Blood Management in Revision Total Hip Arthroplasty for Metal-on-Metal Devices: The Efficiency of an Intraoperative Cell Salvage System

Abstract Background The aim of this series was to investigate the efficiency of an intraoperative cell salvage system (ICS) removing metal ions during revision of metal-on-metal (MoM) devices to proof the possibility of re-transfusion of the collected blood. Materials and methods Between 2014 and 2018, five consecutive patients underwent revision surgery of their MoM total hip arthroplasty due to wear of the polyethylene-metal sandwich inlay or local massive metallosis with aseptic loosing of the cup. Aspiration of joint fluid of all hip prostheses was done and blood was taken to measure the metal ion concentrations, preoperatively. Perioperatively, blood was collected using an ICS before and after filtration and analyzed for Co and Cr concentrations. At that time, there was no re-transfusion of the collected and filtrated blood due to unknown metal ion concentrations. Results The mean preoperative serum Co and Cr concentrations in the blood were 31.28 μg/L (range 0.22–77.47) and 17.33 μg/L (range 0.59–51.31), whereas the mean local concentrations in the aspiration fluid were 728-fold and 822-fold higher. The Co and Cr concentrations measured in the collected blood before filtration were 70.61 μg/L (range 9.40–173.00) and 337.21 μg/L (range 8.76–1383.0) and decreased markedly to average concentrations of 15.49 μg/L and 41.88 μg/L, respectively. These differences were statistically not significant (Co: p = 0.117, Cr: p = 0.175), although the mean reduction rates were 78% and 88% for Co and Cr, respectively. Conclusion The current series showed that in case of revision of MoM hip devices, metal ions are still contained in the collected blood following filtration using a modern high-level ICS. Therefore, we would only recommend blood re-transfusion in case of low preoperative Co and Cr concentrations and sufficient renal function to warrant patients’ safety.

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Blood metal ion concentrations in metal-on-metal total hip arthroplasty

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-017-1931-y ◽

2017 ◽

Vol 27 (4) ◽

pp. 527-532 ◽

Cited By ~ 2

Author(s):

Tadahiko Ohtsuru ◽

Yuji Morita ◽

Yasuaki Murata ◽

Shuji Shimamoto ◽

Yutaro Munakata ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Metal Ion ◽

Ion Concentrations ◽

Total Hip ◽

Metal On Metal

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Outcomes after the conversion of metal-on-metal hip resurfacing arthroplasty to ceramic-on-ceramic total hip arthroplasty: A retrospective observational study with a mean 10-year follow-up

10.21203/rs.2.21421/v1 ◽

2020 ◽

Author(s):

Weiguang Yu ◽

Mao Shuai ◽

Jinluan Lin ◽

Baomin Chen ◽

Mingdong Zhao ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Metal Ion ◽

Hip Resurfacing ◽

Hip Resurfacing Arthroplasty ◽

Resurfacing Arthroplasty ◽

Metal On Metal ◽

The Mean ◽

Ceramic On Ceramic

Abstract Background The purpose of this retrospective study was to assess clinical outcomes following failed metal-on-metal hip resurfacing arthroplasty (MoM-HRA) revised using ceramic-on-ceramic total hip arthroplasty (CoC-THA) via the direct anterior approach (DAA).Methods Data involving 112 patients (112 hips) with failed primary MoM-HRA that was revised using CoC-THA via the DAA during 2006 - 2018 were retrospectively analysed. The mean age was 54.6 years (45–63 years). Frequent surgical indications for conversion were aseptic loosening and femoral neck fracture. The primary endpoint was the Postel-Merle d’Aubigne functional score (PMA). Secondary endpoints were the major orthopaedic complication rate and serum metal ion levels (chromium and cobalt).Results The mean follow-up time was 10 years (range, 4 - 13 years). The mean PMA improved from 9 (4-14) to 16 (13-18) (p = 0.001). Six patients had undergone a re-revision intervention. Fourteen incidents of aseptic loosening and four periprosthetic fractures were observed. A consistent decline in mean serum metal ion levels was detected [chromium decreased from 36.6 μg/L (12.5-76.5 μg/L) prior to conversion to 2.6 μg/L (0.1-13.5 μg/L) at final follow-up (p = 0.001), cobalt decreased from 37.5 μg/L (6.7-93.2 μg/L) to 2.2 μg/L (1.2-18.4 μg/L) (p =0.003)].Conclusion Failed primary MoM-HRA converted to CoC-THA using the DAA yielded acceptable clinical outcomes.

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Serum Metal Ion Concentrations After Unilateral vs Bilateral Large-Head Metal-on-Metal Primary Total Hip Arthroplasty

The Journal of Arthroplasty ◽

10.1016/j.arth.2011.03.037 ◽

2011 ◽

Vol 26 (8) ◽

pp. 1494-1500 ◽

Cited By ~ 15

Author(s):

Christopher E. Pelt ◽

Adam G. Bergeson ◽

Lucas A. Anderson ◽

Gregory J. Stoddard ◽

Christopher L. Peters

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Metal Ion ◽

Ion Concentrations ◽

Total Hip ◽

Large Head ◽

Metal On Metal ◽

Primary Total Hip Arthroplasty

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Comparison of metal ion concentrations and implant survival after total hip arthroplasty with metal-on-metal versus metal-on-polyethylene articulations

Acta Orthopaedica ◽

10.1080/17453674.2017.1350370 ◽

2017 ◽

Vol 88 (5) ◽

pp. 490-495 ◽

Cited By ~ 8

Author(s):

Henrik Dahlstrand ◽

André Stark ◽

Marius C Wick ◽

Lucas Anissian ◽

Nils P Hailer ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Metal Ion ◽

Implant Survival ◽

Ion Concentrations ◽

Total Hip ◽

Metal On Metal

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Clinical Results and Serum Metal Ion Concentrations following Ceramic-on-Metal Total Hip Arthroplasty at a Mean Follow-Up of 60 Months

BioMed Research International ◽

10.1155/2017/3726029 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

W. Maurer-Ertl ◽

D. Pranckh-Matzke ◽

J. Friesenbichler ◽

G. Bratschitsch ◽

L. A. Holzer ◽

...

Keyword(s):

Soft Tissue ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Metal Ion ◽

Ion Concentrations ◽

Current Series ◽

Metal On Metal ◽

Soft Tissue Reactions ◽

Tissue Reactions

Background. Increased metal ion levels following total hip arthroplasty (THA) with metal-on-metal bearings are a highly debated topic. Local soft tissue reactions with chronic pain and systemic side effects such as neuropathy are described. The aim of the current study was to determine the serum metal ion concentrations of Cobalt (Co) and Chrome (Cr) after THA with a ceramic-on-metal (CoM) bearing. Patients and Methods. Between 2008 and 2010, 20 patients underwent THA using a CoM bearing. Clinical function was evaluated by standardized scores systems (Harris Hip Score and WOMAC Score) and radiological examination included X-rays. Patient’s blood samples were obtained for metal ion analysis and correlation analysis was done between these results and implant position. Results. Overall, 13 patients with 14 CoM devices were available for the current series. The mean age at time of surgery was 61 years (range, 41 to 85). The postoperative follow-up ranged from 49 to 68 months (mean, 58). Metal ion determination showed mean concentrations of 3,1 µg/L (range, 0,3–15,2 µg/L) for Co and 1,6 µg/L (range, 0,1–5,5 µg/L) for Cr, respectively. A correlation between cup anteversion and Co and Cr concentrations was shown. Conclusion. The current series showed increments for Co and Cr following CoM THA. However, these levels are lower compared to metal ion concentrations in patients with metal-on-metal bearings and the international accepted threshold for revision of MoM devices. We recommend routine follow-up including at least one obligatory evaluation of serum metal ion concentrations and an MRI once to exclude local soft tissue reactions.

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No association between serum metal ions and implant fixation in large-head metal-on-metal total hip arthroplasty

Acta Orthopaedica ◽

10.3109/17453674.2014.922731 ◽

2014 ◽

Vol 85 (4) ◽

pp. 355-362 ◽

Cited By ~ 3

Author(s):

Mette Holm Hjorth ◽

Kjeld Søballe ◽

Stig Storgaard Jakobsen ◽

Nina Dyrberg Lorenzen ◽

Inger Mechlenburg ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Metal Ions ◽

Hip Arthroplasty ◽

Implant Fixation ◽

Total Hip ◽

Large Head ◽

Metal On Metal

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The Effect Of Different Bearing Surfaces On Metal Ion Levels In Urine Following 28 Mm Metal-On-Metal And 28 Mm Metal-On-Polyethylene Total Hip Arthroplasty

Scandinavian Journal of Surgery ◽

10.1177/1457496913491874 ◽

2013 ◽

Vol 102 (3) ◽

pp. 197-203 ◽

Cited By ~ 4

Author(s):

H. Tiusanen ◽

K. Mäkelä ◽

M. Kiilunen ◽

P. Sarantsin ◽

E. Sipola ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Metal Ion ◽

Total Hip ◽

Metal On Metal

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Metal ion trend in patients with metal-on-metal total hip arthroplasty: a 10-year prospective study

Hip International ◽

10.1177/1120700018812991 ◽

2018 ◽

Vol 28 (2_suppl) ◽

pp. 43-47 ◽

Cited By ~ 2

Author(s):

Rudy Sangaletti ◽

Andrea Spreafico ◽

Flavio Barbieri ◽

Roberto Ferrari ◽

Claudio Carlo Castelli

Keyword(s):

Los Angeles ◽

Metal Ions ◽

Hip Arthroplasty ◽

Metal Ion ◽

Revision Rate ◽

Ionic Concentration ◽

Average Concentration ◽

Old Patients ◽

Metal Head ◽

Metal On Metal

Introduction: There have been reported adverse reactions in patients with large head metal-on-metal hip arthroplasty, therefore metal particle debris are a cause for concern. The aim of this study was to evaluate the release trend of metal ions and the correlated variables. Methods: 54 patients were prospectively enrolled into the study from 2004 to 2006. All patients had 36-mm metal head, Pinnacle acetabular component, Summit stem and Ultamet CoCr alloy liner (Depuy Inc.), and underwent clinical and radiological management. The haematic concentration of Cr-Co at 0, 6, 12, 24, 60 and 120 months after the implantation was analysed in a sub-cohort of 34 patients. Results: 10-year revision rate for each case was 8.9%. The average concentration of Co at 120 months was 3.12 μg/L (median 2.20) with 53% values >2 μg/L and 1 >7 μg/L. After 6 months the median levels of Cr and Co were higher than time 0 ( p < 0.0001); no significant differences were found between 6 and 24 months; while Co had significant increase between 60 and 120 months ( p = 0.002). Overweight, University of California at Los Angeles (UCLA) >9 and <50 years old patients have significantly higher circulating metal ions. Discussion: This is 1 of the few prospective studies on the argument. The revision rate is conforming to records. Our data shows ionic concentration is not predictive of revision or adverse reaction to metals. We described a 3-phase trend for Co probably due to the loss of integrity of the surfaces.

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