The Journal of Bone and Joint Surgery (American). 2005;87:781-787.
doi:10.2106/JBJS.D.01820
© 2005 The Journal of Bone and Joint Surgery, Inc.
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The Relationship Between Activity and Ions in Patients with Metal-on-Metal Bearing Hip Prostheses

Christian Heisel, MD1, Mauricio Silva, MD1, Anastasia K. Skipor, MS2, Joshua J. Jacobs, MD2 and Thomas P. Schmalzried, MD1

1 Joint Replacement Institute at Orthopaedic Hospital, 2400 South Flower Street, Los Angeles, CA 90007
2 Rush Arthritis and Orthopaedics Institute, 1653 West Congress Parkway, Chicago, IL 60612

Investigation performed at the Joint Replacement Institute at Orthopaedic Hospital, Los Angeles, California, and the Rush Arthritis and Orthopaedics Institute, Chicago, Illinois

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from Wright Medical Technology and the Piedmont Fund of the Los Angeles Orthopaedic Hospital Foundation. In addition, one or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (DePuy Orthopaedics). 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.

Background: Total hip replacements with metal-on-metal bearings are frequently implanted in young, active patients. The relationship between patient activity and cobalt and chromium ion levels has not been investigated, to our knowledge.

Methods: Seven patients with well-functioning metal-on-metal bearing hip prostheses and one control subject (no implants), all with normal renal function, were monitored during a two-week-long activity protocol. Lower-extremity activity was continuously assessed with use of a computerized, two-dimensional accelerometer. During the first week, the subjects were requested to limit physical activity. The subjects then completed an hour-long treadmill test followed by a week in which they were encouraged to be as physically active as practically possible. Serum levels of cobalt and chromium ions and urine levels of chromium were assessed at ten time-points during these two weeks.

Results: Regardless of activity, the serum ion levels for a given patient were essentially constant and no correlation was found between patient activity and serum levels of cobalt or chromium, or urine levels of chromium. A mean increase in activity of 28% during the week of high-intensity activity was associated with a mean decrease of 2.7% in the serum cobalt level and a mean increase of 2.0% in the serum chromium level. During the treadmill test, a mean increase in activity of 1621% was associated with a mean increase of 3.0% in the serum cobalt level and a mean increase of 0.8% in the serum chromium level. These results fall within the variability for the measurement accuracy of these tests.

Conclusions: For these patients, serum cobalt and chromium ion levels were not acutely affected by patient activity. Periodic measurements of serum ion levels could be used to monitor the tribologic (lubrication, friction, and wear) performance of a metal-on-metal bearing without adjusting for patient activity. Additional research is needed into the kinetics of ion production, transport, and excretion.

Level of Evidence: Therapeutic Level II. See Instructions to Authors for a complete description of levels of evidence.


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