Systemic Metal Ion Levels in Patients With Modular-Neck Stems: A Prospective Cohort Study

Abstract Background Recent registry data reveal that modular-neck hip prostheses are associated with increased revision rates compared to fixed-neck stems. Poor implant survival has been associated to corrosion at the neck-stem junction, inducing metal ion release and subsequently adverse local tiss...

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Bibliographic Details
Published in:The Journal of arthroplasty 2016-08, Vol.31 (8), p.1750-1755
Main Authors: Laurençon, Jonathan, MD, Augsburger, Marc, PhD, Faouzi, Mohamed, PhD, Becce, Fabio, MD, Hassani, Hassen, MD, Rüdiger, Hannes A., MD
Format: Article
Language:English
Subjects:
Adult
adverse local tissue reaction
Aged
Aged, 80 and over
arthroplasty
Arthroplasty, Replacement, Hip
Chromium - blood
Cobalt - blood
Corrosion
Female
hip
Hip Prosthesis - adverse effects
Humans
Magnetic Resonance Imaging
Male
metal ion release
Middle Aged
modular neck
Molybdenum - blood
Orthopedics
Prospective Studies
Prosthesis Design
Prosthesis Failure
Registries
Titanium - blood
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Summary:Abstract Background Recent registry data reveal that modular-neck hip prostheses are associated with increased revision rates compared to fixed-neck stems. Poor implant survival has been associated to corrosion at the neck-stem junction, inducing metal ion release and subsequently adverse local tissue reactions. Data on metal ion release on the neck-stem junction of such stems are scarce. The purpose of this study was to evaluate corrosion at this interface by determining metal ion release. Methods Serum and whole blood metal ion levels of 40 patients after 1 year of implantation of a modular-neck stem (titanium stem and cobalt-chromium neck) were compared with 10 patients with a monobloc version of the stem (all titanium) and 10 patients having no implant at all. Results Seven of 40 patients (18%) with a modular-neck stem had cobalt or chromium concentrations >2 μg/L. These patients underwent magnetic resonance imaging using metal artifact reduction sequences, which revealed a pseudotumor in 1 patient. Conclusion Corrosion at the neck-stem junction of modular-neck stems is a reported phenomenon, which is in part reflected by elevated systemic ion levels. The use of such implants should be restricted to a minimum, and screening algorithms of patients with such implants must be developed.
ISSN:0883-5403
1532-8406
DOI:10.1016/j.arth.2016.01.030