Abstract
Background
Previous studies have indicated poor outcomes and high complication rate in patients having revision of metal-on-metal (MoM) hip implants resulting from adverse local tissue reactions. Metal ions released by MoM bearings may potentially increase infection occurrence in patients with failed implants.
Questions/purposes
We reviewed all patients at our institution who sustained revision of a failed large-head metal-on-metal hip implant to determine if infection-related complications are associated with the elevation of serum metal ions concentration.
Methods
From December 2005 to April 2013, we performed 44 revisions of large-head MoM total hip arthroplasty (THA) and resurfacing in 44 patients. In all revision procedures MoM couplings (ASR XL Acetabular System and DePuy ASR Hip Resurfacing System) were explanted.
Preoperative diagnosis were: aseptic loosening in 21 hips, hip pain with high serum metal ions levels in 7 hips, high serum metal ions levels without hip pain in 9 hips, deep infections in 4 hips, unexplained hip pain in 2 hips and periprosthetic fracture in 1 hip.
Serum cobalt and chromium analysis were preoperatively conducted in 25 patients. Intraoperative fluid aspiration was performed in all cases to determine the presence or absence of periprosthetic joint infection.
Results
Fluid analysis for bacteria reported that 35 of 45 cases were culture negative and 10 of 45 cases (22%) were culture positive to Staphylococcus (St) Aureus (4), St Capitis (2), St Epidermidis (2), St Hominis (1), Streptococcus Mitis (1). All preoperative diagnoses of deep infection were confirmed.
Within patients evaluated with serum metal ions analysis (mean Co and Cr, 78 μg/l and 39 μg/l, respectively), five cultures resulted positive (20%). The infection rate within patients with higher (> 20 μg/l) metal ions levels (4 positive cultures of 18, 22%) was not significantly higher than infection rate within patients with lower (≤ 20 μg/l) metal ions levels (1 positive culture of 7, 14%).
Conclusions
We observed a high rate of periprosthetic joint infection among our revision cases. High metal ions concentrations released by MoM bearings might promote bacterial infections in patients with MoM THA and resurfacing. When evaluating patients with failed MoM hip devices, there may be an increased incidence of co-infection in these patients.
