Online citations, reference lists, and bibliographies.

Surveillance Of Patients With Metal-on-Metal Hip Resurfacing And Total Hip Prostheses: A Prospective Cohort Study To Investigate The Relationship Between Blood Metal Ion Levels And Implant Failure.

Alister J. Hart, Shiraz A Sabah, Barry A. Sampson, John Andrew Skinner, Jonathan J Powell, Luigi Palla, K J J Pajamäki, Timo J S Puolakka, Aleksi Reito, Antti P Eskelinen
Published 2014 · Medicine
Cite This
Download PDF
Analyze on Scholarcy
Share
BACKGROUND We designed a prospective, single-center study to assess whether blood metal ion levels could predict implant failure in patients managed with unilateral metal-on-metal hip resurfacing or total hip arthroplasty. METHODS Five hundred and ninety-seven patients who had received unilateral Articular Surface Replacement prostheses at least twelve months earlier were recruited. Blood metal ion levels were compared between the group of patients with failed implants and the group with non-failed implants. Implant failure was defined as prostheses associated with revision, an intention to revise, or poor patient-reported hip function (Oxford Hip Score, <31 of 48). Specificity, sensitivity, area under the curve, positive and negative predictive values, and odds ratios were calculated. Logistic regression analysis was used to identify other risk factors for implant failure. RESULTS Patients with failed arthroplasty had significantly higher blood cobalt and chromium ion levels than did patients with non-failed arthroplasty (p < 0.01). Blood cobalt ion levels were disproportionately raised in patients with failed total hip arthroplasty (8.2 μg/L) compared with patients with failed hip resurfacing (2.5 μg/L) (p = 0.018). Blood chromium ion levels were not significantly different in patients with failed total hip arthroplasty and failed hip resurfacing (p = 0.058). The maximum value of either metal ion had good discriminant ability to predict implant failure (area under the curve, 0.76). A 7-μg/L cutoff had a positive predictive value of 0.75 (95% confidence interval, 0.66 to 0.82) and a negative predictive value of 0.82 (95% confidence interval, 0.78 to 0.86). In patients managed with total hip arthroplasty, for each increase of 1 μg/L there was a 23% (p < 0.001) increase in the odds of them being in the failed group. For patients managed with hip resurfacing, the increase in odds was 5% (p < 0.001). CONCLUSIONS Raised levels of blood metal ions were associated with failed metal-on-metal hip resurfacings and total hip arthroplasties. A threshold level of 7 μg/L had inadequate sensitivity to be used in isolation as a screening test for implant failure, but it provided nearly optimal misclassification rates. No level had a perfect positive predictive value, and so we discourage surgeons from performing revision surgery based on blood metal ion levels alone. Levels of cobalt ions were raised out of proportion to levels of chromium ions in failed total hip arthroplasty and may reflect a different mechanism for metal ion generation. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
This paper references
10.2106/JBJS.H.01220
The epidemiology of bearing surface usage in total hip arthroplasty in the United States.
Kevin John Bozic (2009)
The determination of cobalt and chromium in whole blood sampled from metal-metal and metal-polyethylene hip articulation patients by DRC-ICP-MS
P ↵Collery (2008)
Metal Ions in Biology And Medicine
Philippe Collery (2000)
10.1136/bmj.d3009
Commentary: Metal on metal hips
John Andrew Skinner (2011)
10.1080/17453670610012863
Exposure to chromium, cobalt and molybdenum from metal-on-metal total hip replacement and hip resurfacing arthroplasty
Wolf-Christoph Witzleb (2006)
10.2106/JBJS.J.00125
Arthroprosthetic cobaltism: neurological and cardiac manifestations in two patients with metal-on-metal arthroplasty: a case report.
Stephen S. Tower (2010)
The determination of cobalt and chromium in whole blood sampled from metal-metal and metal-polyethylene hip articulation patients by DRC-ICP-MS
PD Winship (2008)
Could it be the hip? Lancet
MC Rizzetti (2009)
said to agree to $4 billion settlement over hip implants
Meier B. Johnson (2013)
10.1016/j.arth.2009.11.008
Magnetic resonance imaging findings in painful metal-on-metal hips: a prospective study.
Shiraz A Sabah (2011)
10.1016/j.arth.2010.05.030
"Asymptomatic" pseudotumors after metal-on-metal hip resurfacing arthroplasty: prevalence and metal ion study.
Young-Min Kwon (2011)
10.2106/JBJS.J.01885
Comparison of whole-blood metal ion levels in four types of metal-on-metal large-diameter femoral head total hip arthroplasty: the potential influence of the adapter sleeve.
Martin Lavigne (2011)
10.1302/0301-620X.92B1.22770
Early failure of metal-on-metal bearings in hip resurfacing and large-diameter total hip replacement: A consequence of excess wear.
David John Langton (2010)
10.1302/0301-620X.78B2.0780185
Questionnaire on the perceptions of patients about total knee replacement.
Jill Dawson (1998)
10.1302/0301-620X.93B10.26249
Sensitivity and specificity of blood cobalt and chromium metal ions for predicting failure of metal-on-metal hip replacement.
Alister J. Hart (2011)
10.1302/0301-620X.95B1.30060
Fatal cardiomyopathy after revision total hip replacement for fracture of a ceramic liner.
Michael G. Zywiel (2013)
10.2106/JBJS.J.01657
Commentary on an article by Stephen S. Tower, MD: "Arthroprosthetic cobaltism: neurological and cardiac manifestations in two patients with metal-on-metal arthroplasty. a case report".
Joshua J. Jacobs (2010)
10.1136/bmj.e306
The saga of Poly Implant Prosthèse breast implants
Carl J Heneghan (2012)
10.2106/JBJS.K.00330
Impact of obesity on orthopaedics.
Sanjeev Sabharwal (2012)
10.1302/0301-620X.93B8.26040
Accelerating failure rate of the ASR total hip replacement.
David John Langton (2011)
10.1002/mus.21638
Polyneuropathy caused by cobalt-chromium metallosis after total hip replacement.
Tokuhei Ikeda (2010)
10.1258/acb.2011.011141
Clinical usefulness of blood metal measurements to assess the failure of metal-on-metal hip implants
Barry A. Sampson (2012)
10.1007/s11999-009-1029-x
The John Charnley Award: Metal-on-Metal Hip Resurfacing versus Large-diameter Head Metal-on-Metal Total Hip Arthroplasty: A Randomized Clinical Trial
Donald S. Garbuz (2010)
10.2106/JBJS.L.00093
Quality in orthopaedic surgery--an international perspective: AOA critical issues.
Khaled J. Saleh (2013)
10.1016/S0140-6736(09)60490-6
Loss of sight and sound. Could it be the hip?
Maria Cristina Rizzetti (2009)
10.1302/0301-620X.94B8.27626
The sensitivity, specificity and predictive values of raised plasma metal ion levels in the diagnosis of adverse reaction to metal debris in symptomatic patients with a metal-on-metal arthroplasty of the hip.
Ibrahim A. Malek (2012)
10.1302/0301-620X.93B3.25551
Retrieval analysis of 240 metal-on-metal hip components, comparing modular total hip replacement with hip resurfacing.
Ashley K Matthies (2011)
10.1302/0301-620X.91B6.21682
The painful metal-on-metal hip resurfacing.
Alister J. Hart (2009)
10.1007/s11999-010-1372-y
Histological Features of Pseudotumor-like Tissues From Metal-on-Metal Hips
Patricia A Campbell (2010)
Medical Device Alert MDA/2010/033: All metal-on-metal (MOM) hip replacements
(2010)
NJR 10th annual report
(2013)
johnson-said-to-agree-to-4-billion-settlement-over-hipimplants.html?_r=0. Accessed
B Meier
10.1302/0301-620X.80B1.7859
Questionnaire on the perceptions of patients about total hip replacement.
Jill Dawson (1996)
10.1177/112070001002000101
A Comparison of Clinical Results of Hip Resurfacing Arthroplasty and 28 mm Metal on Metal Total Hip Arthroplasty: A Randomised Trial with 3–6 Years Follow-Up
Pascal-André Vendittoli (2010)



This paper is referenced by
10.1016/j.arth.2018.01.066
Comparison of Postoperative Complications Following Metal-on-Metal Total Hip Arthroplasty With Other Hip Bearings in Medicare Population.
Lindsay T. Kleeman (2018)
10.1302/0301-620X.98B11.38042
Can blood metal ion levels be used to identify patients with bilateral Birmingham Hip Resurfacings who are at risk of adverse reactions to metal debris?
Gulraj S. Matharu (2016)
Tekoniveltä ympäröivän kudoksen kromipitoisuus on yhteydessä metallireaktion tyyppiin
Lari Lehtovirta (2015)
10.5312/wjo.v7.i5.272
Management of metal-on-metal hip implant patients: Who, when and how to revise?
Reshid Berber (2016)
11931 Matharu D.indd
Gulraj S. Matharu (2018)
Strategic Alliance Joint Implant Surgery & Research Foundation is Pleased to Continue a Strategic Alliance with the Donaldson Arthritis Research Foundation
Ian Clarke (2019)
10.2106/JBJS.O.00526
What's New in Hip Replacement.
James T Ninomiya (2015)
10.1016/j.jbiomech.2017.08.016
Response to Letter to the Editor concerning "How symmetric are metal-on-metal hip resurfacing patients during gait? Insights for the rehabilitation".
Renan Alves Resende (2017)
10.1080/17453674.2017.1398011
What is appropriate surveillance for metal-on-metal hip arthroplasty patients?
Gulraj S. Matharu (2018)
10.3390/ma13030557
Long-Term Results of a Second-Generation, Small-Diameter, Metal-On-Metal Bearing in Primary Total Hip Arthroplasty at 14-Year Follow-Up
Tobias Reiner (2020)
10.1016/j.arth.2018.03.039
Association Between Pseudotumor Formation and Patient Factors in Metal-on-Metal Total Hip Arthroplasty Population.
Lindsay T. Kleeman (2018)
10.1080/17453674.2016.1213596
Worse health-related quality of life and hip function in female patients with elevated chromium levels
Daniel K Hussey (2016)
10.1007/s00402-017-2723-x
Correlation of serum metal ion levels with pathological changes of ARMD in failed metal-on-metal-hip-resurfacing arthroplasties
George Grammatopoulos (2017)
10.5301/hipint.5000258
Predicting High Blood Metal Ion Concentrations following Hip Resurfacing
Gulraj S. Matharu (2015)
10.1016/j.arth.2015.03.009
Follow-Up of Metal-on-Metal Hip Arthroplasty Patients Is Currently Not Evidence Based or Cost Effective.
Gulraj S. Matharu (2015)
10.1016/j.arth.2015.04.036
The Symmetry of Adverse Local Tissue Reactions in Patients with Bilateral Simultaneous and Sequential ASR Hip Replacement.
Rami Madanat (2015)
10.1302/0301-620X.98B2.36201
International metal-on-metal multidisciplinary teams: do we manage patients with metal-on-metal hip arthroplasty in the same way? An analysis from the International Specialist Centre Collaboration on MOM Hips (ISCCoMH).
Reshid Berber (2016)
10.1007/s12178-016-9321-3
Diagnosis of adverse local tissue reactions following metal-on-metal hip arthroplasty
Brian P. Chalmers (2016)
10.1007/978-3-319-64177-5_30
Revision of Metal on Metal THA
Eustathios I Kenanidis (2018)
10.1016/j.otsr.2015.12.015
Repeated metal ion measurement in patients with bilateral metal on metal (ASR™) hip replacements.
Aleksi Reito (2016)
10.1007/s00402-016-2565-y
Do cobalt and chromium levels predict osteolysis in metal-on-metal total hip arthroplasty?
Lisa Renner (2016)
10.1055/s-0040-1710388
A Mid- to Long-Term Follow-Up Experience with a Specific Metal-on-Metal Total Hip Arthroplasty Design
Christian Carulli (2020)
10.1371/journal.pone.0197614
Association between periprosthetic tissue metal content, whole blood and synovial fluid metal ion levels and histopathological findings in patients with failed metal-on-metal hip replacement
Lari Lehtovirta (2018)
10.1055/s-0038-1676126
T2‐weighted Hypointense Tumors and Tumor‐like Lesions
Olympia Papakonstantinou (2019)
10.17116/hirurgia201910155
[Mid-term and long-term results of metal-on-metal total hip arthroplasty].
Vladimir Lubchak (2019)
10.1007/s00402-016-2439-3
Cobalt serum levels differ in well functioning Birmingham resurfacing and Birmingham modular THA
Lisa Renner (2016)
10.1371/journal.pone.0186323
Trace metal release after minimally-invasive repair of pectus excavatum
Caroline Fortmann (2017)
10.15438/RR.9.1.214
Can We Improve Screening Costs in Asymptomatic Metal on Metal Total Hip Arthroplasties
J. Ryan Martin (2019)
10.1080/17453674.2016.1246276
Heart failure after conventional metal-on-metal hip replacements
Marianne H Gillam (2017)
10.1016/j.arth.2017.02.031
The Utility of Metal Ion Trends in Predicting Revision in Metal-on-Metal Total Hip Arthroplasty.
Bayard C. Carlson (2017)
10.1007/s11999-016-4860-x
Are Females at Greater Risk for Revision Surgery After Hip Resurfacing Arthroplasty With the Articular Surface Replacement Prosthesis?
Gabrielle S. Donahue (2016)
10.1007/s12178-016-9326-y
Conversion of a failed hip resurfacing arthroplasty to total hip arthroplasty: pearls and pitfalls
Jacob A. Haynes (2016)
See more
Semantic Scholar Logo Some data provided by SemanticScholar