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1.
Ashley K. Matthies Johann Henckel Suzie Cro Alexander Suarez Philip C. Noble John Skinner Alister J. Hart 《Journal of orthopaedic research》2014,32(1):167-174
Suboptimal component position and design are thought to lead to edge wear and raised blood metal ion levels in metal‐on‐metal hip resurfacing (MOM‐HR). These factors are thought to influence the “contact patch to rim distance” (CPRD), and calculation of this distance may improve prediction of wear and blood metal ion levels. We measured blood cobalt and chromium ion levels and the wear rates of the bearing surfaces in 165 MOM‐HR retrieval cases. We then determined the contribution and effect sizes of cup inclination and version angles, component size and design, and CPRD (calculated from case‐specific data) on blood metal ion levels and component wear rates. Acetabular orientation explained between 16.3% and 28.5% of the variation in wear rates and metal ion levels, whereas component size and design explained between 7.3% and 21.8% of the variability. In comparison, CPRD explained up to 67.7% of the variability, significantly greater than any other variable (all p < 0.0001). CPRD is a good predictor of wear and improves our understanding of wear performance and the mechanisms leading to edge loading. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:167–174, 2014. 相似文献
2.
Richard Lass Alexander Grübl Alexander Kolb David Stelzeneder Alexander Pilger Bernd Kubista Alexander Giurea Reinhard Windhager 《Journal of orthopaedic research》2014,32(9):1234-1240
Diagnosis of adverse reactions to metal debris in metal‐on‐metal hip arthroplasty is a multifactorial process. Systemic ion levels are just one factor in the evaluation and should not be relied upon solely to determine the need for revision surgery. Furthermore, the correlation between cobalt or chromium serum, urine, or synovial fluid levels and adverse local tissue reactions is still incompletely understood. The hypothesis was that elevated serum and urine metal‐ion concentrations are associated with elevated local metal‐ion concentrations in primary total hip arthroplasties (THA) and with failure of metal‐on‐metal articulations in the long‐term. In our present study, we evaluated these concentrations in 105 cementless THA with metal‐on‐metal articulating surfaces with small head diameter at a minimum of 18 years postoperatively. Spearman correlation showed a high correlation between the joint fluid aspirate concentration of cobalt and chromium with the serum cobalt (r = 0.81) and chromium level (r = 0.77) in patients with the THA as the only source of metal‐ions. In these patients serum metal‐ion analysis is a valuable method for screening. In patients with more than one source of metal or renal insufficiency additional investigations, like joint aspirations are an important tool for evaluation of wear and adverse tissue reactions in metal‐on‐metal THA. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:1234–1240, 2014. 相似文献
3.
María Rodríguez de la Flor Daniel Hernández‐Vaquero José Manuel Fernández‐Carreira 《Journal of orthopaedic research》2013,31(12):2025-2031
The elevation of metal levels in serum and urine during post‐operative follow‐up is a frequent find following the implantation of certain models of metal‐on‐metal hip prostheses. Among 45 patients with the same resurfacing prostheses, chromium (Cr) and cobalt (Co) levels in serum and urine were determined at 3, 4, 5, and 6 years after surgery. In the same period, levels of Cr, Co and molibdene (Mo) in scalp hair were also measured. Mean Cr and Co levels in serum were 8.29 µg/L (SD 17.97) and 8.38 µg/L (SD 21.97), respectively, whereas in urine levels were 16.20 µg/L (SD SD 32.55) and 75.40 µg/L (SD 190.86), respectively. In hair, mean Cr level were 163.27 µg/g (SD 300.62), mean Co level 61.98 µg/g (SD 126.48), and Mo 31.36 µg/g (SD 37.86). A high concordance was observed between chromium‐urine and chromium‐serum and between cobalt‐urine and cobalt‐hair. A moderate concordance was present between cobalt‐urine and cobalt‐serum, and between cobalt‐hair and cobalt‐serum. Eleven patients required revision surgery, five of them due to metallosis and periarticular cyst. At 1 year after reintervention, analytics were performed again and the following decrease rates were found: 42.8% in Cr levels, 51.1% in Mo levels, and 90.3% in Co levels. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31:2025–2031, 2013 相似文献
4.
Bisseling P Zeilstra DJ Hol AM van Susante JL 《The Journal of bone and joint surgery. British volume》2011,93(7):949-954
The purpose of this study was to evaluate whether concerns about the release of metal ions in metal-on-metal total hip replacements (THR) should be extended to patients with metal-bearing total disc replacements (TDR). Cobalt and chromium levels in whole blood and serum were measured in ten patients with a single-level TDR after a mean follow-up of 34.5 months (13 to 61) using inductively-coupled plasma mass spectrometry. These metal ion levels were compared with pre-operative control levels in 81 patients and with metal ion levels 12 months after metal-on-metal THR (n = 21) and resurfacing hip replacement (n = 36). Flexion-extension radiographs were used to verify movement of the TDR. Cobalt levels in whole blood and serum were significantly lower in the TDR group than in either the THR (p = 0.007) or the resurfacing group (p < 0.001). Both chromium levels were also significantly lower after TDR versus hip resurfacing (p < 0.001), whereas compared with THR this difference was only significant for serum levels (p = 0.008). All metal ion levels in the THR and resurfacing groups were significantly higher than in the control group (p < 0.001). In the TDR group only cobalt in whole blood appeared to be significantly higher (p < 0.001). The median range of movement of the TDR was 15.5° (10° to 22°). These results suggest that there is minimal cause for concern about high metal ion concentrations after TDR, as the levels appear to be only moderately elevated. However, spinal surgeons using a metal-on-metal TDR should still be aware of concerns expressed in the hip replacement literature about toxicity from elevated metal ion levels, and inform their patients appropriately. 相似文献
5.
Ashley K. Matthies Radu Racasan Paul Bills Liam Blunt Suzie Cro Anna Panagiotidou Gordon Blunn John Skinner Alister J. Hart 《Journal of orthopaedic research》2013,31(11):1677-1685
It has been speculated that material loss, either as corrosion or wear, at the head–stem taper junction is implicated in the high revision rates reported for metal‐on‐metal total hip replacements. We measured the volume of material loss from the taper and bearing surfaces of retrieved devices, and investigated the associations with blood metal ion levels and the diagnosis of a cystic or solid pseudotumor. The median volumes of material lost from the female and male taper surfaces were 2.0 and 0.29 mm3, respectively, while the median volumes of wear from the cup and head bearing surfaces were 1.94 and 3.44 mm3, respectively. Material loss from the female taper was similar to that from the acetabular bearing surface (p = 0.55), but significantly less than that from the femoral bearing surface (p < 0.001). Material loss from the male taper was less than that from both bearing surfaces (p < 0.001). Multivariable analysis demonstrated no significant correlations between the volume of material lost from the taper surfaces and either blood cobalt or chromium ions, or the presence of pseudotumor. While a substantial volume of material is lost at the taper junction, the clinical significance of this debris remains unclear. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31:1677–1685, 2013 相似文献
6.
Young‐Min Kwon Peter Thomas Burkhard Summer Hemant Pandit Adrian Taylor David Beard David W. Murray Harinderjit S. Gill 《Journal of orthopaedic research》2010,28(4):444-450
Locally destructive soft tissue pseudotumor has been reported in patients following metal‐on‐metal hip resurfacing arthroplasty (MoMHRA). A delayed hypersensitivity reaction type IV to nickel (Ni), chromium (Cr), or cobalt (Co) has been suggested to play a role in its aetiology. The aim of this study was to investigate the incidence and level of metal‐induced systemic hypersensitivity in patients with MoMHRA, both with and without pseudotumor by measuring lymphocyte proliferation responses to metals. A total of 92 patients were investigated: (1) MoMHRA patients with pseudotumors (nine female, one male); (2) MoMHRA patients without pseudotumors (30 female, 30 male); and (3) age‐matched control subjects without metal implants (9 female, 13 male). The venous blood samples were collected for serum Ni, Co, and Cr ion level measurements and lymphocyte transformation tests (LTT). A higher incidence and level of enhanced lymphocyte reactivity only to Ni was found in patients with MoMHRA compared to the patients without MoM implants, reflecting exposure and immune reactivity. However, lymphocyte reactivity to Co, Cr, and Ni did not significantly differ in patients with pseudotumors compared to those patients without pseudotumors. This suggests that systemic hypersensitivity type IV reactions, as measured by lymphocyte proliferation response to these metals, may not be the dominant biological reaction involved in the occurrence of the soft tissue pseudotumors. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 28:444–450, 2010 相似文献
7.
Munir Khan Tomoki Takahashi Jan H Kuiper Christine E Sieniawska Katsumasa Takagi James B Richardson 《Journal of orthopaedic research》2006,24(11):2029-2035
Baseline metal ion levels are elevated in patients with metal-on-metal (MOM) hip arthroplasty. Interpretation of baseline levels is difficult as measurements are influenced by wear, corrosion, and metal ion release from stored metal in the body. Schmalzried et al. demonstrated that "wear is the function of use, not time." The specific research question we asked was: Does physiological exercise increase the wear of metal-on-metal articulation which can be measured from the plasma metal ion levels? Patients with three different well functioning MOM bearings [two types of resurfacing (BHR 46.8 mm and Cormet 48 mm) and Metasul 28 mm] were included. Blood samples were taken immediately before, immediately after, and 1 h after exercise to determine cobalt and chromium levels. A significant increase (p<0.005) in serum cobalt and chromium of 13% and 11%, respectively, was noticed after the exercise. Rise of cobalt levels in patients with a resurfacing MOM was 8.5 times (BHR group) or 6.5 times (Cormet group) larger than in those with a Metasul MOM (p=0.021 and p=0.047). Neither rise of metal levels nor baseline levels correlated with any other factor (p>0.27). Exercise-related elevations of plasma cobalt level provides information on current in vivo wear production that cannot be inferred from a baseline measurement of cobalt levels. Chromium levels cannot provide reliable information on the in vivo wear of the devices. Diameter was the important feature of the implant in determining exercise-related elevations of plasma cobalt level. Exercise-related elevations of plasma cobalt level is a potential in vivo tool to understand and improve the tribology of metal-metal bearings. 相似文献
8.
Daniel K Hussey Rami Madanat Gabrielle S Donahue Ola Rolfson Orhun K Muratoglu 《Acta orthopaedica》2016,87(5):485-491
Background and purpose — Blood metal ion levels can be an indicator for detecting implant failure in metal-on-metal (MoM) hip arthroplasties. Little is known about the effect of bilateral MoM implants on metal ion levels and patient-reported outcomes. We compared unilateral patients and bilateral patients with either an ASR hip resurfacing (HR) or an ASR XL total hip replacement (THR) and investigated whether cobalt or chromium was associated with a broad spectrum of patient outcomes.Patients and methods — From a registry of 1,328 patients enrolled in a multicenter prospective follow-up of the ASR Hip System, which was recalled in 2010, we analyzed data from 659 patients (311?HR, 348 THR) who met our inclusion criteria. Cobalt and chromium blood metal ion levels were measured and a 21-item patient-reported outcome measures (PROMs) questionnaire was used mean 6 years after index surgery.Results — Using a minimal threshold of ≥7?ppb, elevated chromium ion levels were found to be associated with worse health-related quality of life (HRQoL) (p < 0.05) and hip function (p < 0.05) in women. These associations were not observed in men. Patients with a unilateral ASR HR had lower levels of cobalt ions than bilateral ASR HR patients (p < 0.001) but similar levels of chromium ions (p = 0.09). Unilateral ASR XL THR patients had lower chromium and cobalt ion levels (p < 0.005) than bilateral ASR XL THR patients.Interpretation — Chromium ion levels of ≥7?ppb were associated with reduced functional outcomes in female MoM patients. 相似文献
9.
Alicia J. JohnsonMichel J. Le Duff MA James P. YoonMariam Al-Hamad BS Harlan C. Amstutz 《The Journal of arthroplasty》2013
Recent studies suggest that the tapered interface between stem and femoral head may be a substantial source of cobalt and chromium ion release after metal-on-metal (MOM) total hip arthroplasty (THA). This study compared patient ion levels after MOM hip resurfacing (HR) and MOM THA performed with identical acetabular components. 110 HRs were compared with 22 THAs. All had well-oriented components, unilateral implants, and serum ion studies beyond one year post-operatively. The HR group’s median cobalt value was 1.11 μg/L vs. 2.86 μg/L for the THA patients. The HR group’s median chromium value was 1.49 μg/L vs. 2.94 μg/L for THA. Significantly higher THA ion levels suggest a source of ions other than the MOM bearing itself. 相似文献
10.
Shorter,rough trunnion surfaces are associated with higher taper wear rates than longer,smooth trunnion surfaces in a contemporary large head metal‐on‐metal total hip arthroplasty system
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Timothy M. Brock Raghavendra Sidaginamale Steven Rushton Antoni V. F. Nargol John G. Bowsher Christina Savisaar Tom J. Joyce David J. Deehan James K. Lord David J. Langton 《Journal of orthopaedic research》2015,33(12):1868-1874
11.
Metal ion concentrations and semen quality in patients undergoing hip arthroplasty: A prospective comparison between metal‐on‐metal and metal‐on‐polyethylene implants
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Szu‐Yuan Chen Chih‐Hsiang Chang Chih‐Chien Hu Chun‐Chieh Chen Yu‐Han Chang Pang‐Hsin Hsieh 《Journal of orthopaedic research》2016,34(3):544-551
Purpose: The widespread usage of metal‐on‐metal (MoM) articulations in total hip arthroplasty (THA) has been tempered by concerns of increased metal ion production. The purpose of the study is to evaluate the influence of metal ion exposure on semen quality in young male patients undergoing THA. Methods: Male patients who were scheduled for unilateral THA and aged between 20 and 45 years were prospectively enrolled. Patients were sorted into MoM and metal‐on‐polyethylene (MoP) groups with equal case number. Semen and blood metal ion levels were measured and sperm analysis was performed before, 6 months after, and 1 year after surgery. Results: Compared to preoperative baseline, patients (n = 50) in both groups had increased cobalt (Co) and chromium (Cr) concentrations in blood and seminal fluid after surgery. Between‐group comparisons at 6 months and 1 year after surgery showed that patients in the MoM group both had a greater Co concentration in blood and semen and a greater Cr concentration in blood and semen. Patients receiving MoM prosthesis had a reduced percentage of morphologically normal sperm, and decreases from the preoperative level (44.7%) were significant at 6 months (36.8%, p = 0.03) and 1 year (33.8%, p = 0.004). Conclusions: Our data shows a significantly greater concentration of metal ion in blood and semen in patients with MoM prosthesis with a reduced percentage of morphologically normal sperm. Despite small effects on sperm quality, some concerns remain. Further studies are necessary to determine sources of metal ion and to investigate effects on male fertility. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:544–551, 2016. 相似文献
12.
《Journal of orthopaedic research》2017,35(11):2557-2566
13.
Wear testing of a canine hip resurfacing implant that uses highly cross‐linked polyethylene
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Kevin J. Warburton John B. Everingham Jillian L. Helms Andrew J. Kazanovicz Katherine A. Hollar Jeff D. Brourman Steven M. Fox Trevor J. Lujan 《Journal of orthopaedic research》2018,36(4):1196-1205
14.
Christoph Stotter Bojana Stojanovi Christoph Bauer Manel Rodríguez Ripoll Friedrich Franek Thomas Klestil Stefan Nehrer 《Journal of orthopaedic research》2019,37(12):2531-2539
The aim of this in vitro study was to investigate the response of articular cartilage to frictional load when sliding against a metal implant, and identify potential mechanisms of damage to articular cartilage in a metal‐on‐cartilage pairing. Bovine osteochondral cylinders were reciprocally slid against metal cylinders (cobalt–chromium–molybdenum alloy) with several variations of load and sliding velocity using a microtribometer. The effects of different loads and velocities, and the resulting friction coefficients on articular cartilage, were evaluated by measuring histological and metabolic outcomes. Moreover, the biotribocorrosion of the metal was determined. Chondrocytes stimulated with high load and velocity showed increased metabolic activity and cartilage‐specific gene expression. In addition, higher load and velocity resulted in biotribocorrosion of the metal implant and damage to the surface of the articular cartilage, whereas low velocity and a high coefficient of friction increased the expression of catabolic genes. Articular cartilage showed particular responses to load and velocity when sliding against a metal implant. Moreover, metal implants showed tribocorrosion. Therefore, corrosion particles may play a role in the mechano‐biochemical wear of articular cartilage after implantation of a metal implant. These findings may be useful to surgeons performing resurfacing procedures and total knee arthroplasty. © 2019 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society J Orthop Res 37:2531–2539, 2019 相似文献
15.
16.
Smolders JM Bisseling P Hol A Van Der Straeten C Schreurs BW van Susante JL 《Hip international》2011,21(5):587-595
Metal ions generated from joint replacements are a cause for concern. There is no consensus on the best surrogate measure of metal ion exposure, and both serum and whole blood measurements are used in clinical practice. This study provides a guideline for interpretation of metal ion analysis in clinical practice. In a prospective trial comparing hip resurfacing (HR) with a conventional metal-on-metal (MoM) total hip arthroplasty (THA) cobalt and chromium levels were determined for whole blood and serum in 343 paired samples at regular intervals up to 24 months postoperatively. Cobalt whole blood and serum levels increased significantly after both procedures. Cobalt concentrations were significantly higher for the HR group compared to the THA group, at 3, 6 and 12 months, for whole blood and serum. At 24 months cobalt levels decreased and differences between HR and THA were no longer significant. In contrast, chromium whole blood levels remained significantly higher for HR until 24 months. Whole blood and serum levels could not be used interchangeably. The mean differences for cobalt and chromium between blood and serum values were +0.13 μg/L and -0.91 μg/L respectively. Regression analysis provided a formula for conversion from serum to blood of 0.34+[0.88*Co serum] for cobalt and 0.14 + [0.58*Cr serum] for chromium, with an acceptable prediction error below ±1.0 μg/L. Cobalt and chromium levels were significantly higher for HR versus THA, especially during the run-in phase of one year. Overall, the metal ion levels were well below 5 μg/L. We cannot recommend the use of whole blood over serum measurements or vice versa. The provided conversion formula between whole blood and serum in combination with the presented practical guidelines may be useful for clinical practice. 相似文献
17.
Lucia Savarino Giovanni Padovani Massimo Ferretti Michelina Greco Elisabetta Cenni Giorgio Perrone Francesco Greco Nicola Baldini Armando Giunti 《Journal of orthopaedic research》2008,26(12):1569-1576
Alternative bearing surfaces for total hip arthroplasty, such as metal‐on‐metal and ceramic‐on‐ceramic, offer the potential to reduce mechanical wear and osteolysis. In the short and medium term, the second generation of metal‐on‐metal bearings demonstrated high systemic metal ion levels, whereas ceramic‐on‐ceramic bearings showed the lowest ones. We aimed to verify whether the long‐term ion release in metal‐on‐metal subjects was still relevant at a median 10‐year follow‐up, and whether a fretting process at the modular junctions occurred in ceramic‐on‐ceramic patients and induced an ion dissemination. Serum levels were measured in 32 patients with alumina‐on‐alumina implants (group A), in 16 subjects with metal‐on‐metal implants (group B), and in 47 healthy subjects (group C). Group B results were compared with medium‐term findings. Cobalt and chromium levels were significantly higher in metal‐on‐metal implants than in ceramic‐on‐ceramic ones and controls. Nevertheless, ion levels showed a tendency to decrease in comparison with medium‐term content. In ceramic‐on‐ceramic implants, ion values were not significantly different from controls. Both in groups A and B, aluminum and titanium release were not significantly different from controls. In conclusion, negligible serum metal ion content was revealed in ceramic‐on‐ceramic patients. On the contrary, due to the higher ion release, metal‐on‐metal coupling must be prudently considered, especially in young patients, in order to obtain definitive conclusions. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 相似文献
18.
Levels of metal ions after small- and large-diameter metal-on-metal hip arthroplasty 总被引:10,自引:0,他引:10
Clarke MT Lee PT Arora A Villar RN 《The Journal of bone and joint surgery. British volume》2003,85(6):913-917
Metal-on-metal (MOM) bearings for hip arthroplasty are increasing in popularity. Concern remains, however, regarding the potential toxicological effects of the metal ions which these bearings release. The serum levels of cobalt and chromium in 22 patients who had undergone MOM resurfacing arthroplasty were compared with a matched group of 22 patients who had undergone 28 mm MOM total hip arthroplasty (THA). At a median of 16 months (7 to 56) after resurfacing arthroplasty, we found the median serum levels of cobalt and chromium to be 38 nmol/l (14 to 44) and 53 nmol/l (23 to 165) respectively. These were significantly greater than the levels after 28 mm MOM THA which were 22 nmol/l (15 to 87, p = 0.021) and 19 nmol/l (2 to 58, p < 0.001) respectively. Since the upper limit for normal patients without implants is typically 5 nmol/l, both groups had significantly raised levels of metal ions. MOM bearings of large diameter, however, result in a greater systemic exposure of cobalt and chromium ions than bearings of small diameter. This may be of relevance for potential long-term side-effects. It is not known to what extent this difference is due to corrosion of the surfaces of the component or of the wear particles produced. 相似文献
19.
The current study measured ion release among large-head metal-on-metal hip bearings. Twenty-six patients with a modular, Profemur? TL with A-Class? big femoral head total hip replacement were matched (gender, femoral size, BMI) with a group of 26 patients with the Conserve? Plus implant hip resurfacing. Compared with HR patients, THR patients had higher median serum cobalt ion levels at 6 months (3.26 vs 1.12 μg/L, P = .002) 1 year (4.51 vs 1.02, P = .002), and 2 years (3.77 vs 1.22, P<.001) following surgery. No differences in chromium ions were observed. Further research is required to determine the clinical significance of elevated serum cobalt ions. 相似文献
20.
Hart AJ Hester T Sinclair K Powell JJ Goodship AE Pele L Fersht NL Skinner J 《The Journal of bone and joint surgery. British volume》2006,88(4):449-454
We have studied the relationship between metal ion levels and lymphocyte counts in patients with metal-on-metal hip resurfacings. Peripheral blood samples were analysed for lymphocyte subtypes and whole blood cobalt and chromium ion levels in 68 patients (34 with metal-on-metal hip resurfacings and 34 with standard metal-on-polyethylene total hip replacements). All hip components were radiologically well-fixed and the patients were asymptomatic. Cobalt and chromium levels were significantly elevated in the patients with metal-on-metal hip resurfacings, compared with the patients with standard metal-on-polyethylene designs (p < 0.0001). There was a statistically significant decrease in the level of CD8(+) cells (T-cytotoxic/suppressor) (p = 0.005) in the metal-on-metal hip resurfacing group. A threshold level of blood cobalt and chromium ions was associated with reduced CD8(+) T-cell counts. We have no evidence that our patients suffered as a result of this reduced level of CD8(+) T-cells. 相似文献