Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Pranckh-Matzke, D.
Serum metal ion levels 5 years after total hip replacement with ceramic-on-metal bearing
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2017. pp.
[OPEN ACCESS]
FullText
- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Leithner Andreas
- Maurer-Ertl Werner
- Altmetrics:
- Abstract:
- Background: Increased metal ion levels following total hip replacement with metal-on-metal bearings are currently a highly debated topic. Known effects of increased metal debris are local soft tissue reactions (Adverse Reactions to Metal Debris, ARMD) with chronic pain. Further systemic side effects such as central and peripheral neuropathy, allergic skin lesions or chromosomal aberrations are described. The aim of the current study was to determine the serum metal ion concentrations of cobalt (Co) and chrome (Cr) after total hip replacement with a ceramic-on-metal bearing, and their correlation with the implant position. Patients and Methods: Between 2008 and 2010, 20 patients were treated with total hip replacements for osteoarthritis using a ceramic-on-metal bearing at our department. The mean age at time of surgery was 61 years (range, 41 to 85 years). The postoperative follow-up was on average 60 months and ranged from 49 to 70 months. Out of these 20 patients, 16 patients took part in the current series. One of the study participants receives a bilateral implantation of ceramic-on-metal bearing. That implies a total number of 17 hips with ceramic-on-metal bearing. In addition, x-rays were performed in two planes. To determine the inclination and anteversion of the cup the mediCAD program was used. Furthermore, the arc of cover was calculated. Results: The average metal ion concentration of Co was 5.0 µg/L (range, 0.3 to 39.0 µg/L) and 3.3 µg/L (range, 0.09 to 22.6 µg/L) for Cr. After exclusion of patients (n = 3) with a metal-on-metal large-head device implanted at the contralateral side, the remaining patients (n=13) showed an average concentration of 3,2 µg/L (range, 0.3 to 15.2 µg/L) for Co and 1.6 µg/L (range, 0.09 to 5.5 µg/L) for Cr. The statistical analysis showed a strong correlation between the anteversion and the measured Co and Co concentrations (Co: Pearson 0.684, p =0.007; Cr: Pearson 0,678, p=0,008) after exclusion of 3 patients with contralateral ASR (MoM) hips. Conclusion: The current series showed increments for Co and Cr following metal-on-ceramic hip arthroplasty. Nevertheless, compared with patients with metal-on-metal large-head prostheses or metal-on-metal hip resurfacing, these patients showed significantly lower serum concentrations of Co and Cr. We detected two patients with Co and Cr values over the international accepted reference value of 7 µg/L. The get a term for a control of the metal ion levels a few months after the first measurement. However, routine follow-up is recommended with investigation of serum metal ion concentrations at least once.