Can We Improve Screening Costs in Asymptomatic Metal on Metal Total Hip Arthroplasties?

  • J. Ryan Martin OrthoCarolina
  • Jesse Otero University of Iowa
  • Bryan Springer OrthoCarolina
  • William Griffin OrthoCarolina
Keywords: Metal on metal, Total Hip Replacements, Screening Protocols, Cost savings

Abstract

Introduction:

Metal on Metal (MoM) total hip arthroplasty (THA) has been largely abandoned in the United States secondary to high failure rates. Many of the failures are attributed to adverse local tissue reactions (ALTR). Therefore, patients that have a MoM THA are routinely screened by checking serum metal ion levels every two years, as was recommended by the FDA. However, there is limited data on the costs of current screening protocols.

 

Materials and Methods:

318 consecutive patients who underwent a MoM THA at a single institution were retrospectively enrolled. The average follow-up was 8.2 years. Clinical data, metal ion levels, revision and reoperation rates were prospectively collected. The costs of clinical screening for this patient population was calculated and compared to the cost of an annual screening protocol.

 

Results:

12 patients had either an elevated Co or Cr level (>4.5 ppb). Eight patients were revised secondary to ALTR. The total cost of screening during the study was $612,250. Additionally, if annual screening had been performed, total screening costs would be approximately $1,719,200.

 

Discussion:

Eight patients in the following study were revised secondary to ALTR with a total cost of screening of $612,500. These costs are substantially less than the cost of annual screening ($1,719,200). Due to the considerable costs of screening asymptomatic MoM THA patients, we recommend both optimizing the frequency of screening and evaluating the specific risk of the implant being screened. 

References

Chalmers BP, Perry KI, Taunton MJ, Mabry TM, Abdel MP. Diagnosis of adverse local tissue reactions following metal-on-metal hip arthroplasty. Curr Rev Musculoskelet Med. 2016;9(1):67-74. doi:10.1007/s12178-016-9321-3.

Mokka J, Junnila M, Seppänen M, et al. Adverse reaction to metal debris after ReCap-M2A-Magnum large-diameter-head metal-on-metal total hip arthroplasty. Acta Orthop. 2013;84(6):549-554. doi:10.3109/17453674.2013.859419.

Bernthal NM, Celestre PC, Stavrakis AI, Ludington JC, Oakes DA. Disappointing short-term results with the DePuy ASR XL metal-on-metal total hip arthroplasty. J Arthroplasty. 2012;27(4):539-544. doi:10.1016/j.arth.2011.08.022.

Matharu GS, Pandit HG, Murray DW. Poor Survivorship and Frequent Complications at a Median of 10 Years After Metal-on-Metal Hip Resurfacing Revision. Clin Orthop Relat Res. 2016;475(2):304-314. doi:10.1007/s11999-016-4882-4.

Plummer DR, Berger RA, Paprosky WG, Sporer SM, Jacobs JJ, Della Valle CJ. Diagnosis and Management of Adverse Local Tissue Reactions Secondary to Corrosion at the Head-Neck Junction in Patients With Metal on Polyethylene Bearings. J Arthroplasty. 2016;31(1):264-268. doi:10.1016/j.arth.2015.07.039.

Griffin WL. Metal ion levels: how can they help us? J Arthroplasty. 2014;29(4):659-660. doi:10.1016/j.arth.2014.02.005.

Mistry A, Cahir J, Donell ST, Nolan J, Toms AP. MRI of asymptomatic patients with metal-on-metal and polyethylene-on-metal total hip arthroplasties. Clin Radiol. 2011;66(6):540-545. doi:10.1016/j.crad.2011.02.002.

Sutphen SA, MacLaughlin LH, Madsen AA, Russell JH, McShane MA. Prevalence of Pseudotumor in Patients After Metal-On-Metal Hip Arthroplasty Evaluated with Metal Ion Analysis and MARS-MRI. J Arthroplasty. 2016;31(1):260-263. doi:10.1016/j.arth.2015.07.011.

Garbuz DS, Hargreaves BA, Duncan CP, Masri BA, Wilson DR, Forster BB. The John Charnley Award: Diagnostic accuracy of MRI versus ultrasound for detecting pseudotumors in asymptomatic metal-on-metal THA. Clin Orthop Relat Res. 2014;472(2):417-423. doi:10.1007/s11999-013-3181-6.

Griffin WL, Fehring TK, Kudrna JC, et al. Are Metal Ion Levels a Useful Trigger for Surgical Intervention? J Arthroplasty. 2012;27(8):32-36. doi:10.1016/j.arth.2012.03.020.

Hart A., Sabah S., Sampson B, et al. Surveillance of Patients with Metal-on-Metal Hip Resurfacing and Total Hip Prostheses. J Bone Jt Surgery-American Vol. 2014;96(13):1091-1099. doi:10.2106/JBJS.M.00957.

Paustenbach DJ, Galbraith DA, Finley BL. Interpreting cobalt blood concentrations in hip implant patients. Clin Toxicol (Phila). 2014;52(2):98-112. doi:10.3109/15563650.2013.857024.

Medical and Healthcare products Regulatory Agency (MHRA). Medical Device Alert: all metal-on-metal (MoM) hip replacements. MDA/2012/036. http://www.mhra.gov.uk/. Published 2012.

Kiran M, Shivarathre D, Peter VK. Blood Metal Ion Levels Have Limited Utility in the Surveillance of Asymptomatic Large-Head Metal-on-Metal Total Hip Arthroplasties. J Arthroplasty. July 2017. doi:10.1016/j.arth.2017.07.015.

Sidaginamale RP, Joyce TJ, Lord JK, et al. Blood metal ion testing is an effectivescreening tool to identify poorly performing metal-on-metal bearingsurfaces. Bone Joint Res. 2013;2(5):84-95. doi:10.1302/2046-3758.25.2000148.

Hjorth MH, Stilling M, Soballe K, et al. No association between pseudotumors, high serum metal-ion levels and metal hypersensitivity in large-head metal-on-metal total hip arthroplasty at 5–7-year follow-up. Skeletal Radiol. 2016;45(1):115-125. doi:10.1007/s00256-015-2264-8.

Reito A, Parkkinen J, Puolakka T, Pajamäki J, Eskelinen A. Diagnostic utility of joint fluid metal ion measurement for histopathological findings in metal-on-metal hip replacements. BMC Musculoskelet Disord. 2015;16(1):393. doi:10.1186/s12891-015-0851-4.

Renner L, Schmidt-Braekling T, Faschingbauer M, Boettner F. Do cobalt and chromium levels predict osteolysis in metal-on-metal total hip arthroplasty? Arch Orthop Trauma Surg. 2016;136(12):1657-1662. doi:10.1007/s00402-016-2565-y.

Fehring TK, Fehring K, Odum SM. Metal Artifact Reduction Sequence MRI Abnormalities Occur in Metal-on-polyethylene Hips. Clin Orthop Relat Res. 2015;473(2):574-580. doi:10.1007/s11999-014-3873-6.

Jennings JM, Martin JR, Kim RH, Yang CC, Miner TM, Dennis DA. Metal Artifact Reduction Sequence MRI Abnormalities in Asymptomatic Patients with a Ceramic-on-Polyethylene Total Hip Replacement. J Bone Jt Surg. 2017;99(7):593-598. doi:10.2106/JBJS.16.00910.

Smith J, Lee D, Bali K, et al. Does bearing size influence metal ion levels in large-head metal-on-metal total hip arthroplasty? A comparison of three total hip systems. J Orthop Surg Res. 2014;9:3. doi:10.1186/1749-799X-9-3.

Matharu GS, Berryman F, Brash L, Pynsent PB, Treacy RBC, Dunlop DJ. The Effectiveness of Blood Metal Ions in Identifying Patients with Unilateral Birmingham Hip Resurfacing and Corail-Pinnacle Metal-on-Metal Hip Implants at Risk of Adverse Reactions to Metal Debris. J Bone Jt Surg. 2016;98(8):617-626. doi:10.2106/JBJS.15.00340.

Matharu GS, Berryman F, Judge A, et al. Blood Metal Ion Thresholds to Identify Patients with Metal-on-Metal Hip Implants at Risk of Adverse Reactions to Metal Debris. J Bone Jt Surg. 2017;99(18):1532-1539. doi:10.2106/JBJS.16.01568.

Hothi HS, Eskelinen AP, Berber R, et al. Factors Associated With Trunnionosis in the Metal-on-Metal Pinnacle Hip. J Arthroplasty. 2017;32(1):286-290. doi:10.1016/j.arth.2016.06.038.

Published
2019-04-08
How to Cite
Martin, J. R., Otero, J., Springer, B., & Griffin, W. (2019). Can We Improve Screening Costs in Asymptomatic Metal on Metal Total Hip Arthroplasties?. Reconstructive Review, 9. https://doi.org/10.15438/rr.9.1.214
Section
Original Article