Chromium and cobalt ion release following the Durom high carbon content, forged metal-on-metal surface replacement of the hip.

Surgery Department, Maisonneuve-Rosemont Hospital, Montréal University, Montréal, Canada.
Journal of Bone and Joint Surgery - British Volume (Impact Factor: 2.8). 05/2007; 89(4):441-8. DOI: 10.1302/0301-620X.89B4.18054
Source: PubMed

ABSTRACT We evaluated the concentrations of chromium and cobalt ions in blood after metal-on-metal surface replacement arthroplasty using a wrought-forged, high carbon content chromium-cobalt alloy implant in 64 patients. At one year, mean whole blood ion levels were 1.61 microg/L (0.4 to 5.5) for chromium and 0.67 microg/L (0.23 to 2.09) for cobalt. The pre-operative ion levels, component size, female gender and the inclination of the acetabular component were inversely proportional to the values of chromium and/or cobalt ions at one year postoperatively. Other factors, such as age and level of activity, did not correlate with the levels of metal ions. We found that the levels of the ions in the serum were 1.39 and 1.37 times higher for chromium and cobalt respectively than those in the whole blood. The levels of metal ions obtained may be specific to the hip resurfacing implant and reflect its manufacturing process.

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    ABSTRACT: Chromium (Cr) (III) is a trace metal essential to human health and exposure typically occurs via the diet on a daily basis. Some groups of individuals, such as those consuming Cr(III) supplements or patients with Cr-containing implants, may have elevated blood Cr(III) concentrations. Although blood Cr(III) levels are thought to be an accurate metric of exposure, little is known about the relationship between these concentrations and possible adverse health risks. This study evaluated the various effects reported in animal and human epidemiological studies of Cr(III) exposure in an attempt to correlate them with blood Cr(III) concentrations. The target endpoints identified in this analysis included the hematological, hepatic, and renal systems. Animal and human physiological-based pharmacokinetic (PBPK) models were used to estimate steady state blood Cr(III) concentrations from a variety of dosing regimens. Based on the animal studies, our results suggest that blood Cr(III) concentrations as high as 480–580 μg/L are not associated with any responses. For each of the three health endpoints considered in this analysis (hematological, hepatic, and renal) no adverse effects were observed below 3,700 μg/L. Some hematological responses were observed at 3,700 μg/L, and adverse effects clearly occurred at 7,500 μg/L. These findings can be used to assess potential health risks to individuals with elevated blood Cr(III) concentrations.
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    ABSTRACT: Résumé Les qualités tribologiques du couple de frottement métal—métal ont permis la réin-troduction du resurfaçage de hanche de deuxième génération. Les avantages de ce type d'arthroplastie par rapport à une prothèse de hanche « conventionnelle » sont nombreux : pré-servation du capital osseux fémoral (et acétabulaire), conservation de la biomécanique de l'articulation coxofémorale (offset fémoral, longueur des membres inférieurs. . .), facilité d'une reprise d'activité physique et sportive élevée, facilité de révision, diminution du risque de luxation, réduction du risque d'extension diaphysaire en cas d'ostéolyse. . . Le resurfaçage de hanche apparaît donc véritablement comme une « chirurgie osseuse mini-invasive ». Il existe cependant des complications spécifiques au resurfaçage telles que les fractures du col fémo-ral, l'effondrement de la tête fémorale. . . L'implantation d'un resurfaçage peut s'effectuer par tous les abords classiques de la hanche mais demande une technique chirurgicale précise et difficile. En effet, l'implantation et le positionnement de la pièce fémorale constituent un élément capital de cette arthroplastie. Ainsi, afin de réduire le risque d'effet came, de pré-server le capital osseux fémoral et de conserver un transfert de charge harmonieux, il apparaît indispensable de respecter certaines règles biomécaniques d'implantation. Le resurfaçage de hanche s'adresse à des sujets jeunes et/ou actifs pour qui la restauration de la biomécanique de la hanche constitue un réel avantage par rapport aux prothèses de hanche conventionnelles. Les résultats à moyen terme sont encourageants tant sur le plan clinique que radiologique. Summary The tribologic quality of metal-on-metal bearings has enabled a second generation of hip resurfacing techniques. Compared with a conventional hip prosthesis, this type of arthro-plasty has many advantages: sparing femoral (and acetabular) bone stock, preservation of hip joint biomechanics (femoral offset, leg length), better recovery for high-level sports activities, * Auteur correspondant.
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    ABSTRACT: Background - The mechanism of failure of metal-on-metal (MoM) total hip arthroplasty (THA) has been related to a high rate of metal wear debris, which is partly generated from the head-trunnion interface. However, it is not known whether implant fixation is affected by metal wear debris. Patients and methods - 49 cases of MoM THA in 41 patients (10 women) with a mean age of 52 (28-68) years were followed with stereoradiographs after surgery and at 1, 2, and 5 years to analyze implant migration by radiostereometric analysis (RSA). Patients also participated in a 5- to 7-year follow-up with measurement of serum metal ions, questionnaires (Oxford hip score (OHS) and Harris hip score (HHS)), and measurement of cup and stem positions and systemic bone mineral density. Results - At 1-2 years, mean total translation (TT) was 0.04 mm (95% CI: -0.07 to 0.14; p = 0.5) for the stems; at 2-5 years, mean TT was 0.13 mm (95% CI: -0.25 to -0.01; p = 0.03), but within the precision limit of the method. For the cups, there was no statistically significant TT or total rotation (TR) at 1-2 and 2-5 years. At 2-5 years, we found 4 cups and 5 stems with TT migrations exceeding the precision limit of the method. There was an association between cup migration and total OHS < 40 (4 patients, 4 hips; p = 0.04), but there were no statistically significant associations between cup or stem migration and T-scores < -1 (n = 10), cup and stem positions, or elevated serum metal ion levels (> 7µg/L (4 patients, 6 hips)). Interpretation - Most cups and stems were well-fixed at 1-5 years. However, at 2-5 years, 4 cups and 5 stems had TT migrations above the precision limits, but these patients had serum metal ion levels similar to those of patients without measurable migrations, and they were pain-free. Patients with serum metal ion levels > 7 µg/L had migrations similar to those in patients with serum metal ion levels < 7 µg/L. Metal wear debris does not appear to influence the fixation of hip components in large-head MoM articulations at medium-term follow-up.
    Acta Orthopaedica 05/2014; · 2.45 Impact Factor

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