The 2012 Otto Aufranc Award: The Interpretation of Metal Ion Levels in Unilateral and Bilateral Hip Resurfacing View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2013-02

AUTHORS

Catherine Van Der Straeten, George Grammatopoulos, Harinderjit S. Gill, Alessandro Calistri, Patricia Campbell, Koen A. De Smet

ABSTRACT

BACKGROUND: The interpretation of metal ion concentrations and their role in clinical management of patients with metal-on-metal implants is still controversial. QUESTIONS/PURPOSES: We questioned whether patients undergoing hip resurfacing with no clinical problems could be differentiated from those with clinical (pain, loss of function) and/or radiographic (component malpositioning, migration, bone loss), problems based on metal ion levels, and if there was a threshold metal level that predicted the need for clinical intervention. Furthermore, we asked if patient and implant factors differed between these functional groups. METHODS: We retrospectively identified 453 unilateral and 139 bilateral patients with ion measurements at minimum followup of 12 months (mean, 4.3 years; range, 1-12.9 years). Patients were designated as well functioning or poorly functioning based on strict criteria. The acceptable upper levels within the well-functioning group were determined from the 75th percentile plus 1.5× interquartile range. The sensitivity and specificity of these levels to predict clinical problems were calculated. RESULTS: Well-functioning group ions were lower than the poorly functioning group ion levels. The acceptable upper levels were: chromium (Cr) 4.6 μg/L, cobalt (Co) 4.0 μg/L unilateral and Cr 7.4 μg/L, Co 5.0 μg/L bilateral. The specificity of these levels in predicting poor function was high (95%) and sensitivity was low (25%). There were more males in the well-functioning group and more females and smaller femoral components in the poorly functioning group. CONCLUSIONS: Metal levels higher than these proposed safe upper limits can predict problems with metal-on-metal resurfacings and are important parameters in the management of at-risk patients. LEVEL OF EVIDENCE: Level II, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence. More... »

PAGES

377-385

References to SciGraph publications

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s11999-012-2526-x

DOI

http://dx.doi.org/10.1007/s11999-012-2526-x

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1006486078

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/22930211


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48 schema:description BACKGROUND: The interpretation of metal ion concentrations and their role in clinical management of patients with metal-on-metal implants is still controversial. QUESTIONS/PURPOSES: We questioned whether patients undergoing hip resurfacing with no clinical problems could be differentiated from those with clinical (pain, loss of function) and/or radiographic (component malpositioning, migration, bone loss), problems based on metal ion levels, and if there was a threshold metal level that predicted the need for clinical intervention. Furthermore, we asked if patient and implant factors differed between these functional groups. METHODS: We retrospectively identified 453 unilateral and 139 bilateral patients with ion measurements at minimum followup of 12 months (mean, 4.3 years; range, 1-12.9 years). Patients were designated as well functioning or poorly functioning based on strict criteria. The acceptable upper levels within the well-functioning group were determined from the 75th percentile plus 1.5× interquartile range. The sensitivity and specificity of these levels to predict clinical problems were calculated. RESULTS: Well-functioning group ions were lower than the poorly functioning group ion levels. The acceptable upper levels were: chromium (Cr) 4.6 μg/L, cobalt (Co) 4.0 μg/L unilateral and Cr 7.4 μg/L, Co 5.0 μg/L bilateral. The specificity of these levels in predicting poor function was high (95%) and sensitivity was low (25%). There were more males in the well-functioning group and more females and smaller femoral components in the poorly functioning group. CONCLUSIONS: Metal levels higher than these proposed safe upper limits can predict problems with metal-on-metal resurfacings and are important parameters in the management of at-risk patients. LEVEL OF EVIDENCE: Level II, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.
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