The Journal of Bone and Joint Surgery 80:1447-58 (1998)
© 1998 The Journal of Bone and Joint Surgery, Inc.
Metal Release in Patients Who Have Had a Primary Total Hip Arthroplasty. A Prospective, Controlled, Longitudinal Study*
JOSHUA J. JACOBS, M.D. ,
ANASTASIA K. SKIPOR, M.S.,
LESLIE M. PATTERSON, R.N.,
NADIM J. HALLAB, PH.D.,
WAYNE G. PAPROSKY, M.D., CHICAGO,
JONATHAN BLACK, PH.D. , KING OF PRUSSIA, PENNSYLVANIA and
JORGE O. GALANTE, M.D., D.SC., CHICAGO, ILLINOIS
Investigation performed at Rush-Presbyterian-St. Luke's Medical Center, Chicago
There is an increasing recognition that, in the long term, total joint replacement may be associated with adverse local and remote tissue responses that are mediated by the degradation products of prosthetic materials. Particular interest has centered on the metal-degradation products of total joint replacements because of the known toxicities of the metal elements that make up the alloys used in the implants. We measured the concentrations of titanium, aluminum, cobalt, and chromium in the serum and the concentration of chromium in the urine of seventy-five patients during a three-year prospective, longitudinal study. Twenty patients had had a so-called hybrid total hip replacement (insertion of a modular cobalt-alloy femoral stem and head with cement and a titanium acetabular cup without cement), fifteen had had insertion of an extensively porous-coated cobalt-alloy stem with a cobalt-alloy head and a titanium-alloy socket without cement, and twenty had had insertion of a proximally porous-coated titanium-alloy stem with a cobalt-alloy head and a titanium socket without cement. The remaining twenty patients did not have an implant and served as controls.
The results of our study showed that, thirty-six months postoperatively, patients who have a well functioning prosthesis with components containing titanium have as much as a threefold increase in the concentration of titanium in the serum and those who have a well functioning prosthesis with cobalt-alloy components have as much as a fivefold and an eightfold increase in the concentrations of chromium in the serum and urine, respectively. The predominant source of the disseminated chromium-degradation products is probably the modular head-neck junction and may be a function of the geometry of the coupling. Passive dissolution of extensively porous-coated cobalt-alloy stems was not found to be a dominant mode of metal release.
CLINICAL RELEVANCE: Increased concentrations of circulating metal-degradation products derived from orthopaedic implants may have deleterious biological effects over the long term that warrant investigation. This is a particularly timely concern because of recent clinical trends, including the reintroduction of metal-on-metal bearing surfaces and the increasing popularity of extensively porous-coated devices with large surface areas of exposed metal. Accurate monitoring of the concentrations of metal in the serum and urine after total hip replacement also can provide insights into the mechanisms of metal release. Our findings suggest that fretting corrosion at the head-neck coupling is an important source of metal release that can lead to increased concentrations of chromium in the serum. Determinations of the concentrations of metal in the serum and urine may be useful in the diagnosis of patients who are symptomatic after a total joint replacement as increased levels are indicative of at least one mode of mechanical dysfunction (for example, fretting corrosion) of the device.
 CiteULike  Connotea  Del.icio.us  Facebook  Technorati  Twitter What's this?
This article has been cited by other articles:
|
|
|
|
 
K. J. Bozic, S. Kurtz, E. Lau, K. Ong, V. Chiu, T. P. Vail, H. E. Rubash, and D. J. Berry
The Epidemiology of Bearing Surface Usage in Total Hip Arthroplasty in the United States
J. Bone Joint Surg. Am.,
July 1, 2009;
91(7):
1614 - 1620.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. De Smet, R. De Haan, A. Calistri, P.A. Campbell, E. Ebramzadeh, C. Pattyn, and H.S. Gill
Metal Ion Measurement as a Diagnostic Tool to Identify Problems with Metal-on-Metal Hip Resurfacing
J. Bone Joint Surg. Am.,
November 1, 2008;
90(Supplement_4):
202 - 208.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. G. Bitsch, M. Zamorano, T. Loidolt, C. Heisel, J. J. Jacobs, and T. P. Schmalzried
Ion Production and Excretion in a Patient with a Metal-on-Metal Bearing Hip Prosthesis. A Case Report
J. Bone Joint Surg. Am.,
December 1, 2007;
89(12):
2758 - 2763.
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Savarino, M. Greco, E. Cenni, L. Cavasinni, R. Rotini, N. Baldini, and A. Giunti
Differences in ion release after ceramic-on-ceramic and metal-on-metal total hip replacement: MEDIUM-TERM FOLLOW-UP
J Bone Joint Surg Br,
April 1, 2006;
88-B(4):
472 - 476.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Y.-S. Park, Y.-W. Moon, S.-J. Lim, J.-M. Yang, G. Ahn, and Y.-L. Choi
Early Osteolysis Following Second-Generation Metal-on-Metal Hip Replacement
J. Bone Joint Surg. Am.,
July 1, 2005;
87(7):
1515 - 1521.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Heisel, M. Silva, A. K. Skipor, J. J. Jacobs, and T. P. Schmalzried
The Relationship Between Activity and Ions in Patients with Metal-on-Metal Bearing Hip Prostheses
J. Bone Joint Surg. Am.,
April 1, 2005;
87(4):
781 - 787.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. J. Bozic, R. G. Pierce, and J. H. Herndon
Health Care Technology Assessment. Basic Principles and Clinical Applications
J. Bone Joint Surg. Am.,
June 1, 2004;
86(6):
1305 - 1314.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Campbell, R. M. Urban, I. Catelas, A. K. Skipor, and T. P. Schmalzried
Autopsy Analysis Thirty Years After Metal-on-Metal Total Hip Replacement. A Case Report
J. Bone Joint Surg. Am.,
November 1, 2003;
85(11):
2218 - 2222.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. S. Greenwald and J. P. Garino
Alternative Bearing Surfaces: The Good, the Bad, and the Ugly
J. Bone Joint Surg. Am.,
November 1, 2001;
83(90022):
S68 - 72.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. M. Jones, J. L. Marsh, J. V. Nepola, J. J. Jacobs, A. K. Skipor, R. M. Urban, J. L. Gilbert, and J. A. Buckwalter
Focal Osteolysis at the Junctions of a Modular Stainless-Steel Femoral Intramedullary Nail
J. Bone Joint Surg. Am.,
April 1, 2001;
83(4):
537 - 537.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
C. P. Case, L. Ellis, J. C. Turner, and B. Fairman
Development of a Routine Method for the Determination of Trace Metals in Whole Blood by Magnetic Sector Inductively Coupled Plasma Mass Spectrometry with Particular Relevance to Patients with Total Hip and Knee Arthroplasty
Clin. Chem.,
February 1, 2001;
47(2):
275 - 280.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. D. Dorr, Z. Wan, D. B. Longjohn, B. Dubois, and R. Murken
Total Hip Arthroplasty with Use of the Metasul Metal-on-Metal Articulation : Four to Seven-Year Results
J. Bone Joint Surg. Am.,
June 1, 2000;
82(6):
789 - 789.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
