ABSTRACT
BACKGROUND: The recent experiences with adverse local tissue reactions have highlighted the need to establish what are normal serum levels of cobalt (Co), chromium (Cr), and titanium (Ti) after hip arthroplasty. METHODS: Serum Co, Cr, and Ti levels were measured in 80 nonconsecutive patients with well-functioning unilateral total hip arthroplasty and compared among 4 bearing surfaces: ceramic-on-ceramic (CoC); ceramic-on-polyethylene (CoP); metal-on-polyethylene (MoP), and dual mobility (DM). The preoperative and most recent University of California, Los Angeles (UCLA) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were compared among the different bearing surfaces. RESULTS: No significant difference was found among serum Co and Cr levels between the 4 bearing surface groups (P = .0609 and P = .1577). Secondary analysis comparing metal and ceramic femoral heads demonstrated that the metal group (MoP, modular dual mobility (Stryker Orthopedics, Mahwah, NJ) [metal]) had significant higher serum Co levels compared with the ceramic group (CoC, CoP, MDM [ceramic]) (1.05 mg/L ± 1.25 vs 0.59 mg/L ± 0.24; P = .0411). Spearman coefficient identified no correlation between metal ion levels and patient-reported outcome scores. CONCLUSION: No serum metal ion level differences were found among well-functioning total hip arthroplasty with modern bearing couples. Significantly higher serum Co levels were seen when comparing metal vs ceramic femoral heads in this study and warrants further investigation. Metal ion levels did not correlate with patient-reported outcome measures.
Subject(s)
Arthroplasty, Replacement, Hip/adverse effects , Chromium/blood , Cobalt/blood , Hip Prosthesis/adverse effects , Metals/blood , Titanium/blood , Aged , Arthritis/etiology , Arthroplasty, Replacement, Hip/instrumentation , Ceramics , Female , Follow-Up Studies , Humans , Ions/blood , Male , Middle Aged , Polyethylene , Prospective Studies , Prosthesis DesignABSTRACT
BACKGROUND: The early short-term outcomes and complications after revision of the recalled Rejuvenate modular neck hip arthroplasty have not been previously reported. This study's purpose is to describe the early outcomes and complications after revision of the Rejuvenate modular femoral neck. METHODS: A retrospective cohort included 92 patients with 92 Rejuvenate modular neck total hip arthroplasty (THA) who underwent revision surgery between July 2011 and April 2014. Preoperative, 1-year, and 2-year patient-reported outcome measures including Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Short Form 12 (SF-12) were described in 92 patients. RESULTS: Complications arose in (12 of 92) 13% of patients including 8 greater trochanteric fractures, 1 intraoperative periprosthetic acetabular fracture, 2 dislocations, 1 early aseptic loosening, and 1 infection requiring a 2-stage revision. Overall, 66% of patients with a complication required reoperation. Significant changes were noted between preoperative and 1- and 2-year outcomes with respect to WOMAC pain score (P = .0031), WOMAC total score (P = .021), SF-12 mental component score (P < .0001), and physical component score (P < .0001). CONCLUSIONS: Patients can expect an improvement in pain (WOMAC pain) and function (total WOMAC, SF-12 Physical Health Composite Scale), but overall worsening in the SF-12 mental component scores. Patients' physical function improvements are offset by worsened mental function scores. Patients undergoing revision of Rejuvenate modular neck THA implants should be counseled on modest functional improvements and relative frequency of complications.
