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Metal on Metal Bearing in Total Hip Arthroplasty and Its Impact on Synovial Cell Count
Introduction: The effect of different bearings on synovial white blood cell (WBC) count and polymorphonuclear percentage (PMN%) in aspirations remains unclear. Therefore, this study investigates the impact of aseptic Metal-on-Metal (MoM) bearing on synovial fluid. Methods: We searched our arthroplas...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7603093/ https://www.ncbi.nlm.nih.gov/pubmed/33081071 http://dx.doi.org/10.3390/jcm9103349 |
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author | Bäcker, Henrik C. Wu, Chia H. Krüger, David Gwinner, Clemens Perka, Carsten Hardt, Sebastian |
author_facet | Bäcker, Henrik C. Wu, Chia H. Krüger, David Gwinner, Clemens Perka, Carsten Hardt, Sebastian |
author_sort | Bäcker, Henrik C. |
collection | PubMed |
description | Introduction: The effect of different bearings on synovial white blood cell (WBC) count and polymorphonuclear percentage (PMN%) in aspirations remains unclear. Therefore, this study investigates the impact of aseptic Metal-on-Metal (MoM) bearing on synovial fluid. Methods: We searched our arthroplasty registry for aseptic painful THAs with MoM bearings between 2011 and 2018. Then, a case-matched control group was selected with septic and aseptic Total Hip Arthroplasty (THA) with ceramic on a polyethylene (PE) bearing. The matching criteria consisted of gender, age +/−10 years, and time of aspiration (+/−2years). Periprosthetic Joint Infection (PJI) was defined according to the Infectious Diseases Society of America (IDSA), and Musculoskeletal Infection Society (MSIS) using bacterial cultures, sonication and histology. Results: In total, 19 patients who underwent hip aspiration with MoM bearing were identified. Five patients had to be excluded due to insufficient synovial fluid obtained (n = 2) or bacterial growth after sonication that was initially negative with the standard microbiological cultures (n = 3). As such, 14 were included. These patients were matched with 14 aseptic and 14 septic THAs with ceramic on a PE bearing, which constituted the control group. The mean serum chrome level was 20.0 ± 15.5 nmol/L and cobalt level 18.4 ± 22.1 nmol/L. The synovial WBC and PMN% varied significantly between MoM bearing group and the aseptic THA ceramic PE group (both p < 0.001), as well as the septic THA group (WBC p = 0.016, PMN% p < 0.001). Furthermore, the septic THA group had significantly higher CRP values than the aseptic MoM group (p = 0.016). Conclusion: MoM bearing shows significantly higher synovial WBC and PMN% when compared to aseptic THA with ceramic on PE bearing above the MSIS cut-off. This is an important consideration when diagnosing periprosthetic joint infection using the MSIS guidelines. |
format | Online Article Text |
id | pubmed-7603093 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-76030932020-11-01 Metal on Metal Bearing in Total Hip Arthroplasty and Its Impact on Synovial Cell Count Bäcker, Henrik C. Wu, Chia H. Krüger, David Gwinner, Clemens Perka, Carsten Hardt, Sebastian J Clin Med Article Introduction: The effect of different bearings on synovial white blood cell (WBC) count and polymorphonuclear percentage (PMN%) in aspirations remains unclear. Therefore, this study investigates the impact of aseptic Metal-on-Metal (MoM) bearing on synovial fluid. Methods: We searched our arthroplasty registry for aseptic painful THAs with MoM bearings between 2011 and 2018. Then, a case-matched control group was selected with septic and aseptic Total Hip Arthroplasty (THA) with ceramic on a polyethylene (PE) bearing. The matching criteria consisted of gender, age +/−10 years, and time of aspiration (+/−2years). Periprosthetic Joint Infection (PJI) was defined according to the Infectious Diseases Society of America (IDSA), and Musculoskeletal Infection Society (MSIS) using bacterial cultures, sonication and histology. Results: In total, 19 patients who underwent hip aspiration with MoM bearing were identified. Five patients had to be excluded due to insufficient synovial fluid obtained (n = 2) or bacterial growth after sonication that was initially negative with the standard microbiological cultures (n = 3). As such, 14 were included. These patients were matched with 14 aseptic and 14 septic THAs with ceramic on a PE bearing, which constituted the control group. The mean serum chrome level was 20.0 ± 15.5 nmol/L and cobalt level 18.4 ± 22.1 nmol/L. The synovial WBC and PMN% varied significantly between MoM bearing group and the aseptic THA ceramic PE group (both p < 0.001), as well as the septic THA group (WBC p = 0.016, PMN% p < 0.001). Furthermore, the septic THA group had significantly higher CRP values than the aseptic MoM group (p = 0.016). Conclusion: MoM bearing shows significantly higher synovial WBC and PMN% when compared to aseptic THA with ceramic on PE bearing above the MSIS cut-off. This is an important consideration when diagnosing periprosthetic joint infection using the MSIS guidelines. MDPI 2020-10-18 /pmc/articles/PMC7603093/ /pubmed/33081071 http://dx.doi.org/10.3390/jcm9103349 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Bäcker, Henrik C. Wu, Chia H. Krüger, David Gwinner, Clemens Perka, Carsten Hardt, Sebastian Metal on Metal Bearing in Total Hip Arthroplasty and Its Impact on Synovial Cell Count |
title | Metal on Metal Bearing in Total Hip Arthroplasty and Its Impact on Synovial Cell Count |
title_full | Metal on Metal Bearing in Total Hip Arthroplasty and Its Impact on Synovial Cell Count |
title_fullStr | Metal on Metal Bearing in Total Hip Arthroplasty and Its Impact on Synovial Cell Count |
title_full_unstemmed | Metal on Metal Bearing in Total Hip Arthroplasty and Its Impact on Synovial Cell Count |
title_short | Metal on Metal Bearing in Total Hip Arthroplasty and Its Impact on Synovial Cell Count |
title_sort | metal on metal bearing in total hip arthroplasty and its impact on synovial cell count |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7603093/ https://www.ncbi.nlm.nih.gov/pubmed/33081071 http://dx.doi.org/10.3390/jcm9103349 |
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