False profile view is independently associated with serum metal levels in patients with metal-on-metal hip arthroplasty
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ORIGINAL ARTICLE
False profile view is independently associated with serum metal levels in patients with metal‑on‑metal hip arthroplasty Bo Madvig Larsen1 · Arne Borgwardt1 · Søren Ribel‑Madsen1 · Bo Zerahn2 Received: 9 July 2020 / Accepted: 16 November 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Purpose Elevated levels of serum metal ions can be found in some patients with metal-on-metal (MoM) hip replacements. This study seeks to identify whether there is a significant association between the contact patch to rim distance (CPRD) and the anterior center edge angle (ACEA), respectively, and serum cobalt (Co) and chromium (Cr) levels in patients treated with unilateral MoM hip replacements by using standing anteroposterior and false profile view radiographs. Methods This is a retrospective analysis on 53 patients with either unilateral ReCap or M2a-Magnum MoM hip replacements operated in 2006 or 2007. Univariate linear regression and multivariable linear regression (MLR) analyses were performed using the CPRD and ACEA along with risk factors for elevated serum levels of Co and Cr previously suggested in the literature as explanatory variables. Serum Co and Cr were measured using inductively coupled plasma mass spectrometry. Results The MLR model showed that the same three variables (gender, CPRD and ACEA) were significantly associated with serum levels of both Co and Cr explaining approximately half of the variation. A univariate analysis showed a polynomial association between both anteversion angle and the ACEA with serum levels of Co and Cr. The vertex of the polynomial function was located at approximately 20° and 40°, respectively. Conclusion Gender, CPRD and ACEA are independently associated with serum levels of Co and Cr. Both ACEA and anteversion angles have optimae associated with low serum metal levels which may be useful for post-surgery evaluation of cup positioning. Keywords Contact patch to rim distance · False profile view · Anterior center edge angle · Chromium · Cobalt · Metal-onmetal prostheses · Total hip arthroplasty
Introduction When this study was initiated, metal-on-polyethylene (MoP) hips had high volumetric wear and instability particularly in younger and active patients [1]. Large metal-on-metal (MoM) hips provided lower dislocation rates and lower wear rates compared to MoP implants. However, small and very Arne Borgwardt: Deceased January 6th 2020. * Bo Madvig Larsen [email protected] 1
Department of Orthopaedic Surgery, Bispebjerg and Frederiksberg University Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
Department of Clinical Physiology and Nuclear Medicine, Herlev University Hospital, Borgmester Ib Juuls Vej 1, Herlev 2730, Denmark
2
reactive wear particles and high ion concentrations in the blood caused an increased number of revisions [2]. Some MoM implants presented very high revision rates compared to conventional MoP implants [3]. Cup inclination and anteversion, femoral head size, level of activity and female gender ha
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