title: Comparison of Whole-Blood Metal Ion Levels Among Four Types of Large-Head, Metal-on-Metal Total Hip Arthroplasty Implants: A Concise Follow-up, at Five Years, of a Previous Report.
abstract: Few studies of total hip arthroplasty (THA) implants with a large-diameter femoral head and metal-on-metal design have directly compared the progression of metal ion levels over time and the relationship to complications. As we previously reported, 144 patients received one of four types of large-diameter-head, metal-on-metal THA designs (Durom, Birmingham, ASR XL, or Magnum implants). Cobalt, chromium, and titanium ion levels were measured over five years. We compared ion levels and clinical results over time. The Durom group showed the highest levels of cobalt (p ≤ 0.002) and titanium ions (p ≤ 0.03). Both the Durom and Birmingham groups demonstrated significant ongoing cobalt increases up to five years. Eight patients (seven with a Durom implant and one with a Birmingham implant) developed adverse local tissue reaction. Six Durom implants and one Birmingham implant required revision, with one pseudotumor under surveillance at the time of the most recent follow-up. We found that ion generation and related complications varied among designs. More concerning was that, for some designs, ion levels continued to increase. Coupling a cobalt-chromium adapter sleeve to an unmodified titanium femoral trunnion along with a large metal-on-metal bearing may explain the poor performances of two of the designs in the current study.
authors.affiliation: Department of Trauma and Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, United Kingdom.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Hutt
authors.affiliation: Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Martin
authors.initials: M
authors.lastname: Lavigne
authors.affiliation: Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Eugen
authors.initials: E
authors.lastname: Lungu
authors.affiliation: Centre Hospitalier Universitaire de Québec, Québec, Québec, Canada.
authors.forename: Etienne
authors.initials: E
authors.lastname: Belzile
authors.affiliation: Centre Hospitalier Universitaire de Québec, Québec, Québec, Canada.
authors.forename: François
authors.initials: F
authors.lastname: Morin
authors.affiliation: Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada pa.vendittoli@me.com.
authors.forename: Pascal-André
authors.initials: PA
authors.lastname: Vendittoli
mesh_terms: D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000295:instrumentation*; D015415:Biomarkers / Q000097:blood; D002857:Chromium / Q000097:blood*; D003035:Cobalt / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006622:Hip Prosthesis / Q000009:adverse effects; D006801:Humans; D007477:Ions / Q000097:blood; D008297:Male; D061825:Metal-on-Metal Joint Prostheses / Q000009:adverse effects; D008875:Middle Aged; D011446:Prospective Studies; D011474:Prosthesis Design; D013997:Time Factors; D014025:Titanium / Q000097:blood*
chemical_list: D015415:Biomarkers; D007477:Ions; D002857:Chromium; D003035:Cobalt; D014025:Titanium