Introduction: Although metal-on-metal (MoM) total hip arthroplasty (THA) and hip resurfacings (HR) have similar bearing surfaces and comparable wear rates, metal ion levels and risk of failure are higher for MoM-THA. The mechanism behind the increased metal ion levels in large head MoM-THA is not completely understood. The current study aims to identify predictive factors for increased metal ion levels in unilateral and bilateral large head MoM-THA.
Materials and methods: 99 Birmingham modular MoM-THA in 87 patients with metal ion levels at least 36 months after index procedure were analyzed. Mean follow-up time was 61.3 months (range 37-108) and the relationship of the following variables (gender, age, BMI, follow-up time, UCLA Activity Score, cup inclination, femoral head size, bilateral surgery) on metal ion levels were analyzed with multivariate regression models.
Results: Multivariate regression analysis revealed that bilateral MoM-THA surgery (p < 0.001) had a positive predictive effect on cobalt serum levels, while BMI had a negative (p = 0.018). Female gender (p = 0.012), activity (p = 0.001) and bilateral MoM-THA (p = 0.004) were positively correlated with chromium levels. Positive independent predictors for the cobalt-chromium ratio in the multivariate analysis were overall follow-up time (p = 0.004), bilateral MoM-THA (p < 0.001) and femoral head size (p = 0.007).
Conclusions: The data of the current study suggest that bilateral MoM-THA, increased patient activity levels and female gender are associated with increased chromium levels. Patients with larger component size, longer follow-up time and bilateral MoM-THAs have an increased cobalt-chromium ratio. These patients might be at increased risk for adverse local soft tissue reactions secondary to corrosion. Continuous close monitoring is recommended and bearing-surface change should be discussed if local tissue reactions occur.
Keywords: Chromium; Cobalt; Cobalt–chromium ratio; Metal-on-metal (MoM); Total hip arthroplasty.