Can blood metal ion levels be used to identify patients with bilateral Birmingham Hip Resurfacings who are at risk of adverse reactions to metal debris?
| Autor: | DJ Dunlop, Paul Pynsent, Gulraj S. Matharu, Lesley Brash, R. B. C. Treacy, Fiona Berryman |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Chromium Male Reoperation medicine.medical_specialty Arthroplasty Replacement Hip medicine.medical_treatment Prosthesis Design Sensitivity and Specificity Chromium atom 03 medical and health sciences 0302 clinical medicine Statistical significance Humans Medicine Orthopedics and Sports Medicine Prospective Studies 030212 general & internal medicine Aged Whole blood 030222 orthopedics Receiver operating characteristic analysis business.industry Area under the curve Cobalt Metal debris Middle Aged Foreign Bodies Hip resurfacing eye diseases Prosthesis Failure Surgery ROC Curve Metal-on-Metal Joint Prostheses Female Hip Prosthesis Implant business Nuclear medicine Biomarkers |
| Zdroj: | The Bone & Joint Journal. :1455-1462 |
| ISSN: | 2049-4408 2049-4394 |
| DOI: | 10.1302/0301-620x.98b11.38042 |
| Popis: | Aims We investigated whether blood metal ion levels could effectively identify patients with bilateral Birmingham Hip Resurfacing (BHR) implants who have adverse reactions to metal debris (ARMD). Patients and Methods Metal ion levels in whole blood were measured in 185 patients with bilateral BHRs. Patients were divided into those with ARMD who either had undergone a revision for ARMD or had ARMD on imaging (n = 30), and those without ARMD (n = 155). Receiver operating characteristic analysis was used to determine the optimal thresholds of blood metal ion levels for identifying patients with ARMD. Results The maximum level of cobalt or chromium ions in the blood was the parameter which produced the highest area under the curve (91.0%). The optimal threshold for distinguishing between patients with and without ARMD was 5.5 µg/l (83.3% sensitivity, 88.4% specificity, 58.1% positive and 96.5% negative predictive values). Similar results were obtained in a subgroup of 111 patients who all underwent cross-sectional imaging. Between 3.2% and 4.3% of patients with ARMD were missed if United Kingdom (7 µg/l) and United States (10 µg/l) authority thresholds were used respectively, compared with 2.7% if our implant specific threshold was used, though these differences did not reach statistical significance (p ≥ 0.248). Conclusion Patients with bilateral BHRs who have blood metal ion levels below our implant specific threshold were at low-risk of having ARMD. Cite this article: Bone Joint J 2016;98-B:1455–62. |
| Databáze: | OpenAIRE |
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