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Retrieval analyses of total hip replacements.

H F Hildebrand¹, P Laffargue, J Decoulx

¹Groupe de Recherche sur Les Biomatériaux, Laboratoire de Biophysique, Faculté de Medecine, 1 Place de Verdun, F-59045 Lille Cedex, France, Tel: +3320626975; Fax: +3320626868.

The International Journal of Risk & Safety in Medicine

|March 21, 2013

Summary

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Metal ion release from total hip replacements (THR) was studied. Cobalt-chromium (Co-Cr) alloys showed significantly higher metal concentrations in patients, necessitating systematic follow-up and surveillance.

Area of Science:

Biomaterials Science
Orthopedic Surgery
Toxicology

Background:

Loosening of total hip replacements (THR) can lead to metal ion release.
Different prosthetic alloys (stainless steel, Ni-Cr-Mo, Co-Cr) have varying compositions and potential for ion leaching.

Purpose of the Study:

To assess metal ion release and tissue distribution in patients with loosened THR.
To correlate metal ion levels with specific prosthetic alloy types.

Main Methods:

Analysis of metal ion release in 31 patients with loosened THR using various alloys.
Intracellular deposit identification in macrophages, fibroblasts, histiocytes, and giant cells.
X-ray microprobe analysis (EDS) for elemental composition of tissues and body fluids.

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Main Results:

Intracellular deposits contained alloy elements (Ni, Cr, Fe, Mo) and other elements (P, Cl, Ca, S).
Co-Cr THR induced significantly higher cobalt levels (100-1000 fold) compared to normal.
Stainless steel THR showed the lowest metal concentrations; Ni-Cr-Mo alloys increased Ni and Cr levels.

Conclusions:

Metal ion distribution is alloy-dependent, with Co-Cr alloys posing the highest risk.
Elevated metal ion concentrations persist long after device removal.
Systematic patient follow-up and surveillance are crucial for managing metal ion release from THR.