Correlation between serum metal ion levels and adverse local tissue reactions after Conserve® Plus hip resurfacing arthroplasty.
BACKGROUND
Adverse local tissue reactions (ALTR) have been associated with the use of metal-on-metal (MoM) bearings and the monitoring of cobalt (Co) and chromium (Cr) ion levels in blood or serum may be the best way to evaluate in vivo the wear of these bearings. However, the relationship between Co and Cr ion concentrations and the formation of ALTR remains unclear.


METHODS
We investigated the relationship between ALTR and serum Co and Cr ion levels and identified the clinical factors influencing the formation of ALTR in patients treated with MoM hip resurfacing arthroplasties. 228 patients with unilateral Conserve® Plus MoM hip resurfacing had serum metal ion studies performed more than 1 year after surgery. Metal artifact reduction sequence magnetic resonance imaging (MARS MRI) was performed on subjects at risk for ALTR as determined by a screening protocol.


RESULTS
12 patients had ALTR. Logistic regression showed a strong association of ALTR with elevated ion levels and with low (<10 mm) contact patch to rim distance.


CONCLUSIONS
MoM bearings require enough functional coverage of the socket by design and then precise implantation to maximise functional coverage of the femoral ball, enhance lubrication, and avoid edge-loading wear.
Joint Replacement Institute at St. Vincent Medical Center, Los Angeles - USA.
Harlan C
HC
Amstutz
Joint Replacement Institute at St. Vincent Medical Center, Los Angeles - USA.
Michel J
MJ
Le Duff
D000293:Adolescent; D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D002857:Chromium / Q000097:blood; D003035:Cobalt / Q000097:blood; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000601:surgery; D006622:Hip Prosthesis; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D061825:Metal-on-Metal Joint Prostheses / Q000009:adverse effects*; D008670:Metals / Q000097:blood*; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D055815:Young Adult
D008670:Metals; D002857:Chromium; D003035:Cobalt