title: Sensitivity and Specificity of Metal Ion Levels in Predicting "Pseudotumors" due to Taper Corrosion in Patients With Dual Taper Modular Total Hip Arthroplasty.
abstract: Currently, no serum metal ion threshold exists to identify adverse tissue reactions in total hip arthroplasty (THA) patients with taper corrosion. Our study aims to investigate the sensitivity and specificity of serum metal ions in detecting taper corrosion related pseudotumors in patients with dual taper modular THA.
  
  
  
  A total of 148 patients with dual taper modular THA were investigated: (1) 90 patients with pseudotumors detected with metal artifact reduction sequence-magnetic resonance imaging (MARS-MRI) and (2) 58 patients without pseudotumors on MARS-MRI. Receiver operating characteristic curves were constructed to determine the sensitivity and specificity using different metal ion thresholds. The severity of intraoperative tissue damage was correlated with preoperative metal ion levels.
  
  
  
  Pseudotumor was associated with higher cobalt (5.0 μg/L vs 3.7 μg/L, P < .01) and Co/Cr ratio (6.0 vs 3.7, P < .01). The sensitivity and specificity for cobalt level of 2.8 μg/L and Co/Cr ratio of 3.8 in detecting taper corrosion-related pseudotumors on MARS-MRI was 88% and 32% and 70% and 50%, respectively. Higher intraoperative tissue damage grades demonstrated significantly higher Co/Cr ratios (8.6 vs 3.4, P = .03).
  
  
  
  Although metal ion levels alone should not be relied on as the sole parameter to determine revision surgery, cobalt level >2.8 μg/L and the Co/Cr ratio >3.8 are useful clinical diagnostic adjuncts in the systematic clinical evaluation for taper corrosion-related adverse tissue reactions in patients with dual modular taper THA.
authors: Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors: Young-Min
authors: YM
authors: Kwon
authors: Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors: Tsung-Yuan
authors: TY
authors: Tsai
authors: Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors: William A
authors: WA
authors: Leone
authors: Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors: Ming Han Lincoln
authors: MHL
authors: Liow
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000295:instrumentation*; D002857:Chromium / Q000097:blood; D003035:Cobalt / Q000097:blood; D003343:Corrosion; D005260:Female; D006104:Granuloma, Plasma Cell / Q000097:blood* / Q000175:diagnosis / Q000209:etiology*; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D007477:Ions; D008279:Magnetic Resonance Imaging; D008297:Male; D008670:Metals / Q000097:blood*; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012372:ROC Curve; D012086:Reoperation; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
chemical_list: D007477:Ions; D008670:Metals; D002857:Chromium; D003035:Cobalt
keywords: dual taper modular stem; metal ion threshold; pseudotumor; receiver operating characteristics curve; taper corrosion; total hip arthroplasty