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Are Metal Ion Levels Elevated After Dual Mobility Acetabular Systems Minimum Five-Year Analysis.

Zhongming Chen, Steven F Harwin, Michael A Mont

    Bulletin of the Hospital for Joint Disease (2013)
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    Dual mobility acetabular systems show low blood and urine cobalt and chromium levels at a minimum 5-year follow-up. These metal ion levels remain clinically insignificant, regardless of implant specifics or follow-up duration.

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    Area of Science:

    • Orthopedic Surgery
    • Biomaterials Science
    • Toxicology

    Background:

    • Dual mobility acetabular systems in total hip arthroplasty (THA) reduce dislocation and revision rates.
    • Concerns exist regarding potential adverse local tissue reactions from metal ion release (cobalt, chromium).
    • Long-term studies on metal ion levels after dual mobility THA are lacking.

    Purpose of the Study:

    • To investigate blood and urine cobalt and chromium levels at a minimum 5-year follow-up after dual mobility THA.
    • To analyze metal ion levels stratified by follow-up duration and implant metrics (offset, cup size, stem, neck angle).

    Main Methods:

    • Retrospective analysis of 41 patients who underwent THA with dual mobility systems (mean follow-up: 6 years).
    • Measurement of serum/plasma, blood, and urine cobalt and chromium levels at final follow-up.
    • Analysis of implant-related parameters: head material/size, stem offset, cup size, stem-neck angle.

    Main Results:

    • Mean blood cobalt (0.6 ± 0.5 μg/L) and urine cobalt (0.8 ± 0.8 μg/L) were below normal thresholds.
    • Mean blood chromium (0.8 ± 0.2 μg/L) and urine chromium (1.2 ± 0.5 ng/mL) were also below normal.
    • Metal ion levels showed minimal changes with longer follow-up or varying implant metrics.

    Conclusions:

    • Dual mobility systems, with the studied stems, result in low cobalt and chromium levels at 5+ years post-THA.
    • Levels remained clinically insignificant, irrespective of follow-up length, head material, or implant measurements.
    • This study is the first to report low metal ion levels beyond 4 years, offering valuable data for implant selection.