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A Comparison of Blood Metal Ions in Total Hip Arthroplasty Using Metal and Ceramic Heads



In recent time, metal ion debris and adverse local tissue reaction have reemerged as an area of clinical concern with the use of large femoral heads after total hip arthroplasty (THA).


Between June 2014 and January 2015, 60 patients with a noncemented THA using a titanium (titanium, molybdenum, zirconium, and iron alloy) femoral stem and a V40 trunnion were identified with a minimum 5-year follow-up. All THAs had a 32- or 36-mm metal (n = 30) or ceramic (n = 30) femoral head coupled with highly cross-linked polyethylene. Cobalt, chromium, and nickel ions were measured.


Patients with metal heads had detectable cobalt and chromium levels. Cobalt levels were detectable in 17 (56.7%) patients with a mean of 2.0 μg/L (range: <1.0-10.8 μg/L). Chromium levels were detectable in 5 (16.7%) patients with a mean of 0.3 μg/L (range: <1.0-2.2 μg/L). All patients with a ceramic head had nondetectable cobalt and chromium levels. Cobalt and chromium levels were significantly higher with metal heads compared to ceramic heads (P < .01). Cobalt levels were significantly higher with 36-mm metal heads compared with 32-mm heads (P < .01). Seven patients with metal femoral heads had mild hip symptoms, 4 of whom had positive findings of early adverse local tissue reaction on magnetic resonance imaging. All ceramic THA was asymptomatic.


The incidence and magnitude of cobalt and chromium levels is higher in metal heads compared to ceramic heads with this implant system (P < .01). Thirty-six millimeter metal femoral heads result in larger levels of cobalt compared with 32-mm metal heads.

The Journal of Arthroplasty

Volume 31, Issue 10, October 2016, Pages 2215-2220

Peter B.White BA, Morteza Meftah MD, Amar S. Ranawat MD, Chitranjan S. Ranawat MD

Hospital for Special Surgery, New York, New York

Received 28 December 2015, Revised 29 February 2016, Accepted 11 March 2016, Available online 23 March 2016.