Metal-on-metal bearings total hip arthroplasty: The cobalt and chromium ions release concern

Summary With certain concerns recently reported on metal-on-metal bearing couples in total hip arthroplasty, this study's objective is to review the current knowledge concerning release of metal ions and its potential consequences. Each metal-on-metal implant presents different tribological pro...

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Bibliographic Details
Published in:Orthopaedics & traumatology, surgery & research surgery & research, 2010-12, Vol.96 (8), p.894-904
Main Authors: Delaunay, C, Petit, I, Learmonth, I.D, Oger, P, Vendittoli, P.A
Format: Article
Language:English
Subjects:
Chromium - analysis
Chromium - toxicity
Cobalt - analysis
Cobalt - toxicity
Equipment Failure Analysis
Female
Granuloma, Plasma Cell - etiology
Hip Prosthesis
Humans
Hypersensitivity
Hypersensitivity, Delayed - etiology
Ions - analysis
Male
Metal-on-metal bearings
Metals - toxicity
Neoplasms - chemically induced
Orthopedics
Osteolysis - etiology
Prosthesis Design
Pseudotumors
Resurfacing
Risk Factors
Surgery
Total hip arthroplasty
Vasculitis, Leukocytoclastic, Cutaneous - etiology
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Summary:Summary With certain concerns recently reported on metal-on-metal bearing couples in total hip arthroplasty, this study's objective is to review the current knowledge concerning release of metal ions and its potential consequences. Each metal-on-metal implant presents different tribological properties. The analytical techniques for metals are accurate and the Co ion rates seem acceptable up to 2 μg/L. A delayed type IV hypersensitivity reaction (atypical lymphocytic vasculitis-associated lesion [ALVAL]) may be the source of arthroplasty failure. Idiosyncratic, it remains unpredictable even using cutaneous tests and apparently is rare (0.3%). Today, there are no scientific or epidemiologic data supporting a risk of carcinogenesis or teratogenesis related to the use of a metal-on-metal bearings couple. Solid pseudotumors nearly exclusively are observed with resurfacing procedures, carrying a high annual revision rate in women under 40 years of age, occurring particularly in cases of acetabular malposition and with use of cast molded Cr-Co alloys. Osteolysis manifests through complete and progressive radiolucent lines or through cavitary lesions stemming from ALVAL-type alterations or impingement problems or implant incompatibility. The formation of wear debris exceeding the biological tolerance is possible with implant malposition, subluxation, and jamming of the femoral head in cases of cup deformity. Moreover, each implant presents different metal ion production; assessment of their performance and safety is required before their clinical use. With the knowledge available today, metal-on-metal bearing couples are contraindicated in cases of metal allergies or end stage renal dysfunction and small size resurfacing should cautiously be used.
ISSN:1877-0568
1877-0568
DOI:10.1016/j.otsr.2010.05.008