion concentrations and semen quality in patients undergoing hip arthroplasty: A prospective comparison between metal-on-metal and metal-on-polyethylene implants.
abstract: OBJECTIVE
  The widespread usage of metal-on-metal (MoM) articulations in total hip arthroplasty (THA) has been tempered by concerns of increased metal ion production. The purpose of the study is to evaluate the influence of metal ion exposure on semen quality in young male patients undergoing THA.
  
  
  METHODS
  Male patients who were scheduled for unilateral THA and aged between 20 and 45 years were prospectively enrolled. Patients were sorted into MoM and metal-on-polyethylene (MoP) groups with equal case number. Semen and blood metal ion levels were measured and sperm analysis was performed before, 6 months after, and 1 year after surgery.
  
  
  RESULTS
  Compared to preoperative baseline, patients (n = 50) in both groups had increased cobalt (Co) and chromium (Cr) concentrations in blood and seminal fluid after surgery. Between-group comparisons at 6 months and 1 year after surgery showed that patients in the MoM group both had a greater Co concentration in blood and semen and a greater Cr concentration in blood and semen. Patients receiving MoM prosthesis had a reduced percentage of morphologically normal sperm, and decreases from the preoperative level (44.7%) were significant at 6 months (36.8%, p = 0.03) and 1 year (33.8%, p = 0.004).
  
  
  CONCLUSIONS
  Our data shows a significantly greater concentration of metal ion in blood and semen in patients with MoM prosthesis with a reduced percentage of morphologically normal sperm. Despite small effects on sperm quality, some concerns remain. Further studies are necessary to determine sources of metal ion and to investigate effects on male fertility.
authors: Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.|Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.|Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors: Szu-Yuan
authors: SY
authors: Chen
authors: Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.|Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.|Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors: Chih-Hsiang
authors: CH
authors: Chang
authors: Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.|Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.|Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors: Chih-Chien
authors: CC
authors: Hu
authors: Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.|Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.|Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors: Chun-Chieh
authors: CC
authors: Chen
authors: Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.|Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.|Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors: Yu-Han
authors: YH
authors: Chang
authors: Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.|Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.|Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors: Pang-Hsin
authors: PH
authors: Hsieh
mesh_terms: D000328:Adult; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D002857:Chromium / Q000032:analysis*; D003035:Cobalt / Q000032:analysis*; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D020959:Polyethylene; D011446:Prospective Studies; D012661:Semen / Q000737:chemistry*
chemical_list: D002857:Chromium; D003035:Cobalt; D020959:Polyethylene
keywords: metal ion; metal-on-metal; semen analysis; total hip arthroplasty