title: Elevated Intra-Articular Cobalt and Chromium Levels in Mechanically Assisted Crevice Corrosion in Metal-on-Polyethylene Total Hip Arthroplasty.
abstract: Failed total hip arthroplasty (THA) caused by mechanically assisted crevice corrosion (MACC) has serious consequences such as adverse local tissue reaction (ALTR). Serum cobalt (Co) and chromium (Cr) ion levels have been used to diagnose taper corrosion, but have not been shown to be an accurate measure of the severity of MACC or associated ALTRs. Additionally, elevated serum ions are not specific in patients with multiple artificial joints.
  
  
  
  We examined the relationship between serum and intra-articular (IA) Co and Cr levels in a cohort of 20 patients undergoing revision THA, 16 who had symptomatic MACC. IA Co and Cr levels in MACC patients were compared with demographic, pre-operative, and operative findings.
  
  
  
  Serum and IA metal levels were found to be relatively low in THA patients undergoing revision surgery for isolated instability, aseptic loosening, or infection (average serum Co 0.03 ppb [parts per billion], IA Co 1.4 ppb, serum Cr 0.32 ppb, IA Cr 3.3 ppb). In patients with MACC, average IA Co (940 ppb) was significantly higher than serum Co (5.1 ppb) (P = .0003) and IA Cr (491 ppb) was significantly higher than serum Cr (1.3 ppb) (P = .0003). IA Co level was associated with shorter time of hip symptoms to revision surgery (P = .0043).
  
  
  
  Serum levels of Co and Cr correlated with joint levels in the entire cohort, but IA levels of MACC patients were 100 times greater than serum levels. IA Co and Cr levels may be useful in confirming MACC in a specific joint and the striking elevation may explain symptoms and ALTR with relatively low serum values.
authors.affiliation: Tufts University School of Medicine, Boston, Massachusetts; Maine Joint Replacement Institute, Portland, Maine; Maine Medical Center Division of Joint Replacements, Falmouth, Maine.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: McGrory
authors.affiliation: Maine Medical Center Research Institute, Scarborough, Maine.
authors.forename: Abigail M
authors.initials: AM
authors.lastname: Payson
authors.affiliation: Maine Medical Center Division of Joint Replacements, Falmouth, Maine.
authors.forename: Johanna A
authors.initials: JA
authors.lastname: MacKenzie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D002857:Chromium / Q000097:blood*; D003035:Cobalt / Q000097:blood*; D015331:Cohort Studies; D003343:Corrosion; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects; D006801:Humans; D008297:Male; D008670:Metals / Q000737:chemistry*; D008875:Middle Aged; D020959:Polyethylene / Q000737:chemistry*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation
chemical_list: D008670:Metals; D002857:Chromium; D003035:Cobalt; D020959:Polyethylene
keywords: adverse local tissue reaction; chromium; cobalt; mechanically assisted crevice corrosion; revision; total hip arthroplasty