Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Oct 18, 2021; 12(10): 768-780
Published online Oct 18, 2021. doi: 10.5312/wjo.v12.i10.768
Osteolysis in total hip arthroplasty in relation to metal ion release: Comparison between monolithic prostheses and different modularities
Francesco Manfreda, Egzon Bufi, Enrico Francesco Florio, Paolo Ceccarini, Giuseppe Rinonapoli, Auro Caraffa, Pierluigi Antinolfi
Francesco Manfreda, Division of Orthopedics and Trauma Surgery, Santa Maria della Misericordia Hospital, Perugia 06100, Italy
Francesco Manfreda, Egzon Bufi, Paolo Ceccarini, Auro Caraffa, Pierluigi Antinolfi, Department of Orthopedics and Traumatology, University of Perugia, Perugia 06100, Italy
Enrico Francesco Florio, Department of Orthopaedic and Traumatology, Infermi Hospital, AUSL Romagna, Rimini 47921, Italy
Giuseppe Rinonapoli, Department of Orthopaedic, University of Perugia, Perugia 06100, Italy
Author contributions: All the authors contributed equally to this work; Manfreda F and Florio E designed the research and collected the data; Ceccarini P and Rinonapoli G analysed the data; Manfreda F and Bufi E wrote the paper; Antinolfi P and Caraffa A contributed to manuscript revision; all authors approved the final version of the manuscript
Institutional review board statement: The study was reviewed and approved by the Internal Board of local Institution.
Informed consent statement: Informed consent statement was waived.
Conflict-of-interest statement: The Authors declare that there is no conflict of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Francesco Manfreda, MD, Research Scientist, Surgeon, Department of Orthopedics and Traumatology, University of Perugia, Via G. Dottori, Perugia 06100, Italy.
Received: April 30, 2021
Peer-review started: April 30, 2021
First decision: June 16, 2021
Revised: June 30, 2021
Accepted: August 23, 2021
Article in press: August 23, 2021
Published online: October 18, 2021
Research background

Osteolysis is one of the most common and important adverse reactions to total hip arthroplasty (THA). Therefore it’s important to define if there are conditions that facilitate its occurrence.

Research motivation

There is a lack of works studying the correlation between metal ions levels and osteolysis and its different prevalence between modular THA and monolithic prostheses.

Research objectives

Studies analyzing these topics would help the surgeons in the choice of the implants and in the in a correct patients’ follow-up. So that we designed this work aiming to have a comprehensive vision of a complication, such as the osteolysis, in THA.

Research methods

We enrolled 76 patients who underwent an operation of first implant of THA, with no other prosthesis and no Cobalt and Chrome (CoCr) work exposure. We divided them in three groups: Patients with monoblock prosthesis with metal head (Group A,), patients with modular prosthesis with ceramic head (Group B), patients with modular prosthesis with metal head (Group C). We analyzed the presence, if any, of osteolysis, its localization and the serum and urinary metal ions levels (Cr and Co).

Research results

We found out a direct correlation between the release of periprosthetic metal ions and osteolysis, also this study highlights that modularity is related to a higher metal ion release and osteolysis events.

Research conclusions

Our study reveals that there is a correlation between metal ions levels and presence and severity of osteolysis and that this is more evident in modular THA, due to higher corrosion.

Research perspectives

Obviously there is a need for more studies to obtain a good level of evidence and confirm these findings.