Metal-on-metal hip prostheses and systemic health: a cross-sectional association study 8 years after implantation.

There is public concern over the long term systemic health effects of metal released from hip replacement prostheses that use large-diameter metal-on-metal bearings. However, to date there has been no systematic study to determine which organs may be at risk, or the magnitude of any effect. We under...

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Autores principales:	Jennifer R Prentice, Matthew J Clark, Nigel Hoggard, Allison C Morton, Claire Tooth, Martyn N Paley, Ian Stockley, Marios Hadjivassiliou, J Mark Wilkinson
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/27c3d64099934784b91e1ba53bd28f85
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spelling	oai:doaj.org-article:27c3d64099934784b91e1ba53bd28f852021-11-18T07:42:26ZMetal-on-metal hip prostheses and systemic health: a cross-sectional association study 8 years after implantation.1932-620310.1371/journal.pone.0066186https://doaj.org/article/27c3d64099934784b91e1ba53bd28f852013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23762480/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203There is public concern over the long term systemic health effects of metal released from hip replacement prostheses that use large-diameter metal-on-metal bearings. However, to date there has been no systematic study to determine which organs may be at risk, or the magnitude of any effect. We undertook a detailed cross-sectional health screen at a mean of 8 years after surgery in 35 asymptomatic patients who had previously received a metal-on-metal hip resurfacing (MoMHR) versus 35 individually age and sex matched asymptomatic patients who had received a conventional hip replacement. Total body bone mineral density was 5% higher (mean difference 0.05 g/cm², P = 0.02) and bone turnover was 14% lower (TRAP 5b, mean difference -0.56IU/L, P = 0.006; osteocalcin, mean difference -3.08 ng/mL, P = 0.03) in the hip resurfacing versus conventional hip replacement group. Cardiac ejection fraction was 7% lower (mean absolute difference -5%, P = 0.04) and left ventricular end-diastolic diameter was 6% larger (mean difference 2.7 mm, P = 0.007) in the hip resurfacing group versus those patients who received a conventional hip replacement. The urinary fractional excretion of metal was low (cobalt 5%, chromium 1.5%) in patients with MoMHR, but creatinine clearance was normal. Diuretic prescription was associated with a 40% increase in the fractional excretion of chromium (mean difference 0.5%, P = 0.03). There was no evidence of difference in neuropsychological, renal tubular, hepatic or endocrine function between groups (P>0.05). Our findings of differences in bone and cardiac function between patient groups suggest that chronic exposure to low elevated metal concentrations in patients with well-functioning MoMHR prostheses may have systemic effects. Long-term epidemiological studies in patients with well-functioning metal on metal hip prostheses should include musculoskeletal and cardiac endpoints to quantitate the risk of clinical disease.Jennifer R PrenticeMatthew J ClarkNigel HoggardAllison C MortonClaire ToothMartyn N PaleyIan StockleyMarios HadjivassiliouJ Mark WilkinsonPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 6, p e66186 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Jennifer R Prentice Matthew J Clark Nigel Hoggard Allison C Morton Claire Tooth Martyn N Paley Ian Stockley Marios Hadjivassiliou J Mark Wilkinson Metal-on-metal hip prostheses and systemic health: a cross-sectional association study 8 years after implantation.
description	There is public concern over the long term systemic health effects of metal released from hip replacement prostheses that use large-diameter metal-on-metal bearings. However, to date there has been no systematic study to determine which organs may be at risk, or the magnitude of any effect. We undertook a detailed cross-sectional health screen at a mean of 8 years after surgery in 35 asymptomatic patients who had previously received a metal-on-metal hip resurfacing (MoMHR) versus 35 individually age and sex matched asymptomatic patients who had received a conventional hip replacement. Total body bone mineral density was 5% higher (mean difference 0.05 g/cm², P = 0.02) and bone turnover was 14% lower (TRAP 5b, mean difference -0.56IU/L, P = 0.006; osteocalcin, mean difference -3.08 ng/mL, P = 0.03) in the hip resurfacing versus conventional hip replacement group. Cardiac ejection fraction was 7% lower (mean absolute difference -5%, P = 0.04) and left ventricular end-diastolic diameter was 6% larger (mean difference 2.7 mm, P = 0.007) in the hip resurfacing group versus those patients who received a conventional hip replacement. The urinary fractional excretion of metal was low (cobalt 5%, chromium 1.5%) in patients with MoMHR, but creatinine clearance was normal. Diuretic prescription was associated with a 40% increase in the fractional excretion of chromium (mean difference 0.5%, P = 0.03). There was no evidence of difference in neuropsychological, renal tubular, hepatic or endocrine function between groups (P>0.05). Our findings of differences in bone and cardiac function between patient groups suggest that chronic exposure to low elevated metal concentrations in patients with well-functioning MoMHR prostheses may have systemic effects. Long-term epidemiological studies in patients with well-functioning metal on metal hip prostheses should include musculoskeletal and cardiac endpoints to quantitate the risk of clinical disease.
format	article
author	Jennifer R Prentice Matthew J Clark Nigel Hoggard Allison C Morton Claire Tooth Martyn N Paley Ian Stockley Marios Hadjivassiliou J Mark Wilkinson
author_facet	Jennifer R Prentice Matthew J Clark Nigel Hoggard Allison C Morton Claire Tooth Martyn N Paley Ian Stockley Marios Hadjivassiliou J Mark Wilkinson
author_sort	Jennifer R Prentice
title	Metal-on-metal hip prostheses and systemic health: a cross-sectional association study 8 years after implantation.
title_short	Metal-on-metal hip prostheses and systemic health: a cross-sectional association study 8 years after implantation.
title_full	Metal-on-metal hip prostheses and systemic health: a cross-sectional association study 8 years after implantation.
title_fullStr	Metal-on-metal hip prostheses and systemic health: a cross-sectional association study 8 years after implantation.
title_full_unstemmed	Metal-on-metal hip prostheses and systemic health: a cross-sectional association study 8 years after implantation.
title_sort	metal-on-metal hip prostheses and systemic health: a cross-sectional association study 8 years after implantation.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/27c3d64099934784b91e1ba53bd28f85
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Metal-on-metal hip prostheses and systemic health: a cross-sectional association study 8 years after implantation.

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