Retention of metals in periprosthetic tissues of patients with metal-on-metal total hip arthroplasty is reflected in the
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(2020) 21:610
RESEARCH ARTICLE
Open Access
Retention of metals in periprosthetic tissues of patients with metal-on-metal total hip arthroplasty is reflected in the synovial fluid to blood cobalt transfer ratio in the presence of a pseudotumour Tomi Nousiainen1,2*† , Sanna Palosaari1†, Sirpa Peräniemi3, Arja Tervahauta4, Jaakko Niinimäki5, Juhana Leppilahti2 and Petri Lehenkari1,2
Abstract Background: Modern metal-on-metal (MOM) arthroplasties were performed for over a decade before alarming reports of adverse metal reactions dramatically reduced their use. Failures are seen more often with high-wearing implants, but also well-positioned components with more favourable wear patterns can cause problems. There are no specific clinical indicators that could help us to predict the prognosis of these implants. For this reason, we still need more information on the effect of underlying factors that contribute to this process. Methods: In this prospective cohort study, we investigated how cup orientation and type of pseudotumour determined by the Hart classification effect the distribution of metals in blood, synovial fluid and tissues surrounding the metal-on-metal hip prosthesis in revision surgery patients. One thousand two hundred twenty-nine metal-on-metal hip patients were screened and of those, 60 patients that had a revision surgery due to adverse metal reaction were included. Whole blood, synovial fluid and synovial/pseudotumour tissue samples were analysed for metal ion concentrations (Co, Cr, Mo and Ti). Results: The lowest metal concentrations were found when both cup anteversion and inclination were optimal, and the highest when both were suboptimal. Suboptimal anteversion alone raised Cr-ion concentrations more than suboptimal inclination. The concentrations of metals in blood, synovial fluid or synovial soft tissue were the same in patients with and without a pseudotumour, but the relative transfer percentage of cobalt from synovial fluid to blood was higher in patients with a pseudotumour. (Continued on next page)
* Correspondence: [email protected] † Tomi Nousiainen and Sanna Palosaari contributed equally to this work. 1 Medical Faculty, Cancer and Translational Medicine Research Unit, University of Oulu and Medical Research Center, Oulu University Hospital, P.O. Box 5000, 90014 Oulu, Finland 2 Division of Orthopaedic Surgery, Oulu University Hospital, Oulu, Finland Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material i
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