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Revista Española de Cirugía Ortopédica y Traumatología (English Edition)
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Original Article
Metal-on-metal surface hip arthroplasties. Is annual monitoring of blood metal levels necessary?
Artroplastias de superficie metal-metal en cadera. ¿Es necesario realizar seguimiento anual mediante determinación de metales en sangre?
D. Hernández-Vaqueroa,b,
Corresponding author
danielhvaquero@gmail.com

Corresponding author.
, M. García-Pascualb, S. Iglesias-Fernándezb, A. Escandon-Rodríguezb
a Departamento de Cirugía, Facultad de Medicina, Universidad de Oviedo, Oviedo, Spain
b Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario San Agustín, Avilés, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The good results obtained at the end of the last century with metal-on-metal &#40;MoM&#41; hip arthroplasties were overshadowed by the appearance of high levels of metal ions in the blood and urine&#46; Together with the formation of periarticular cysts and a high level of failures&#44; this forced certain companies to withdraw some models of implants from the market in 2010&#46; The presence of high levels of metals in the blood is a serious complication and its effects over the long-term are still unknown&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">1</span></a> Due to this situation scientific societies &#40;the Hip Society&#44; BOA&#44; AOA&#44; EFORT&#44; SECOT and SECCA&#41;&#44; international agencies &#40;the FDA&#41; and health authorities &#40;the Ministry of Health in Spain&#41;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">2</span></a> published monitoring protocols for patients who had been operated using these procedures&#44; indicating when revision surgery should be recommended and how patients with these arthroplasties should be monitored&#46; These protocols are based on the clinical situation of patients&#44; radiographic findings&#44; raised levels of chrome &#40;Cr&#41; and cobalt &#40;Co&#41; in the blood&#46; They are also based on the presence&#44; detected by imaging techniques&#44; of periarticular cysts known as ALVAL &#40;aseptic lymphocytic vasculitis associated lesions&#41;&#44; the histology of which is dominated by B-lymphocytes and plasma cells&#44; suggesting an immune response similar to a delayed hypersensitivity reaction&#46; These complications deriving from high level of metal in the blood are grouped in the literature under the name ARMD &#40;adverse reactions to metal debris&#41;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">During the first years after the said alarm the necessary revision surgical operations were performed to remove MoM prostheses and implant conventional arthroplasties&#46; The other patients have continued to regularly attend Hospital out-patient departments for evaluation using series of analytical checks&#46; Although the literature states that MoM surface models have a shorter long-term lifespan than conventional arthroplasty models&#44;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">3</span></a> a good number of patients with MoM arthroplasty implants are asymptomatic and show excellent evolution over the medium term&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Although discrepancies exist regarding the usefulness of determining metal levels in the blood to indicate revision surgery&#44;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">4</span></a> this technique is still accepted as a means of evaluating whether these arthroplasties are functioning well or not in asymptomatic patients&#46; It also supplies a criterion accepted by the majority to detect the presence of adverse reactions&#46; The figure of 7<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;L or ppb of Co or Cr in the blood is considered to mark the limit of normality&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">1&#44;5&#44;6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The correct guideline for monitoring these patients is unknown&#44; as is how often analysis should take place for metals in the blood and how long this should continue&#46; The main question of our work is whether it is necessary to monitor levels analytically during the whole lifetime of asymptomatic patients who have MoM surface arthroplasties&#46; We analysed blood levels of Cr and Co and how they evolved over the years in patients who have shown no clinical or radiographic alterations&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">A case study &#8211; monitoring diagnostic techniques&#46; Our series is composed of 51 patients &#40;52 arthroplasties&#44; with one bilateral case&#41; operated from 2005 to 2010 using the same type of arthroplasty &#40;ASR&#44; DePuy Orthopaedics&#44; Inc&#46;&#44; Warsaw&#44; IN&#44; U&#46;S&#46;A&#46;&#41;&#44; in the same hospital and by the same surgeons&#46; The indication was highly selective&#44; given that these cases amounted to only 4&#37; of all the total hip arthroplasties &#40;THA&#41; implanted the 6 years in question in the Department&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The average age in the group of patients was 57&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;05 years old &#40;35&#8211;76&#41; and the average body mass index was 29&#46;42<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;37 &#40;19&#46;48&#8211;43&#46;58&#41;&#46; Two patients were women and 49 were men&#46; Sixteen revision surgeries were performed in as many patients&#46; The causes were&#58; 8 due to high levels of metals in the blood and the presence of ALVAL&#44; 2 due to the presence of ALVAL with normal levels&#44; 2 due to fracture of the neck of the femur&#44; one due to osteolysis in the neck of the femur&#44; one due to instability with repeated luxations&#44; and 2 due to pain with an unexplained cause&#46; 5 cases were lost&#58; 2 whose evolution is unknown&#44; and 3 patients died&#44; 2 of them after the switch to a conventional THA &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The bilateral case was excluded from this study because of the possibility of introducing distortions in blood metal levels&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Thus during all of the years in question we monitored 31 MoM arthroplasties implanted from 2005 to 2010 &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; At the time we undertook our work the arthroplasties had an age of from 7 to 13 years &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The patients attended the department clinic annually for analytical studies of the blood and 24 hour urine&#44; a clinical examination &#40;filling out the WOMAC&#44; SF-12 and Oxford Hip questionnaires&#41; and a standard radiographic study of the operated hip&#46; Blood was extracted and transported to the laboratory under the conditions set for this process&#46; Samples were analysed using mass spectrometry with an inductively coupled source &#40;ICP-MS&#41;&#46; Until the year 2013 molybdenum in blood and urine was also measured&#44; together with detection of metals in the hair thanks to a SECOT research grant &#40;results already published&#41;&#46; Magnetic resonance &#40;MR&#41; imaging was indicated to rule out ALVAL or osteolysis if the patient showed functional reduction and pain&#44; or when levels above 20<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;L were detected in annual analysis&#46; If levels of Co and Cr were from 7 to 19<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;L and the patient was asymptomatic then they visited again after 6 months for another metal ion analysis&#46; This work was approved by the Regional Ethics Committee &#40;Reference 037&#47;2011&#41; and the patients signed an informed consent document prepared specifically for this study&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">The prosthesis sizes used in the series were above all those with a 58<span class="elsevierStyleHsp" style=""></span>mm diameter acetabular cup &#40;19 cases&#41; and 56<span class="elsevierStyleHsp" style=""></span>mm &#40;12 cases&#41;&#46; Taking into account that this model has a range of sizes from 50<span class="elsevierStyleHsp" style=""></span>mm to 64<span class="elsevierStyleHsp" style=""></span>mm in diameter&#44; it can be said that medium sized were implanted above all&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">During the years in question Cr Levels in the blood remained at from &#46;5 to 14<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;L&#44; with a median level from 1&#46;3 to 5&#46;4<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;L &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; Co levels were from &#46;5 to 13&#46;8<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;L&#44; with a median at from &#46;5 to 1&#46;2<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;L &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46; After 5 years a reduction in both metals was detected&#44; although they increased during the sixth year before falling again&#46; No changes were detected after 7 years &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">Figs&#46; 2 and 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Under the circumstances described above &#40;raised levels of Cr or Co in the blood or change in clinical and functional situation&#41; MR imaging was performed with normal results in all cases&#44; without detecting ALVAL-type periarticular cysts&#46; The levels of both metals were not found to increase continuously in successive annual checks in any patient&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">One patient with high levels of Cr and Co in annual checks refused to undergo hip MR imaging to search for periarticular cysts&#59; he remains asymptomatic and regularly attends for clinical&#44; radiographic and analytical tests&#46; In this case figures for Cr have evolved from 11&#46;4 to 14<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;L&#44; while those for Co have evolved from 13&#46;8 to 6&#46;6<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;L&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Data analysis and representation</span>&#46; As there are a small number of highly variable data&#44; the levels of Cr and Co per year are shown as their median together with their confidence interval at 95&#37;&#46; These figures were calculated using the binomial method that does not make suppositions on the underlying distribution of the variable&#46; Box graphs were created according to the levels of Cr and Co for each year of monitoring&#46; These graphs adjust data to a straight line&#44; using the squared minimums method and a curve using the &#8220;lowess&#8221; command in STATA v&#46;15 &#40;STATA Corp&#46;&#44; TX&#44; U&#46;S&#46;A&#46;&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0065" class="elsevierStylePara elsevierViewall">After time the true scope of the failures of MoM surface arthroplasties is becoming clear&#46; A period in which they were used for a wide range of indications has been followed by another period of almost complete restriction due to health alarms&#46; As longer-term monitoring bears fruit we are able to learn the true place these models should occupy in the surgical arsenal for hips&#46; They are less aggressive and offer better bone conservation&#44; easier revision surgery and many patients describe their good evolution&#46; In the future these factors will lead to the design of new types of surface once problems deriving from the materials used have been resolved&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The percentage of failures of MoM arthroplasties in our series is similar to those published by other authors&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">7&#44;8</span></a> As is the case in other series&#44; when revision surgery was carried out during the early years after implant&#44; the most common cause was progressive pain together with high levels of metals in the blood and the finding of ALVAL in MR imaging&#46; Other complications were less common and coincide with those published in broader series&#46; We do not know the reason why patients progress in different ways&#46; While in some patients failure occurs in the short term&#44; in others the clinical result is excellent and patients request this same type of prosthesis for their other hip when an arthroplasty becomes necessary&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Although the presence of metals in other organic structures such as hair<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">9</span></a> has been analysed&#44; as has the concentration of other metals like molibdenum&#44;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">10</span></a> the studies usually used to rule out metal intoxication after MoM arthroplasties centre on analysing blood Cr and Co&#46; Although the literature on this respect is not fully in agreement&#44; it is accepted that patients with low levels of metal ions in the blood are at low risk of ARMD following MoM hip arthroplasty&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">11&#44;12</span></a> Nevertheless&#44; the decision to perform revision surgery must depend on individual factors and not exclusively on a certain specific analysis&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">13</span></a> Several associated findings are considered to be necessary for this&#58; clinical&#44; imaging and analytical&#46; For the latter&#44; series of measurements and the tendency they display are considered to be more important than momentary values in predicting failure for arthroplasties of this type&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">There is no agreement in the literature on acceptable limits for blood metal levels&#59; although some works do not accept that &#62;7<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;L indicates a potential soft tissue reaction&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">14</span></a> this is the threshold recommended in monitoring protocols&#46; Figures higher than 7<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;L of Cr and Co in the blood after the implant of a MoM arthroplasty are considered to be raised and need special monitoring&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">6</span></a> Levels up to 10<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;L are considered to indicate risk and should be evaluated together with the results of other examinations&#46; Co values &#8805;10<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;L indicate an increase in joint wear&#44; with a specificity of 100&#37; and a sensitivity of 93&#37;&#46; A Co concentration of from 10 to 20<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;L has to be considered highly abnormal&#44; while above concentrations higher than 20<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;L Co in repeated measurements are unacceptable due to the risk of systemic intoxication&#44; and surgical treatment in the short term must be considered&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">15</span></a> Intoxication by this metal is known as cobaltism&#44; and it may also occur in the case of other types of prosthesis surfaces&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">16</span></a> In our study we consider different alternatives depending on the levels found&#44; considering 7 to 19<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;L to be the range which demands careful monitoring&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The cause of high blood levels of metals in cases of MoM arthroplasties has not been determined&#46; It has been blamed on wear of the surfaces&#44; an exaggerated acetabular angle&#44; large cup size&#44; gender&#44; individual hypersensitivity&#44; defective treatment of the metal surfaces or their corrosion&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">17&#8211;19</span></a> Nor is it known why metal levels vary over time&#46; Some studies<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">20</span></a> detect a fall in Cr but not in Co over the years&#46; Other studies<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">21</span></a> detect raised levels of both metals in the first two years that then fall&#44; although a rise in the level of Co was detected after 4 years together with a rise in Cr 6 years after the implant&#44; followed by a fall&#46; In our study we did not find such high levels in the first years&#44; although there was an increase after 6&#8211;7 years which went on to normalise &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">Figs&#46; 2 and 3</a>&#41;&#46; We also found higher levels of Cr than Co throughout the follow-up&#44; as well as a wider range between the upper and lower limits and less uniform data for Cr&#46; As we pointed out above&#44; the causes of these variations are unknown&#59; it seems that they are not important if the curve remains flat or falls over time&#46; Although our study is limited by its short duration&#44; as are others&#44;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">21</span></a> it seems that after 7 years levels of these ions either stabilise or continue falling&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Although recommendations for monitoring these patients have changed over the years&#44; they have not been agreed&#46; Some scientific societies recommend increasing the time between analytical studies in asymptomatic patients 7 years after the implant&#46; Given how these patients are observed to progress&#44; annual analysis is not thought to be cost-effective if they have no pathological clinical data&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">22&#44;23</span></a> Other organisations recommend continuing regular checks only in certain cases&#44; due to patient sex&#44; cup size or the type of implant&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">24&#44;25</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Our work has limitations&#46; Its greatest limitation is due to the small number of patients studied&#44; as this also prevents appropriate statistical analysis and therefore may reduce the validity of the conclusions&#46; Our patients have a limited follow-up&#46; Nevertheless&#44; the period studied is of similar length to those of other published studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">21&#44;26</span></a> Men predominate in our series&#44; so this may lead to major distortion if the results are extrapolated to the general population&#46; On the other hand&#44; this work does not analyse how hip arthroplasties evolve over the years radiographically&#44; clinically or functionally&#59; our study is solely concerned with series of analytical determinations of blood Cr and Co&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">A slight rise in blood Cr and Co levels in a single annual evaluation should not lead to revision surgery in patients with MoM arthroplasties&#46; On the other hand&#44; it is more important to observe how levels change in a series of analyses over time than it is to base our decision on a single isolated high level of metals&#46; It is also indispensible to evaluate other findings and most especially the clinical state of the patient&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">For asymptomatic patients blood metal levels remain stable over the medium term&#44; so that it seems unnecessary to continue repeating annual determinations of the same&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Level of evidence</span><p id="par0110" class="elsevierStylePara elsevierViewall">Level of evidence IV&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflict of interests</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
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          "titulo" => "Resumen"
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              "titulo" => "Introducci&#243;n"
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              "titulo" => "Material y m&#233;todos"
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    "fechaRecibido" => "2017-11-29"
    "fechaAceptado" => "2018-03-13"
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          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1050668"
          "palabras" => array:3 [
            0 => "Total hip arthroplasty"
            1 => "Surface arthroplasty"
            2 => "Blood metals"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1050667"
          "palabras" => array:3 [
            0 => "Artroplastia total de cadera"
            1 => "Artroplastias de superficie"
            2 => "Metales en sangre"
          ]
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    "resumen" => array:2 [
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Blood cobalt &#40;Co&#41; and chromium &#40;Cr&#41; ion levels have been used as surveillance tools for adverse reaction to metal debris in metal-on-metal &#40;MoM&#41; hip arthroplasty&#46; The aim of our study was to present serial 7&#8211;13 year blood Co and Cr levels in a cohort of MoM total hip arthroplasties in asymptomatic patients&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A total of 52 MoM surface total hip arthroplasties were included in this study with data collected prospectively&#46; Annual follow-up with blood Co and Cr measurements was performed&#46; Revision surgery was necessary for 16 patients and therefore they dropped out of the study&#46; The metal ion levels were analysed separately in 31 asymptomatic patients&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">High Cr or Co levels were not found continuously in any of the asymptomatic patients&#46; The median Cr in blood was maintained between 1&#46;3 and 5&#46;4<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;L and that of Co between 0&#46;5 and 1&#46;2<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;L&#46; After 7 years&#44; there was no significant change in Co and Cr values&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In the medium term and in asymptomatic patients&#44; the metallic blood levels remained unchanged&#59; therefore&#44; it does not seem appropriate to repeat these tests on a permanent basis in annual controls&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and methods"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La determinaci&#243;n peri&#243;dica de los niveles de cromo &#40;Cr&#41; y cobalto &#40;Co&#41; en sangre ha sido utilizada para evaluar las reacciones adversas secundarias al desgaste metal-metal en las artroplastias de superficie de cadera&#46; El objetivo de nuestro estudio es evaluar los niveles de Cr y Co en sangre en una serie de pacientes asintom&#225;ticos con artroplastias de superficie con un seguimiento de 7 a 13 a&#241;os&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Hemos analizado la evoluci&#243;n de los niveles met&#225;licos en sangre en una serie de 52 artroplastias de superficie metal-metal&#46; Se realiz&#243; un control anual de Co y Cr en sangre&#46; En 16 pacientes fue preciso realizar una cirug&#237;a de revisi&#243;n&#44; por lo que salieron del estudio&#46; Los niveles de iones met&#225;licos en sangre fueron analizados en 31 pacientes asintom&#225;ticos&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">En ninguno de los pacientes asintom&#225;ticos aparecieron cifras elevadas de Cr o Co de manera continuada&#46; La mediana de Cr en sangre se mantuvo entre 1&#44;3 y 5&#44;4<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;L y la de Co entre 0&#44;5 y 1&#44;2<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;L&#46; Despu&#233;s de 7 a&#241;os tras la cirug&#237;a no se han apreciado cambios en los niveles referidos&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A medio plazo y en pacientes asintom&#225;ticos&#44; los niveles met&#225;licos en sangre se mantienen sin cambios&#44; por lo que no parece adecuado repetir anualmente estas determinaciones de manera permanente&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as&#58; Hern&#225;ndez-Vaquero D&#44; Garc&#237;a-Pascual M&#44; Iglesias-Fern&#225;ndez S&#44; Escandon-Rodr&#237;guez A&#46; Artroplastias de superficie metal-metal en cadera&#46; &#191;Es necesario realizar seguimiento anual mediante determinaci&#243;n de metales en sangre&#63; Rev Esp Cir Ortop Traumatol&#46; 2018&#59;62&#58;436&#8211;441&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Revision surgery&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&nbsp;\t\t\t\t\t\t\n
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    "bibliografia" => array:2 [
      "titulo" => "References"
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Article information
ISSN: 19888856
Original language: English
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