Do Intraarticular Metal Ion Levels Predict Adverse Local Tissue Reaction in Revision Total Hip Arthroplasty for Mechanically Assisted Crevice Corrosion?
Henry M Gass, Rahul Goel, Kevin Heo, Jason Shah, Jacob Wilson, Ajay Premkumar
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引用次数: 0
Abstract
Background: Mechanically assisted crevice corrosion (MACC) is a complication that may occur in vivo at modular metal interfaces following metal-on-polyethylene (MoP) total hip arthroplasty (THA). Metal ions released in vivo may be associated with adverse local tissue reactions (ALTR). While there is no definitive value, high serum ion levels are implicated as contributors to ALTR, and various screening levels have been recommended. The purpose of this investigation was to evaluate the relationship between synovial fluid (SF) cobalt and chromium ion levels and the risk of developing ALTR.
Methods: This was a retrospective cohort study of 552 patients who underwent 621 MoP primary THAs. A total of 69 patients underwent revision THA due to symptomatic primary failure with elevated serum metal ions levels. There were 28 who had preoperative serum and intraoperative SF chromium and cobalt samples. Patient demographics, surgical, and laboratory data were collected. Descriptive statistics, Mann-Whitney U, Analysis of Variance (ANOVA) tests, and linear regression analyses were performed.
Results: There were 40.6% of revisions that had preoperative serum and intraoperative SF samples. The mean time to revision was 5.7 (range, 3.8 to 7.6) years. Mean SF cobalt and chromium levels were 870.9mcg/L (range, 1.1 to 8,300.0) and 573.5mcg/L (range, 1.3 to 10,000.0). Mean serum and SF cobalt-chromium ratios were 4.0 (range, 0.9 to 7.1) and 6.4 (range, 0 to 15.1), respectively. Elevated serum cobalt levels were predictive of ALTR (P = 0.002), SF levels were not. Analysis of preoperative serum to SF cobalt-chromium ratios showed poor correlation (R2 = 0.05).
Conclusion: There was no correlation between SF ion levels and ALTR. Also, serum and intraarticular ion levels did not correlate, and SF levels did not provide additional value over serum levels for diagnosis or prognosis of MACC. Further studies are needed to better understand the relationship between serum and SF ion levels and its relationship to ALTR.
期刊介绍：
The Journal of Arthroplasty brings together the clinical and scientific foundations for joint replacement. This peer-reviewed journal publishes original research and manuscripts of the highest quality from all areas relating to joint replacement or the treatment of its complications, including those dealing with clinical series and experience, prosthetic design, biomechanics, biomaterials, metallurgy, biologic response to arthroplasty materials in vivo and in vitro.
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