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Study Reports High Level of Metal Ions in Metal-On-Metal Hip Implant Patients at 5-Year Follow-Up

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A new study reveals high levels of metal ions in patients implanted with metal-on-metal hip implants. While the metal ion levels steadied in patients implanted with 28-mm metal-on-metal hip bearings, the levels continued to increase for 36-mm metal-on-metal bearings at the five-year mark, said Ortho SuperSite.

“This was a prospective randomized trial with three arms: A 28-mm polyethylene liner, 28-mm metal-on-metal (MoM), and a 36-mm [MoM],” said C. Anderson Engh Jr., MD, who was speaking at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting, in San Francisco. “The same stem and cup were utilized. We looked at serum, erythrocyte and, at 5 years, whole blood ion levels,” he added, wrote Ortho SuperSite.

Of the 120 patient participants, 105 were eligible for the study at surgery and were randomized into three groups: Those who underwent metal-on-polyethylene (MoP) total hip arthroplasty (THA); those who underwent 28-mm MoM THA; and those who underwent 36-mm MoM THA, said Engh Jr. according to Ortho SuperSite. Blood samples were collected preoperatively and again, after surgery at 6-month and 1, 2, 3, and 5 years, said Ortho SuperSite.

At the 5-year follow-up, patients in the MoP group—those implanted with metal-on-polyethylene devices—tested with chromium and cobalt ion levels significantly lower than the two all-metal groups for all blood samples, said Ortho SuperSite. This backs up the prevailing theory that patients implanted with metal-on-metal devices may be suffering from increased chromium and cobalt levels as a result of their all-metal hip implant devices.

Patients implanted with 36-mm metal-on-metal devices had significantly higher levels for serum and erythrocyte cobalt, said Engh Jr. At the 6-month test, one patient in the 36-mm MoM group had serum or erythrocyte ion levels that were in excess of 7 parts per billion (ppb); this was also seen in four other patients at five years, said Ortho SuperSite. The patients in the 28-mm MoM group did not exhibit these findings, according to the research.

Engh pointed out that the results revealed an ongoing increase of cobalt serum and erythrocyte ion levels in the 36-mm MoM group, while the 28-mm MoM group’s eventually leveled off. “These median ion levels are similar to what we see in other studies,” Engh said. “The cobalt levels are well correlated. The surprising thing was that the MoMs were not performing as well both anecdotally—with adverse tissue reaction, osteolysis, and the higher ion levels—and also the 36 mm having an increasing ion level with time.”

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