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Serum Cobalt Levels After Metal-on-Metal Total Hip Arthroplasty

¹ Department of Orthopaedics (W.B., P.B., and R.K.), Clinical Department of Occupational Medicine, Department of Internal Medicine IV (V.M.), and Department of Medical Computer Sciences (A.K.), Vienna General Hospital, University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria. E-mail address for W. Brodner: wolfram.brodner{at}akh-wien.ac.at
² Department of Orthopaedics, General Hospital Krems, Mitterweg 10, 3500 Krems an der Donau, Austria

Investigation performed at the Vienna General Hospital, University of Vienna, Vienna, Austria

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from Centerpulse Orthopedics. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Methods: A total hip arthroplasty was performed without cement in 100 consecutive patients who had either unilateral osteoarthritis or unilateral osteonecrosis. Fifty patients were randomized to be treated with a metal-on-metal articulation, and fifty patients, with a ceramic-on-polyethylene bearing. The femoral stem was made of a Ti-6Al-7Nb alloy, and the threaded acetabular cup was made of commercially pure titanium. Blood samples were taken before the operation and at multiple time-points for five years after the operation. Serum cobalt concentrations were measured with use of atomic absorption spectrometry.

Results: In the metal-on-metal group, the median serum cobalt concentration was 1 µg/L at one year after surgery and 0.7 µg/L at five years. The median of the serum cobalt concentrations measured from three to twelve months did not differ from the median of subsequent measurements, with the numbers available. The median serum cobalt level in the control group of patients treated with the ceramic-on-polyethylene articulation was below the detection limit at all time-points.

Conclusions: Systemic cobalt release from Metasul metal-on-metal articulations was demonstrated throughout the five-year study period. The median serum cobalt concentrations were found to be slightly above the detection limit and remained in a constant range. The serum cobalt concentrations did not reflect a so-called run-in wear period of the metal-on-metal articulations.

Level of Evidence: Therapeutic study, Level I-1a (randomized controlled trial [significant difference]). See Instructions to Authors for a complete description of levels of evidence.

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