Femoral offset found not to affect metal ion levels in metal-on-metal total hip arthroplasty
Failure to restore femoral offset in metal on polyethylene total hip arthroplasty (THA) causes polyethylene wear and aseptic loosening. To our knowledge, no study to date has investigated the relationship between femoral offset and wear in metal-on-metal (MOM) THA.
In this study, we investigated the relationship between femoral offset and wear by measuring circulating metal ion levels in MOM THA.
In this retrospective study, we identified patients who had undergone MOM THA with the ASR XL system (DePuy International Ltd., Leeds, UK). Femoral offset was measured using anteroposterior radiographs, and circulating metal ion levels (cobalt and chromium) were recorded.
In total, 95 patients were included (68 males and 27 females). The mean age at the time of surgery was 64.9. Mean time from surgery to blood sampling was 15.4 months. No statistically significant relationship was found between femoral offset and cobalt (p = 0.313) or chromium (p = 0.401) ions.
It is known that failure to restore femoral offset during THA can lead to high rates of wear in metal-on-polyethylene articulations. In our study, no statistically significant relationship was found between femoral offset and serum cobalt or chromium ions. This study adds to the information available to surgeons regarding factors that increase wear in metal-on-metal total hip arthroplasty.
KeywordsChromium Cobalt Femoral offset Metal ions Metal-on-metal Total hip arthroplasty
The authors would like to thank Paula Blake, orthopedic nurse at Our Lady’s Hospital, who worked tirelessly in assisting us with data collection and patient identification.
Compliance with ethical standards
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Prior to undertaking this study, the local institutional review board was consulted. As it is a retrospective study, the decision was made that formal consent was not required.
Conflict of interest
The authors declare that they have no conflict of interest.
- 5.de Steiger RN, Hang JR, Miller LN, Graves SE, Davidson DC (2011) Five-year results of the ASR XL acetabular system and the ASR hip resurfacing system: an analysis from the Australian Orthopaedic Association National Joint Replacement Registry. J Bone Joint Surg Am 93:2287–2293. https://doi.org/10.2106/JBJS.J.01727 CrossRefGoogle Scholar
- 12.Hart AJ, Ilo K, Underwood R, Cann P, Henckel J, Lewis A et al (2011) The relationship between the angle of version and rate of wear of retrieved metal-on-metal resurfacings. Bone Joint J 93–B:315–320Google Scholar
- 13.De Haan R, Pattyn C, Gill HS, Murray DW, Campbell PA, De Smet K (2008) Correlation between inclination of the acetabular component and metal ion levels in metal-on-metal hip resurfacing replacement. Bone Joint J 90–B:1291–1297Google Scholar
- 14.Langton DJ, Sprowson AP, Joyce TJ, Reed M, Carluke I, Partington P et al (2009) Blood metal ion concentrations after hip resurfacing arthroplasty: a comparative study of articular surface replacement and birmingham hip resurfacing arthroplasties. J Bone Joint Surg (Br) 9191:1287–1295. https://doi.org/10.1302/0301-620X.91B10 CrossRefGoogle Scholar
- 15.Bayley N, Khan H, Grosso P, Hupel T, Stevens D, Snider M, Schemitsch E, Kuzyk P (2014) What are the predictors and prevalence of pseudotumor and elevated metal ions after large-diameter metal-on-metal THA? Clin Orthop Relat Res 473:477–484. https://doi.org/10.1007/s11999-014-3824-2 CrossRefGoogle Scholar
- 19.McGrory BJ, Morrey BF, Cahalan TD, An KN, Cabanela ME (1995) Effect of femoral offset on range of motion and abductor muscle strength after total hip arthroplasty. Bone Joint J 77–B:865–869Google Scholar
- 20.Fackler CD, Poss R (1980) Dislocation in total hip arthroplasties. Clin Orthop Relat Res 151:169–178Google Scholar
- 25.Craig P, Bancroft G, Burton A, Collier S, Shaylor P, Sinha A (2014) Raised levels of metal ions in the blood in patients who have undergone uncemented metal-on-polyethylene Trident-Accolade total hip replacement. Bone Joint J 96–B:43–47. https://doi.org/10.1302/0301-620X.96B1.30923 CrossRefGoogle Scholar
- 29.Mri M (2012) Ref : No authors listed. Medicines and Healthcare products Regulatory Agency (MHRA). Medical device alert: all metal-on-metal (MOM) hip replacements, 2010 MDA/2010/033. http://www.mhra.gov.uk/Publications/Safetywarnings/MedicalDeviceAlerts/CON079157:6–7
- 30.Hart AJ, Sabah SA, Bandi AS, Maggiore P, Tarassoli P, Sampson B et al (2011) Sensitivity and specificity of blood cobalt and chromium metal ions for predicting failure of metal-on-metal hip replacement. J Bone Joint Surg (Br) 93–B:1308–1313. https://doi.org/10.1302/0301-620X.93B10.26249 CrossRefGoogle Scholar
- 33.Vendittoli P-A, Lavigne M, Girard J, Roy AG (2006) A randomised study comparing resection of acetabular bone at resurfacing and total hip replacement. Bone Joint J 88–B:997–1002Google Scholar
- 38.Langton DJ, Joyce TJ, Jameson SS, Lord J, Van Orsouw M, Holland JP et al (2011) Adverse reaction to metal debris following hip resurfacing. Bone Joint J 93–B:164–171Google Scholar