The concentration of chromium and cobalt ions and parameters of oxidative stress in serum and their impact on clinical outcomes after metaphyseal hip arthroplasty with modular metal heads

PURPOSE: Current epidemiological data forecast an almost 40% increase in the number of hip arthroplasty performed in the population of patients with osteoarthritis in 2060, compared to year 2018. On the basis of 10 years of observation, the failure rate after a metal-on-metal hip replacement is between 56.7 and 88.9%, depending on the used implant. METHODS: Seventy-six men operated using metaphyseal hip prostheses, with modular metal heads: the J&J DePuy ASR and Biomet Recap-Magnum systems, after a period of about 5–7 years after the procedure, were assessed twice (an interval of 6 months) in terms of the parameters of oxidative stress and the concentration of chromium, cobalt and ions nickel, as well as their impact on the current clinical status and quality of life. RESULTS: The mean values of the Co and Cr ion concentrations increased in a statistically significant manner at the individual stages of the study (13.20 Co and 18.16 Cr) for J&J DePuy ASR. Using the WOMAC-hip, HHS and SF-12 rating scales, the functional status of operated patients in both study groups did not change in a statistically significant manner during subsequent visits. There was a statistically significant increase in perceived pain in patients operated bilaterally with the J&J DePuy ASR system. The severity of pain could be related to the increase in the concentration of Co and Cr ions; however, it concerned a small group of bilaterally operated patients (n = 3 + n = 4). CONCLUSIONS: Metal-on-metal configuration in hip arthroplasty significantly influences with the increase in the concentration of chromium and cobalt ions in a double assessment. A statistically significant increase in the concentration of the tested Co and Cr ions in the blood correlates with an increase in the intensity of pain, especially in patients undergoing bilateral surgery. The limitation of this study is the relatively small number of bilaterally operated patients. Elevated levels of Co and Cr ions in the blood of patients operated on with the J&J DePuy ASR system increased steadily during both follow-up visits.