Metal release and metal allergy after total hip replacement with resurfacing versus conventional hybrid prosthesis 5-year follow-up of 52 patients
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Metal release and metal allergy after total hip replacement with resurfacing versus conventional hybrid prosthesis 5-year follow-up of 52 patients. / Gustafson, Klas; Jakobsen, Stig S; Lorenzen, Nina D; Thyssen, Jacob P; Johansen, Jeanne D; Bonefeld, Charlotte M; Stilling, Maiken; Baad-Hansen, Thomas; Søballe, Kjeld.
I: Acta Orthopaedica, Bind 85, Nr. 4, 08.2014, s. 348-354.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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T1 - Metal release and metal allergy after total hip replacement with resurfacing versus conventional hybrid prosthesis 5-year follow-up of 52 patients
AU - Gustafson, Klas
AU - Jakobsen, Stig S
AU - Lorenzen, Nina D
AU - Thyssen, Jacob P
AU - Johansen, Jeanne D
AU - Bonefeld, Charlotte M
AU - Stilling, Maiken
AU - Baad-Hansen, Thomas
AU - Søballe, Kjeld
PY - 2014/8
Y1 - 2014/8
N2 - BACKGROUND: Metal-on-metal (MOM) total hip arthroplasties were reintroduced because of the problems with osteolysis and aseptic loosening related to polyethylene wear of early metal-on-polyethylene (MOP) arthroplasties. The volumetric wear rate has been greatly reduced with MOM arthroplasties; however, because of nano-size wear particles, the absolute number has been greatly increased. Thus, a source of metal ion exposure with the potential to sensitize patients is present. We hypothesized that higher amounts of wear particles result in increased release of metal ions and ultimately lead to an increased incidence of metal allergy.METHODS: 52 hips in 52 patients (median age 60 (51-64) years, 30 women) were randomized to either a MOM hip resurfacing system (ReCap) or a standard MOP total hip arthoplasty (Mallory Head/Exeter). Spot urine samples were collected preoperatively, postoperatively, after 3 months, and after 1, 2, and 5 years and tested with inductively coupled plasma-sector field mass spectrometry. After 5 years, hypersensitivity to metals was evaluated by patch testing and lymphocyte transformation assay. In addition, the patients answered a questionnaire about hypersensitivity.RESULTS: A statistically significant 10- to 20-fold increase in urinary levels of cobalt and chromium was observed throughout the entire follow-up in the MOM group. The prevalence of metal allergy was similar between groups.INTERPRETATION: While we observed significantly increased levels of metal ions in the urine during the entire follow-up period, no difference in prevalence of metal allergy was observed in the MOM group. However, the effect of long-term metal exposure remains uncertain.
AB - BACKGROUND: Metal-on-metal (MOM) total hip arthroplasties were reintroduced because of the problems with osteolysis and aseptic loosening related to polyethylene wear of early metal-on-polyethylene (MOP) arthroplasties. The volumetric wear rate has been greatly reduced with MOM arthroplasties; however, because of nano-size wear particles, the absolute number has been greatly increased. Thus, a source of metal ion exposure with the potential to sensitize patients is present. We hypothesized that higher amounts of wear particles result in increased release of metal ions and ultimately lead to an increased incidence of metal allergy.METHODS: 52 hips in 52 patients (median age 60 (51-64) years, 30 women) were randomized to either a MOM hip resurfacing system (ReCap) or a standard MOP total hip arthoplasty (Mallory Head/Exeter). Spot urine samples were collected preoperatively, postoperatively, after 3 months, and after 1, 2, and 5 years and tested with inductively coupled plasma-sector field mass spectrometry. After 5 years, hypersensitivity to metals was evaluated by patch testing and lymphocyte transformation assay. In addition, the patients answered a questionnaire about hypersensitivity.RESULTS: A statistically significant 10- to 20-fold increase in urinary levels of cobalt and chromium was observed throughout the entire follow-up in the MOM group. The prevalence of metal allergy was similar between groups.INTERPRETATION: While we observed significantly increased levels of metal ions in the urine during the entire follow-up period, no difference in prevalence of metal allergy was observed in the MOM group. However, the effect of long-term metal exposure remains uncertain.
KW - Arthroplasty, Replacement, Hip
KW - Chromium
KW - Cobalt
KW - Female
KW - Follow-Up Studies
KW - Hip Prosthesis
KW - Humans
KW - Hypersensitivity
KW - Lymphocyte Activation
KW - Male
KW - Metals
KW - Middle Aged
KW - Nanoparticles
KW - Osteolysis
KW - Patch Tests
KW - Polyethylene
KW - Prosthesis Failure
KW - Questionnaires
KW - Titanium
U2 - 10.3109/17453674.2014.922730
DO - 10.3109/17453674.2014.922730
M3 - Journal article
C2 - 24930546
VL - 85
SP - 348
EP - 354
JO - Acta Orthopaedica
JF - Acta Orthopaedica
SN - 1745-3674
IS - 4
ER -
ID: 138215897