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General Orthopaedics

The relationship between bearing surface wear, blood metal ion concentrations and osteolysis following MOM hip resurfacing

British Orthopaedic Association 2012 Annual Congress



Abstract

Background

We have previously described the relationship between wear rates of MOM components and soft tissue necrosis. In this study we investigated the link between wear rates, metal ion concentrations and osteolysis.

Methods

All unilateral patients who underwent revision of hip resurfacings at our centre were included. Retrieved components were analysed using a coordinate measuring machine to determine total volumetric material loss and rates of wear. Given the accuracy of the wear calculations (which we have previously published), wear rates were considered “abnormal” if ≥3mm3/yr. ROC curves were constructed to determine a Co concentration which would be clinically useful to detect abnormal wear. During revision, the presence/absence of osteolysis was documented.

Results

There were 65 patients in total (mean time to revision was 41 months (2 to 98). 60 patients had suffered ARMD. 2 hips were revised for infection, 1 for osteolysis and 1 due to a loose cup and 1 for unexplained pain. A blood cobalt concentration >5µg/l was found to be 100%(62.2–100) specific and 94.4%(84.2–98.6) sensitive for the detection of abnormal wear. All patients with wear rates greater than 12mm3/yr (n=21) were found to have osteolysis (the minimum total loss of material in this group of patients was 16mm3). ROC analysis showed that a blood cobalt ≥44.6µg/l was 97.2% specific for the detection of this rate of wear. 3 of the 21 patients with these rates of wear were asymptomatic. They decided on revision after discussion with the surgeon. Two were revised following acute femoral collapse but were completely pain free prior to these events.

Conclusion

These data suggest that a blood cobalt concentration of 5µg/l can reliably identify an abnormally wearing resurfacing prosthesis. Elevated metal ion concentrations are associated with osteolysis, even in the absence of symptoms.