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Comparison of metal ion concentrations and implant survival after total hip arthroplasty with metal-on-metal versus metal-on-polyethylene articulations: a 16-year follow-up of a prospective randomized study
Karolinska Univ Hosp, Karolinska Inst, Sect Orthopaed & Sports Med, Dept Mol Med & Surg, Stockholm, Sweden..
Karolinska Inst, Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden..
Karolinska Univ Hosp, Karolinska Inst Stockholm, Funct Unit Musculoskeletal Radiol Funct Imaging &, Stockholm, Sweden..
Oregon Hlth & Sci Univ, Dept Orthopaed Surg, Portland, OR USA..
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2017 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 88, no 5, 490-495 p.Article in journal (Refereed) Published
Abstract [en]

Background and purpose - Large metal-on-metal (MoM) articulations are associated with metal wear and corrosion, leading to increased metal ion concentrations and unacceptable revision rates. There are few comparative studies of 28-mm MoM articulations with conventional metal-on-polyethylene (MoP) couplings. We present a long-term follow-up of a randomized controlled trial comparing MoM versus MoP 28-mm articulations, focused on metal ions and implant survival. Patients and methods - 85 patients with a mean age of 65 years at surgery were randomized to a MoM (Metasul) or a MoP (Protasul) bearing. After 16 years, 38 patients had died and 4 had undergone revision surgery. 13 patients were unavailable for clinical follow-up, leaving 30 patients (n = 14 MoM and n = 16 MoP) for analysis of metal ion concentrations and clinical outcome. Results - 15-year implant survival was similar in both groups (MoM 96% [95% CI 88-100] versus MoP 97% [95% CI 91-100]). The mean serum cobalt concentration was 4-fold higher in the MoM (1.5 mu g/L) compared with the MoP cohort (0.4 mu g/L, p < 0.001) and the mean chromium concentration was double in the MoM (2.2 mu g/L) compared with the MoP cohort (1.0 mu g/L, p = 0.05). Mean creatinine levels were similar in both groups (MoM 93 mu mol/L versus MoP 92 mu mol/L). Harris hip scores differed only marginally between the MoM and MoP cohorts. Interpretation - This is the longest follow-up of a randomized trial on 28-mm MoM articulations, and although implant survival in the 2 groups was similar, metal ion concentrations remained elevated in the MoM cohort even in the long term.

Place, publisher, year, edition, pages
2017. Vol. 88, no 5, 490-495 p.
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Orthopaedics
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URN: urn:nbn:se:uu:diva-333618DOI: 10.1080/17453674.2017.1350370ISI: 000407612900006OAI: oai:DiVA.org:uu-333618DiVA: diva2:1157688
Available from: 2017-11-16 Created: 2017-11-16 Last updated: 2017-11-16Bibliographically approved

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