No association between pseudotumors, high serum metal-ion levels and metal hypersensitivity in large-head metal-on-metal total hip arthroplasty at 5-7-year follow-up

TY - JOUR

T1 - No association between pseudotumors, high serum metal-ion levels and metal hypersensitivity in large-head metal-on-metal total hip arthroplasty at 5-7-year follow-up

AU - Hjorth, Mette Holm

AU - Stilling, Maiken

AU - Soballe, Kjeld

AU - Bolvig, Lars Hans

AU - Thyssen, Jacob Pontoppidan

AU - Mechlenburg, Inger

AU - Jakobsen, Stig Storgaard

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Objective: The relationship between metal wear debris, pseudotumor formation and metal hypersensitivity is complex and not completely understood. The purpose of this study was to assess the prevalence of pseudotumor formation in a consecutive series of metal-on-metal (MoM) total hip arthroplasty (THA) and to investigate its relationship to serum metal-ion levels and hypersensitivity to metal. Methods: Forty-one patients (31 males), mean age 52 (28–68) years, with a total of 49 large-head MoM THA participated in a 5–7-year follow-up study. Patients underwent ultrasonography, serum metal-ion concentrations were measured, metal allergy and atopic dermatitis were evaluated, and the questionnaires of the Oxford Hip Score (OHS), Harris Hip Score (HHS) and the Short-Form Health Survey (SF-36) were completed. Results: Pseudotumors were found in eight patients, but they were asymptomatic and their serum metal-ion levels were similar to those observed in patients with no pseudotumors (p > 0.36). The capsule-stem distance of mean 8.6 mm (SD 3.82, 95 % CI: 5.40–11.79) was wider (p = 0.02) in patients with pseudotumours than in patients without pseudotumors of mean 5.6 mm (SD 2.89, 95 % CI: 4.68–6.58). Positive patch test reactions were seen in three patients. Higher serum metal-ion levels of chromium and cobalt were significantly correlated with steeper cup inclination and smaller femoral head sizes, and were associated with female gender (p < 0.04). Conclusion: We found no association between pseudotumor formation, serum metal-ion levels, metal patch test reactivity, and atopic dermatitis. However, clinicians should be aware of asymptomatic pseudotumors, and we advise further exploration into the mechanisms involved in the pathogenesis of pseudotumors.

AB - Objective: The relationship between metal wear debris, pseudotumor formation and metal hypersensitivity is complex and not completely understood. The purpose of this study was to assess the prevalence of pseudotumor formation in a consecutive series of metal-on-metal (MoM) total hip arthroplasty (THA) and to investigate its relationship to serum metal-ion levels and hypersensitivity to metal. Methods: Forty-one patients (31 males), mean age 52 (28–68) years, with a total of 49 large-head MoM THA participated in a 5–7-year follow-up study. Patients underwent ultrasonography, serum metal-ion concentrations were measured, metal allergy and atopic dermatitis were evaluated, and the questionnaires of the Oxford Hip Score (OHS), Harris Hip Score (HHS) and the Short-Form Health Survey (SF-36) were completed. Results: Pseudotumors were found in eight patients, but they were asymptomatic and their serum metal-ion levels were similar to those observed in patients with no pseudotumors (p > 0.36). The capsule-stem distance of mean 8.6 mm (SD 3.82, 95 % CI: 5.40–11.79) was wider (p = 0.02) in patients with pseudotumours than in patients without pseudotumors of mean 5.6 mm (SD 2.89, 95 % CI: 4.68–6.58). Positive patch test reactions were seen in three patients. Higher serum metal-ion levels of chromium and cobalt were significantly correlated with steeper cup inclination and smaller femoral head sizes, and were associated with female gender (p < 0.04). Conclusion: We found no association between pseudotumor formation, serum metal-ion levels, metal patch test reactivity, and atopic dermatitis. However, clinicians should be aware of asymptomatic pseudotumors, and we advise further exploration into the mechanisms involved in the pathogenesis of pseudotumors.

KW - Adult

KW - Aged

KW - Arthroplasty, Replacement, Hip

KW - Causality

KW - Comorbidity

KW - Denmark

KW - Female

KW - Follow-Up Studies

KW - Granuloma, Plasma Cell

KW - Hip Prosthesis

KW - Humans

KW - Hypersensitivity

KW - Ions

KW - Longitudinal Studies

KW - Male

KW - Metal-on-Metal Joint Prostheses

KW - Metals

KW - Middle Aged

KW - Prevalence

KW - Reproducibility of Results

KW - Risk Factors

KW - Sensitivity and Specificity

KW - Journal Article

U2 - 10.1007/s00256-015-2264-8

DO - 10.1007/s00256-015-2264-8

M3 - Journal article

C2 - 26454451

SN - 0364-2348

VL - 45

SP - 115

EP - 125

JO - Skeletal Radiology

JF - Skeletal Radiology

IS - 1

ER -