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Comparison of metal ion concentrations and implant survival after total hip arthroplasty with metal-on-metal versus metal-on-polyethylene articulations: A 16-year follow-up of a prospective randomized study

BACKGROUND AND PURPOSE: Large metal-on-metal (MoM) articulations are associated with metal wear and corrosion, leading to increased metal ion concentrations and unacceptable revision rates. There are few comparative studies of 28-mm MoM articulations with conventional metal-on-polyethylene (MoP) cou...

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Autores principales: Dahlstrand, Henrik, Stark, André, Wick, Marius C, Anissian, Lucas, Hailer, Nils P, Weiss, Rüdiger J
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Taylor & Francis 2017
Materias:
Hip
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5560210/
https://www.ncbi.nlm.nih.gov/pubmed/28699417
http://dx.doi.org/10.1080/17453674.2017.1350370
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author Dahlstrand, Henrik
Stark, André
Wick, Marius C
Anissian, Lucas
Hailer, Nils P
Weiss, Rüdiger J
author_facet Dahlstrand, Henrik
Stark, André
Wick, Marius C
Anissian, Lucas
Hailer, Nils P
Weiss, Rüdiger J
author_sort Dahlstrand, Henrik
collection PubMed
description BACKGROUND AND PURPOSE: Large metal-on-metal (MoM) articulations are associated with metal wear and corrosion, leading to increased metal ion concentrations and unacceptable revision rates. There are few comparative studies of 28-mm MoM articulations with conventional metal-on-polyethylene (MoP) couplings. We present a long-term follow-up of a randomized controlled trial comparing MoM versus MoP 28-mm articulations, focused on metal ions and implant survival. PATIENTS AND METHODS: 85 patients with a mean age of 65 years at surgery were randomized to a MoM (Metasul) or a MoP (Protasul) bearing. After 16 years, 38 patients had died and 4 had undergone revision surgery. 13 patients were unavailable for clinical follow-up, leaving 30 patients (n = 14 MoM and n = 16 MoP) for analysis of metal ion concentrations and clinical outcome. RESULTS: 15-year implant survival was similar in both groups (MoM 96% [95% CI 88–100] versus MoP 97% [95% CI 91–100]). The mean serum cobalt concentration was 4-fold higher in the MoM (1.5 μg/L) compared with the MoP cohort (0.4 μg/L, p < 0.001) and the mean chromium concentration was double in the MoM (2.2 μg/L) compared with the MoP cohort (1.0 μg/L, p = 0.05). Mean creatinine levels were similar in both groups (MoM 93 μmol/L versus MoP 92 μmol/L). Harris hip scores differed only marginally between the MoM and MoP cohorts. INTERPRETATION: This is the longest follow-up of a randomized trial on 28-mm MoM articulations, and although implant survival in the 2 groups was similar, metal ion concentrations remained elevated in the MoM cohort even in the long term.
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spelling pubmed-55602102017-10-01 Comparison of metal ion concentrations and implant survival after total hip arthroplasty with metal-on-metal versus metal-on-polyethylene articulations: A 16-year follow-up of a prospective randomized study Dahlstrand, Henrik Stark, André Wick, Marius C Anissian, Lucas Hailer, Nils P Weiss, Rüdiger J Acta Orthop Hip BACKGROUND AND PURPOSE: Large metal-on-metal (MoM) articulations are associated with metal wear and corrosion, leading to increased metal ion concentrations and unacceptable revision rates. There are few comparative studies of 28-mm MoM articulations with conventional metal-on-polyethylene (MoP) couplings. We present a long-term follow-up of a randomized controlled trial comparing MoM versus MoP 28-mm articulations, focused on metal ions and implant survival. PATIENTS AND METHODS: 85 patients with a mean age of 65 years at surgery were randomized to a MoM (Metasul) or a MoP (Protasul) bearing. After 16 years, 38 patients had died and 4 had undergone revision surgery. 13 patients were unavailable for clinical follow-up, leaving 30 patients (n = 14 MoM and n = 16 MoP) for analysis of metal ion concentrations and clinical outcome. RESULTS: 15-year implant survival was similar in both groups (MoM 96% [95% CI 88–100] versus MoP 97% [95% CI 91–100]). The mean serum cobalt concentration was 4-fold higher in the MoM (1.5 μg/L) compared with the MoP cohort (0.4 μg/L, p < 0.001) and the mean chromium concentration was double in the MoM (2.2 μg/L) compared with the MoP cohort (1.0 μg/L, p = 0.05). Mean creatinine levels were similar in both groups (MoM 93 μmol/L versus MoP 92 μmol/L). Harris hip scores differed only marginally between the MoM and MoP cohorts. INTERPRETATION: This is the longest follow-up of a randomized trial on 28-mm MoM articulations, and although implant survival in the 2 groups was similar, metal ion concentrations remained elevated in the MoM cohort even in the long term. Taylor & Francis 2017-10 2017-07-12 /pmc/articles/PMC5560210/ /pubmed/28699417 http://dx.doi.org/10.1080/17453674.2017.1350370 Text en © 2017 The Author(s). Published by Taylor & Francis on behalf of the Nordic Orthopedic Federation. https://creativecommons.org/licenses/by-nc/3.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non-Commercial License (https://creativecommons.org/licenses/by-nc/3.0)
spellingShingle Hip
Dahlstrand, Henrik
Stark, André
Wick, Marius C
Anissian, Lucas
Hailer, Nils P
Weiss, Rüdiger J
Comparison of metal ion concentrations and implant survival after total hip arthroplasty with metal-on-metal versus metal-on-polyethylene articulations: A 16-year follow-up of a prospective randomized study
title Comparison of metal ion concentrations and implant survival after total hip arthroplasty with metal-on-metal versus metal-on-polyethylene articulations: A 16-year follow-up of a prospective randomized study
title_full Comparison of metal ion concentrations and implant survival after total hip arthroplasty with metal-on-metal versus metal-on-polyethylene articulations: A 16-year follow-up of a prospective randomized study
title_fullStr Comparison of metal ion concentrations and implant survival after total hip arthroplasty with metal-on-metal versus metal-on-polyethylene articulations: A 16-year follow-up of a prospective randomized study
title_full_unstemmed Comparison of metal ion concentrations and implant survival after total hip arthroplasty with metal-on-metal versus metal-on-polyethylene articulations: A 16-year follow-up of a prospective randomized study
title_short Comparison of metal ion concentrations and implant survival after total hip arthroplasty with metal-on-metal versus metal-on-polyethylene articulations: A 16-year follow-up of a prospective randomized study
title_sort comparison of metal ion concentrations and implant survival after total hip arthroplasty with metal-on-metal versus metal-on-polyethylene articulations: a 16-year follow-up of a prospective randomized study
topic Hip
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5560210/
https://www.ncbi.nlm.nih.gov/pubmed/28699417
http://dx.doi.org/10.1080/17453674.2017.1350370
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