Large fixed-size metal-on-metal total hip arthroplasty: higher serum metal ion levels in patients with pain

Purpose: Recently, concerns have arisen about metal-on-metal (MoM) total hip arthroplasty (THA). Therefore, the purpose of this cross-sectional cohort study was to describe the incidence of pain, pseudotumours, revisions and the relation between elevated metal ion levels, functional outcome and quality of life after MoM THA.Methods: In 351 patients, 377 MoM THA with a fixed-size 38-mm head were evaluated with a mean follow-up of 30 months (range 11–58). Evaluation included pain, serum metal ions, patient-reported questionnaires (Short Form-36 [SF-36], Hip disability and Osteoarthritis Outcome Score [HOOS] and the Oxford Hip Score [OHS]) and radiological imaging. Sixteen patients did not participate in the screening.Results: One hundred and eighteen (35 %) patients reported pain and showed significantly higher cobalt and chromium levels compared to patients without pain. Median serum cobalt levels were 4.4 μg/l (interquartile range [IQR] 6.6) and chromium levels were 3.6 μg/l (IQR 4.8). Patients with cobalt levels of ≤5 μg/l reported significantly better outcome on the SF-36 and HOOS. Fifty-seven pseudotumours were identified in 227 THAs. A revision rate of 19 % was observed.Conclusions: In conclusion, 35 % of the patients experienced pain after MoM THA. These patients showed significantly higher serum metal ion levels. The patient-reported questionnaires indicated significantly better outcome in patients with cobalt levels ≤5 μg/l.