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How to Interpret Metal Ions in THA
1Mayo Clinic, Rochester, MN.
The Journal of Arthroplasty
|February 17, 2020
Summary
Elevated cobalt and chromium levels in hip arthroplasty patients indicate implant failure. Synovial fluid cobalt is a key indicator for adverse local tissue reactions (ALTRs) in failed hip implants.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Toxicology
Background:
- Increasing failures in total hip arthroplasty linked to adverse local tissue reactions (ALTRs).
- Causes include metal-on-metal (MoM) bearing wear and corrosion at implant junctions (MACC).
Purpose of the Study:
- To guide the selection and interpretation of metal ion testing for identifying failed total hip arthroplasty implants.
- To establish a diagnostic algorithm for symptomatic hip arthroplasties involving cobalt and chromium.
Main Methods:
- Evaluation of patients with painful hip arthroplasties using whole blood and synovial fluid metal ion levels.
- Analysis of chromium and cobalt levels to identify implant failure.
Main Results:
- Synovial fluid cobalt demonstrated the highest correlation with ALTR (threshold 19.75 ng/ml).
- A cobalt-to-chromium ratio > 1.4 ng/ml in metal-on-polyethylene hips showed 95% sensitivity for ALTR.
Conclusions:
- Interpreting whole blood metal ion levels is crucial for managing symptomatic hip arthroplasty.
- Metal ion testing must be integrated into a comprehensive diagnostic algorithm, not used in isolation.
Keywords:
adverse local tissue reactioncobaltmechanically assisted crevice corrosionmetal bearings in total hip arthroplastytotal hip arthroplastytrunnionosisMore Related Videos
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