title: Worse health-related quality of life and hip function in female patients with elevated chromium levels.
abstract: Background and purpose - Blood metal ion levels can be an indicator for detecting implant failure in metal-on-metal (MoM) hip arthroplasties. Little is known about the effect of bilateral MoM implants on metal ion levels and patient-reported outcomes. We compared unilateral patients and bilateral patients with either an ASR hip resurfacing (HR) or an ASR XL total hip replacement (THR) and investigated whether cobalt or chromium was associated with a broad spectrum of patient outcomes. Patients and methods - From a registry of 1,328 patients enrolled in a multicenter prospective follow-up of the ASR Hip System, which was recalled in 2010, we analyzed data from 659 patients (311 HR, 348 THR) who met our inclusion criteria. Cobalt and chromium blood metal ion levels were measured and a 21-item patient-reported outcome measures (PROMs) questionnaire was used mean 6 years after index surgery. Results - Using a minimal threshold of ≥7 ppb, elevated chromium ion levels were found to be associated with worse health-related quality of life (HRQoL) (p < 0.05) and hip function (p < 0.05) in women. These associations were not observed in men. Patients with a unilateral ASR HR had lower levels of cobalt ions than bilateral ASR HR patients (p < 0.001) but similar levels of chromium ions (p = 0.09). Unilateral ASR XL THR patients had lower chromium and cobalt ion levels (p < 0.005) than bilateral ASR XL THR patients. Interpretation - Chromium ion levels of ≥7 ppb were associated with reduced functional outcomes in female MoM patients.
authors.affiliation: a Harris Orthopaedic Laboratory , Massachusetts General Hospital ;
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Hussey
authors.affiliation: a Harris Orthopaedic Laboratory , Massachusetts General Hospital ;|b Harvard Medical School , Department of Orthopaedic Surgery , Boston , USA ;
authors.forename: Rami
authors.initials: R
authors.lastname: Madanat
authors.affiliation: a Harris Orthopaedic Laboratory , Massachusetts General Hospital ;
authors.forename: Gabrielle S
authors.initials: GS
authors.lastname: Donahue
authors.affiliation: a Harris Orthopaedic Laboratory , Massachusetts General Hospital ;|b Harvard Medical School , Department of Orthopaedic Surgery , Boston , USA ;|c Department of Orthopaedics , Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden.
authors.forename: Ola
authors.initials: O
authors.lastname: Rolfson
authors.affiliation: a Harris Orthopaedic Laboratory , Massachusetts General Hospital ;|b Harvard Medical School , Department of Orthopaedic Surgery , Boston , USA ;
authors.forename: Orhun K
authors.initials: OK
authors.lastname: Muratoglu
authors.affiliation: a Harris Orthopaedic Laboratory , Massachusetts General Hospital ;|b Harvard Medical School , Department of Orthopaedic Surgery , Boston , USA ;
authors.forename: Henrik
authors.initials: H
authors.lastname: Malchau
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D015415:Biomarkers / Q000097:blood; D002857:Chromium / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006621:Hip Joint / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D061825:Metal-on-Metal Joint Prostheses; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000097:blood* / Q000601:surgery; D011446:Prospective Studies; D011474:Prosthesis Design; D011788:Quality of Life; D016059:Range of Motion, Articular / Q000502:physiology*; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult
chemical_list: D015415:Biomarkers; D002857:Chromium