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Serum cobalt and chromium concentration following total hip arthroplasty: a Bayesian network meta-analysis
Filippo Migliorini1,2, Marco Pilone3,4, Andreas Bell5
1Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany. migliorini.md@gmail.com.
Insights
Serum chromium (Cr) and cobalt (Co) levels after total hip arthroplasty (THA) depend on implant materials, not patient factors. The CoCr-CoCr coupling showed the highest metal ion concentrations, while CoCr-Polyethylene showed the lowest.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Toxicology
Background:
- Total hip arthroplasty (THA) involves implanting artificial joint components.
- Wear debris from THA implants can release metal ions like chromium (Cr) and cobalt (Co) into the bloodstream.
- Monitoring serum metal ion concentrations is crucial for assessing implant performance and potential adverse effects.
Purpose of the Study:
- To investigate serum concentrations of chromium (Cr) and cobalt (Co) in patients following total hip arthroplasty (THA).
- To determine if different implant material combinations (head-liner) affect serum Cr and Co levels.
- To assess the influence of patient characteristics (time since surgery, BMI, sex, side) on serum metal ion concentrations.
Main Methods:
- Systematic review of data from 2756 total hip arthroplasty (THA) procedures.
- Analysis of serum concentrations of chromium (Cr) and cobalt (Co) based on implant material combinations: Ceramic-CoCr, CoCr-CoCr, CoCr-Polyethylene, and CoCr high carbide-CoCr high carbide.
- Statistical analysis (ANOVA) to compare patient demographics and implant characteristics.
Main Results:
- Serum cobalt (Co) concentrations ranged from 0.5 to 3.5 µg/L, and chromium (Cr) from 0.6 to 2.6 µg/L.
- Implant configuration significantly influenced serum metal ion levels: CoCr-CoCr coupling resulted in the highest concentrations, while CoCr-Polyethylene showed the lowest.
- Patient factors including time since surgery, BMI, sex, and side of implantation did not significantly affect serum Cr and Co levels.
Conclusions:
- Serum concentrations of chromium (Cr) and cobalt (Co) after THA are primarily determined by the implant's material combination.
- The CoCr-CoCr coupling is associated with higher serum metal ion release compared to CoCr-Polyethylene.
- Patient-specific factors do not appear to significantly influence serum metal ion levels in THA patients.
Abstract:
The present systematic review investigated the concentration of chromium (Cr) and cobalt (Co) in serum in patients who have undergone total hip arthroplasty (THA). The first outcome of interest was to investigate the mean concentration in serum of Cr and Co using different material combinations and to verify whether their concentrations change significantly using different patterns of head and liner in THA. The second outcome of interest was to investigate whether the time elapsed from the index surgery to the follow-up, BMI, sex, and side exert an influence on the mean concentration of Cr and Co in serum in patients who have undergone THA. The following material combinations were investigated (head-liner): Ceramic-Co Cr (CoCr), CoCr-CoCr, CoCr-Polyethylene, CoCr high carbide-CoCr high carbide. Data from 2756 procedures were retrieved. The mean length of follow-up was 69.3 ± 47.7 months. The ANOVA test evidenced good comparability in age, length of follow-up, BMI, and sex (P > 0.1). In patients who have undergone THA, the mean concentration in the serum of Co ranged between 0.5 µg/L and 3.5 µg/L, and the mean concentration of Cr from 0.6 to 2.6 µg/L. The difference in the concentration of Co and Cr in serum is strictly related to the implant configuration, with the coupling CoCr-CoCr showing the highest and CoCr-Polyethylene showing the lowest concentration. Patient characteristics, BMI, sex, side and the time elapsed from the index surgery to the last follow-up did not exert a significant influence on the concentration of Co and Cr in serum in patients who have undergone total hip arthroplasty (THA).
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