None of the authors hold any stocks or shares in an organization that may in any way gain or lose financially from the publication of this manuscript. None of the authors hold or are currently applying for any patents relating to the content of the manuscript. TP has received a grant from Smith-Nephew, personal fee from Stryker and non-financial support from DePuy (not related to this manuscript), Biomet, Zimmer and Stryker. JoP has received a personal fee from Zimmer, Biomet and DePuy (not related to this manuscript). AE has received a personal fee from DePuy (not related to this manuscript) and Stryker. AR and JyP have no competing interests to declare.
AR participated in the study design, performed the data recording and statistical analyses and drafted the manuscript. JyP performed the histological analyses and participated to critical evaluation and commenting of the manuscript. TP performed the revision surgeries and study sample collection and participated to critical evaluation and commenting of the manuscript. JoP performed the revision surgeries and study sample collection and participated to critical evaluation and commenting of the manuscript. AE participated in the study design, performed the revision surgeries and study sample collection and participated to critical evaluation and commenting of the manuscript. All authors read and approved the final manuscript.
In vivo assessment of inflammatory responses in the synovia of patients with MoM hip replacements would be useful in the determination of the prognosis of the hip replacement. Aims of the study was to investigate the correlation between cobalt and chrome levels in joint fluid with histopathological findings and the predictive ability of metal ion levels for these findings.
In 163 revision surgeries (141 ASR THAs and 22 ASR hip resurfacings) joint fluid chrome and cobalt levels were assessed and histological analysis of synovial tissues was performed. Histological analysis included assessment of histiocytes, particle load, surface necrosis, lymphocyte cuffs and ALVAL-score.
Surface necrosis correlated positively with cobalt levels both in both groups. Neither chrome nor cobalt level had even fair discriminative ability to predict the presence or severity of any histological finding in the THA group. In the hip resurfacing group, cobalt level had good discriminative ability to predict the presence of perivascular lymphocytes and ALVAL-score of ≥7 whereas chrome had good discriminative ability to predict surface necrosis, metal particle load and ALVAL-score of ≥7.
Measurement of metal ion levels following joint fluid aspirate offers no relevant information with regard to histopathological findings in patients with large-diameter MoM THAs. Limited information may be gained from assessment of joint fluid metal ion levels in patients with hip resurfacings, but disadvantages of an aspirate must be carefully reviewed.
Reito A, Elo P, Puolakka T, Pajamaki J, Eskelinen A. Femoral diameter and stem type are independent risk factors for ARMD in the large-headed ASR THR group. BMC Musculoskelet Disord. 2015;16:118-015-0566-6.
Lainiala O, Eskelinen A, Elo P, Puolakka T, Korhonen J, Moilanen T. Adverse reaction to metal debris is more common in patients following MoM total hip replacement with a 36 mm femoral head than previously thought: results from a modern MoM follow-up programme. Bone Joint J. 2014;96-B(12):1610–7. PubMedCrossRef
Bolland BJ, Culliford DJ, Langton DJ, Millington JP, Arden NK, Latham JM. High failure rates with a large-diameter hybrid metal-on-metal total hip replacement: clinical, radiological and retrieval analysis. J Bone Joint Surg (Br). 2011;93(5):608–15. CrossRef
Langton DJ, Jameson SS, Joyce TJ, Hallab NJ, Natu S, Nargol AV. Early failure of metal-on-metal bearings in hip resurfacing and large-diameter total hip replacement: A consequence of excess wear. J Bone Joint Surg (Br). 2010;92(1):38–46. CrossRef
Cooper HJ, Della Valle CJ, Berger RA, Tetreault M, Paprosky WG, Sporer SM, et al. Corrosion at the head-neck taper as a cause for adverse local tissue reactions after total hip arthroplasty. J Bone Joint Surg Am. 2012;94(18):1655–61. PubMed
Hart AJ, Satchithananda K, Liddle AD, Sabah SA, McRobbie D, Henckel J, et al. Pseudotumors in association with well-functioning metal-on-metal hip prostheses: a case–control study using three-dimensional computed tomography and magnetic resonance imaging. J Bone Joint Surg Am. 2012;94(4):317–25. PubMed
Medicines and Healthcare Products Regulation Agency. Medical Device Alert: ASR™ hip replacement implants manufactured by DePuy International Ltd (MDA/2010/069). 2010.
Hart AJ, Sabah SA, Bandi AS, Maggiore P, Tarassoli P, Sampson B, et al. Sensitivity and specificity of blood cobalt and chromium metal ions for predicting failure of metal-on-metal hip replacement. J Bone Joint Surg (Br). 2011;93(10):1308–13. CrossRef
von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for reporting observational studies. Int J Surg. 2014;12(12):1495–9. CrossRef
Fan J, Upadhye S, Worster A. Understanding receiver operating characteristic (ROC) curves. CJEM. 2006;8(1):19–20. PubMed
Lohmann CH, Meyer H, Nuechtern JV, Singh G, Junk-Jantsch S, Schmotzer H, et al. Periprosthetic Tissue Metal Content but Not Serum Metal Content Predicts the Type of Tissue Response in Failed Small-Diameter Metal-on-Metal Total Hip Arthroplasties. J Bone Joint Surg Am. 2013;95(17):1561–8. PubMedCrossRef
Hart AJ, Sabah SA, Sampson B, Skinner JA, Powell JJ, Palla L, et al. 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. J Bone Joint Surg Am. 2014;96(13):1091–9. PubMedCrossRef
Davda K, Lali FV, Sampson B, Skinner JA, Hart AJ. An analysis of metal ion levels in the joint fluid of symptomatic patients with metal-on-metal hip replacements. J Bone Joint Surg (Br). 2011;93(6):738–45. CrossRef
Carli A, Reuven A, Zukor DJ, Antoniou J. Adverse soft-tissue reactions around non-metal-on-metal total hip arthroplasty - a systematic review of the literature. Bull NYU Hosp Jt Dis. 2011;69 Suppl 1:S47–51. PubMed
Matthies AK, Racasan R, Bills P, Blunt L, Cro S, Panagiotidou A, et al. Material loss at the taper junction of retrieved large head metal-on-metal total hip replacements. J Orthop Res. 2013;31(11):1677–85. PubMed
- Diagnostic utility of joint fluid metal ion measurement for histopathological findings in metal-on-metal hip replacements
- BioMed Central
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