Worse health-related quality of life and hip function in female patients with elevated chromium levels

Daniel K Hussey, Rami Madanat, Gabrielle S Donahue, Ola Rolfson, Orhun K Muratoglu, Henrik Malchau, Daniel K Hussey, Rami Madanat, Gabrielle S Donahue, Ola Rolfson, Orhun K Muratoglu, Henrik Malchau

Abstract

Background and purpose - Blood metal ion levels can be an indicator for detecting implant failure in metal-on-metal (MoM) hip arthroplasties. Little is known about the effect of bilateral MoM implants on metal ion levels and patient-reported outcomes. We compared unilateral patients and bilateral patients with either an ASR hip resurfacing (HR) or an ASR XL total hip replacement (THR) and investigated whether cobalt or chromium was associated with a broad spectrum of patient outcomes. Patients and methods - From a registry of 1,328 patients enrolled in a multicenter prospective follow-up of the ASR Hip System, which was recalled in 2010, we analyzed data from 659 patients (311 HR, 348 THR) who met our inclusion criteria. Cobalt and chromium blood metal ion levels were measured and a 21-item patient-reported outcome measures (PROMs) questionnaire was used mean 6 years after index surgery. Results - Using a minimal threshold of ≥7 ppb, elevated chromium ion levels were found to be associated with worse health-related quality of life (HRQoL) (p < 0.05) and hip function (p < 0.05) in women. These associations were not observed in men. Patients with a unilateral ASR HR had lower levels of cobalt ions than bilateral ASR HR patients (p < 0.001) but similar levels of chromium ions (p = 0.09). Unilateral ASR XL THR patients had lower chromium and cobalt ion levels (p < 0.005) than bilateral ASR XL THR patients. Interpretation - Chromium ion levels of ≥7 ppb were associated with reduced functional outcomes in female MoM patients.

Figures

Figure 1.
Figure 1.
Flow chart of patients included in the study population.
Figure 2.
Figure 2.
The effect of ion levels on Harris hip score (HHS) and EQ-5D index adjusted for age, sex, and contralateral articulation. Any variable with a CI that did not include 0 represents a statistically significant influence. Panels A and B correspond to HHS and EQ-5D outcomes with a chromium ion threshold of 7 ppb and panels C and D show the results of the same analysis using a threshold of 10 ppb in ASR XL patients.
Figure 3.
Figure 3.
The effect of patient- and implant-related characteristics on the chromium and cobalt levels measured in ASR XL patients. Any variable with a CI that did not include 0 represents a statistically significant influence.
Figure 4.
Figure 4.
The effect of patient- and implant-related characteristics on the chromium and cobalt levels measured in ASR hip resurfacing patients. Any variable with a CI that did not include 0 represents a statistically significant influence.

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Source: PubMed

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