Metal levels in cemented total hip arthroplasty: A comparison of well- fixed and loose implants

W. W. Brien, E. A. Salvati, F. Betts, P. Bullough, T. Wright, C. Rimnac, R. Buly, K. Garvin

Research output: Contribution to journalArticlepeer-review

104 Scopus citations

Abstract

In a prospective study, synovial fluid metal levels from stainless steel, cobalt-chromium, and titanium-alloy cemented total hip implants were measured. There were 37 well-fixed and 44 loose hip arthroplasties. Tissue- metal levels were quantitated in the cases revised for loosening. Retrieval analysis for implant wear was performed. Synovial fluid analysis showed a fivefold increase in metal levels of loose compared with well-fixed stainless steel implants. There was a sevenfold increase in metal levels of loose compared with well-fixed cobalt-chromium implants. There was a 21-fold increase in metal levels of loose compared with well-fixed titanium-alloy (Ti-6Al-4V) implants. Tissue-metal levels from revised cobalt-chromium implants averaged 45 μg/g dry tissue weight compared to 4,470 μg/g dry tissue weight from revised titanium-alloy implants, a 100-fold increase. Implant retrieval analysis showed severe burnishing and scratching in all titanium-alloy femoral heads and extensive burnishing and scratching in the majority of the femoral stems. Well-fixed cemented implants have similar low synovial fluid metal levels. However, when loosening of implants occurs, titanium-alloy implants release disproportionate levels of metal into synovial fluid and local tissues compared to stainless steel or cobalt- chromium. These results raise serious concerns regarding the use of cemented titanium-alloy implants.

Original languageEnglish (US)
Pages (from-to)66-74
Number of pages9
JournalClinical Orthopaedics and Related Research
Issue number276
StatePublished - 1992

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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