title: Systemic Metal Ion Levels in Patients With Modular-Neck Stems: A Prospective Cohort Study.
abstract: Recent registry data reveal that modular-neck hip prostheses are associated with increased revision rates compared to fixed-neck stems. Poor implant survival has been associated to corrosion at the neck-stem junction, inducing metal ion release and subsequently adverse local tissue reactions. Data on metal ion release on the neck-stem junction of such stems are scarce. The purpose of this study was to evaluate corrosion at this interface by determining metal ion release.
  
  
  
  Serum and whole blood metal ion levels of 40 patients after 1 year of implantation of a modular-neck stem (titanium stem and cobalt-chromium neck) were compared with 10 patients with a monobloc version of the stem (all titanium) and 10 patients having no implant at all.
  
  
  
  Seven of 40 patients (18%) with a modular-neck stem had cobalt or chromium concentrations >2 μg/L. These patients underwent magnetic resonance imaging using metal artifact reduction sequences, which revealed a pseudotumor in 1 patient.
  
  
  
  Corrosion at the neck-stem junction of modular-neck stems is a reported phenomenon, which is in part reflected by elevated systemic ion levels. The use of such implants should be restricted to a minimum, and screening algorithms of patients with such implants must be developed.
authors.affiliation: Department of Orthopaedics, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Laurençon
authors.affiliation: Forensic Toxicology and Chemistry Unit, Centre Universitaire Romand de Médecine Légale CURML, Lausanne, Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Augsburger
authors.affiliation: Department of Biostatistics, University of Lausanne, Lausanne, Switzerland.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Faouzi
authors.affiliation: Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Fabio
authors.initials: F
authors.lastname: Becce
authors.affiliation: Department of Orthopaedics, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Hassen
authors.initials: H
authors.lastname: Hassani
authors.affiliation: Department of Orthopaedics, Lausanne University Hospital, Lausanne, Switzerland; Department of Orthopaedics, Schulthess Clinic, Zürich, Switzerland.
authors.forename: Hannes A
authors.initials: HA
authors.lastname: Rüdiger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D002857:Chromium / Q000097:blood*; D003035:Cobalt / Q000097:blood*; D003343:Corrosion; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008982:Molybdenum / Q000097:blood; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012042:Registries; D014025:Titanium / Q000097:blood
chemical_list: D002857:Chromium; D003035:Cobalt; D008982:Molybdenum; D014025:Titanium
keywords: adverse local tissue reaction; arthroplasty; corrosion; hip; metal ion release; modular neck