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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...

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Autores principales: Bäcker, Henrik C., Wu, Chia H., Krüger, David, Gwinner, Clemens, Perka, Carsten, Hardt, Sebastian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
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.
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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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