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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Musculoskeletal Disorders 1/2015

Diagnostic utility of joint fluid metal ion measurement for histopathological findings in metal-on-metal hip replacements

Zeitschrift:
BMC Musculoskeletal Disorders > Ausgabe 1/2015
Autoren:
Aleksi Reito, Jyrki Parkkinen, Timo Puolakka, Jorma Pajamäki, Antti Eskelinen
Wichtige Hinweise

Competing interests

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.

Authors’ contributions

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.

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.
Literatur
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