title: Adverse reaction to metal debris in a consecutive series of DUROM™ hip resurfacing: pseudotumour incidence and metal ion concentration.
abstract: BACKGROUND
  The aim of this study was to evaluate the incidence of adverse reactions to metal debris (ARMD) in a consecutive series of DUROM™ Hip Resurfacing Arthroplasty (HRA) at mid-term follow-up.
  
  
  METHODS
  Between October 2003 and March 2007 a total of 134 consecutive DUROM™ HRA in 121 patients were performed at our institution. Follow-up could be obtained in 101 unrevised patients (83%) at a mean time of 8.51 ± 0.97 years postoperatively and included patient-related outcome measurement, plain radiographs, MARS-MRI as well as whole blood metal ion assessment.
  
  
  RESULTS
  17 (16.5%) out of 103 hips revealed pseudotumour occurrence in MRI investigation, 1 (10.6%) with a diameter of ≥2 cm. Higher incidence of pseudotumours was found patients with femoral component size <50 mm. 38 patients had elevated cobalt levels, 36 of them (35%) in the range of 2-7 μg/l and 2 patients (1.9%) at a rate of >7 μg/l. In contrast to cobalt determination, only elevated chromium values showed a positive association with pseudotumour occurrence and size.
  
  
  CONCLUSIONS
  A significant proportion of patients developed pseudotumours and metal ion elevation in a consecutive cohort of DUROM™ HRA after mid-term follow-up. The incidence, however, seems not to differ from results of other well performing resurfacing brands; clinical relevance of our findings is unclear. Regarding potential local as well as systemic effects of metal particle release, close follow-up of patients is essential, even with clinically well-performing implants.
authors.affiliation: University Centre of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus, Technical University Dresden, Dresden - Germany.
authors.forename: Albrecht
authors.initials: A
authors.lastname: Hartmann
authors.affiliation: Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn - Germany.
authors.forename: Jan-Dirk
authors.initials: JD
authors.lastname: Kieback
authors.affiliation: University Centre of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus, Technical University Dresden, Dresden - Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Lützner
authors.affiliation: University Centre of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus, Technical University Dresden, Dresden - Germany.
authors.forename: Klaus-Peter
authors.initials: KP
authors.lastname: Günther
authors.affiliation: University Centre of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus, Technical University Dresden, Dresden - Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Goronzy
mesh_terms: 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; D006104:Granuloma, Plasma Cell / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D061825:Metal-on-Metal Joint Prostheses / Q000009:adverse effects*; D008670:Metals / Q000097:blood*; D008875:Middle Aged; D011475:Prosthesis Failure; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D008670:Metals; D002857:Chromium; D003035:Cobalt