No Change in Serum Metal Ions Levels After Primary Total Hip Replacement With an Additively Manufactured Dual...

Modular junctions of mixed metals have been associated with fretting and corrosion, and in extreme circumstances, adverse local tissue reactions. Since modular dual mobility (MDM) hip constructs involve a titanium shell with a modular cobalt-chromium liner, the aim of this study was to evaluate serum metal ions at minimum 1 year following total hip arthroplasty (THA) in a cohort of patients with these types of implants.

A single surgeon enrolled 30 patients in a prospective study in which all patients were evaluated preoperatively with serum cobalt, chromium, and titanium metal ion levels. Patients underwent primary THA with an additively manufactured titanium acetabular shell, MDM cobalt-chromium liner, titanium cementless stem, and ceramic head. A "Four Quadrant Test" was used to ensure proper liner seating intraoperatively. At minimum 1 year following surgery, clinical and radiographic evaluation was conducted, and repeat metal ion levels were collected. Patient-reported outcome measures were collected preoperatively and postoperatively.

Twenty-five patients completed 1-year follow-up. All patients had normal metal ion levels for cobalt (<1 μg/L), chromium (<5 μg/L), and titanium (sensitivity test) preoperatively and postoperatively. Patient-reported outcome measures improved significantly after primary THA: Veterans RAND-12 Physical Component Score (31.05 to 45.02, P < .001), Visual Analogue Scale Pain score (70.68 to 7.77, P < .001), Hip Disability and Osteoarthritis Outcomes Score, Joint Replacement (51.99 to 86.97, P < .001).

No significant elevation was detected in serum metal ion levels 16 months following THA using an additively manufactured titanium acetabular shell, a cobalt-chromium MDM liner, and titanium stem with a ceramic head.