Article

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

Department of Surgery, Université de Montréal, Montréal, Quebec, Canada
The Bone & Joint Journal (Impact Factor: 3.31). 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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Available from: Pascal-André Vendittoli
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    • "On the other hand, designs with large-diameter metal-on-metal bearing inspired by better lubrication [18] have been re-introduced few years ago; the preliminary results shows an increment of metal ions [19]; the origin has not been explained. Some authors have attributed it to: (a) larger metal area exposed to corrosion [20], (b) cup inclination: edge-contact [21] [22], (c) sex [23] [24] and (d) modular designs resulting in a continuous taper fretting-corrosion system [25] [26]. Nevertheless, it remains unclear whether adverse reactions are dependent and whether they are mediated by an immune response or if they are a toxicological effect [27]. "
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    ABSTRACT: A new hip resurfacing prosthesis design was assessed and compared in terms of kinematics and contact stress regarding to the conventional hip resurfacing prosthesis. For this purpose both designs were virtually implanted in a cadaveric computer-aided design model. Commercial software was employed to simulate the movements of flexion, abduction and internal rotation at 90 degrees of flexion to determinate the impingement between femoral neck and acetabular cup. On the other hand, the edge load effect as consequence of different acetabular component inclinations and micro-separations were analyzed by finite element analysis for both designs. In addition, this effect was validated in the hip joint simulator FIME II. The results of the new design exhibited a significant motion increment before impingement of 12.8 degrees +/- 1.3 degrees for flexion, 13.3 degrees +/- 3.1 degrees for extension, 7.8 degrees +/- 1.9 degrees for abduction and 13.1 degrees +/- 3.2 degrees for internal rotation. Moreover, the new design showed a reduction of the contact stress and stripe wear during the running-in due to the micro-separation effect.
    Full-text · Article · Mar 2014 · Materials and Design
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    • "The biggest advantages of this implant was that it had the same tribological features that made the Metasul TM (Zimmer, Warsaw , USA) metal-on-metal bearing surfaces successful: high carbon content, forged Chrome-Cobalt (Cr-Co) alloy with optimized clearance [18]. Its excellent tribological performance was confirmed by the low amount of chromium and cobalt ions released into the blood [19] [20]. This implant has specific features that distinguish it from other available hip resurfacing systems: acetabular cup of consistent thickness having the shape of a flattened dome (165 • ), convex surface with titanium plasma sprayed coating and peripheral fins. "
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    ABSTRACT: Introduction Les performances des couples de frottement métal–métal de seconde génération ont favorisé la réintroduction du resurfaçage de hanche. Ce travail multicentrique avait pour objectif d’évaluer les résultats radio-cliniques à court terme de l’implant de resurfaçage Durom. Hypothèse La prothèse de resurfaçage de hanche Durom présente des résultats comparables aux autres implants de resurfaçage et aux prothèses conventionnelles. Patients et méthodes Cinq cent quatre-vingt patients (644 hanches) ont été inclus dans quatre centres (406 hommes et 174 femmes âgés en moyenne de 48 ans [16–77]). La voie d’abord était 357 fois postérieure, 182 de type Hardinge et 105 de type Rottinger. Résultats Au recul moyen de 34 mois, 31 hanches (4,8 %) ont été reprises. Les causes de révision étaient : dix (1,6 %) fractures du col (sept après abord de Rottinger, une après abord de Hardinge et une par voie postérieure), 12 (1,9 %) descellements fémoraux (quatre par voie latérale et huit par voie postérieure), quatre (0,6 %) mobilisations de cupules acétabulaires, une (0,2 %) réaction adverse aux débris métalliques, trois (0,5 %) douleurs inexpliquées et une (0,2 %) infection. Quatre hanches (0,6 %) présentaient un épisode de luxation sans récidive (toutes opérées par voie de Hardinge). Les 613 hanches non réopérées présentaient des résultats cliniques satisfaisant avec des scores de Merle d’Aubigné à 17,2 (12–18) et de Womac à 91 (20–100). La survie à cinq ans était de 91 % (IC à 95 % [87–94 %]). L’inclinaison radiologique des cupules était en moyenne de 44,4° (30–70°). L’offset fémoral était diminué en moyenne de 2,4 mm (−31–23 mm) et la longueur du membre inférieur augmentée de 0,8 mm (−15–19 mm) en comparaison du côté controlatéral indemne de toute atteinte. Aucun des implants non révisés ne présentait de signe de descellement. Discussion Cette évaluation multicentrique montre un taux de révision de la prothèse Durom légèrement supérieur à celui d’autres implants de resurfaçage et des prothèses totales conventionnelles. La géométrie et le dessin de la cupule rendant son impaction difficile et sa fixation primaire précaire peuvent expliquer cette différence, malgré une excellente performance tribologique. La voie d’abord utilisée et la technique d’implantation ont joué dans cette série un rôle important dans la survie de cet implant. Niveau de preuve IV étude rétrospective.
    Full-text · Article · May 2013 · Revue de Chirurgie Orthopédique et Traumatologique
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    • "The biggest advantages of this implant was that it had the same tribological features that made the Metasul TM (Zimmer, Warsaw , USA) metal-on-metal bearing surfaces successful: high carbon content, forged Chrome-Cobalt (Cr-Co) alloy with optimized clearance [18]. Its excellent tribological performance was confirmed by the low amount of chromium and cobalt ions released into the blood [19] [20]. This implant has specific features that distinguish it from other available hip resurfacing systems: acetabular cup of consistent thickness having the shape of a flattened dome (165 • ), convex surface with titanium plasma sprayed coating and peripheral fins. "
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    ABSTRACT: INTRODUCTION: The performance of second-generation metal-on-metal bearings has led to the reintroduction of hip resurfacing. The goal of this multicentre study was to evaluate the short-term radiological and clinical outcomes with the Durom hip resurfacing system. HYPOTHESIS: The Durom hip-resurfacing system will have similar results to other hip resurfacing systems and traditional hip arthroplasty implants. MATERIALS AND METHODS: In the four participating centers, 580 patients (406 men, 174 women) and 644 hips were included. The average patient age was 48 years (range 16-77). A posterolateral surgical approach was used in 357 cases; a Hardinge-type approach was used in 182 cases and a Rottinger-type approach in 105. RESULTS: After an average follow-up of 34 months, 31 hips (4.8%) had been revised. The reasons for revision were the following: 10 (1.6%) neck fracture (seven with Rottinger operative approach, one with Hardinge approach and one with posterolateral approach); 12 (1.9%) femoral loosening (four with lateral approach and eight with posterolateral approach); four (0.6%) acetabular cup migration; three (0.5%) unexplained pain; one (0.2%) adverse reaction to metal debris; one (0.2%) infection. Four hips (0.6%) dislocated but without recurrence - all were operated using the Hardinge approach. The 613 hips that were not operated on again had satisfactory clinical results; the Merle d'Aubigné score was 17.2 (range 12-18) and the WOMAC score was 91 (range 20-100). The five-year survival rate was 91% (95% CI: 87-94%). Based on radiographs, the average cup inclination was 44.4° (range 30 to 70°). The femoral offset was reduced by an average of 2.4mm (-31 to 23mm) and the leg length had increased by an average of 0.8mm (-15 to 19mm) relative to the other side, which was prosthesis-free. None of the non-revised implants showed any signs of loosening. DISCUSSION: This multicentre evaluation revealed that the Durom revision rate was slightly higher than the rate with other hip resurfacing systems and traditional total hip arthroplasty. Although the Durom system displayed excellent tribological performance, the differences relative to other implants may be attributed to the challenges associated with impaction, related to the geometry and design of the cup, and to precarious primary fixation. The choice of surgical exposure and implantation technique was an important factor in the survival of the implant. LEVEL OF PROOF: Level IV - Retrospective study.
    Full-text · Article · Apr 2013 · Orthopaedics & Traumatology Surgery & Research
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