Response profiles of circulating leukocytes and metal ions in patients with a modular dual-mobility hip implant

Abstract

Introduction:

The purpose of this study was to retrospectively evaluate blood metal ion levels and leukocyte profiles in patients with modular dual-mobility hip implant (MDM) during a postoperative follow-up up to 2 years.

Methods:

We recruited 49 patients in a retrospective cohort study and had postoperative follow-up up to 2 years. Blood concentrations of chromium (Cr), cobalt (Co) and serum cytokines were measured. Flow cytometry was used to quantify the subpopulations of leukocytes, including CD14⁺ and CD16⁺ monocytes, CD3⁺ T lymphocytes, CD19⁺ B lymphocytes, CD4⁺ Helper T-cells and CD45⁺RA memory vs. naïve T-cells.

Results:

Clinical performances of implants were good during 2 years of follow-up. Cr levels were normal in all patients and only detectable in 1 patient (1.4µg/L, ref < 5.0µg/L). Co levels were mildly elevated in 4 patients at 1 year (mean 1.375µg/L, range 1.2–1.7µg/L, ref < 1.0µg/L) and in 2 patients at 2-year follow-up (both 1.2µg/L). Interestingly, Co level observed in 3 patients at 1 year converted to undetectable at their 2-year follow-up. Percentages of B cells, T cells and their subpopulations were within normal levels. There was no increase of CD16⁺ inflammatory monocytes.

Discussion:

With the recent introduction of MDM systems there is potential for metal ion release from the interface between the acetabular shell and CoCr liner. Clinical results have been good and metal levels undetectable or within acceptable ranges at 1–2 years. There was no evidence of activated immune response, as manifested by constant circulating leukocyte profiles and no increase of CD16⁺ inflammatory monocytes.

Keywords

CD14+ monocyte CD16+ monocytes Cobalt and chromium MDM System metal ions metal-on-metal

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References

Bozic

Kurtz

Lau . et al. The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am 2009; 91: 128–133.

Fessy

Putman

Viste

. et al., What are the risk factors for dislocation in primary total hip arthroplasty? A multicenter case-control study of 128 unstable and 438 stable hips. Orthop Traumatol Surg Res 2017; 103: 663–668.

Lange

Spiro

Westrich

GH.

Utilizing dual mobility components for first-time revision total hip arthroplasty for instability. J Arthroplasty 2018; 33: 505–509.

Rowan

Salvatore

Lange

. et al. Dual-mobility vs fixed-bearing total hip arthroplasty in patients under 55 years of age: a single-institution, matched-cohort analysis. J Arthroplasty 2017; 32: 3076–3081.

Civinini

Carulli

Matassi

. et al. A dual-mobility cup reduces risk of dislocation in isolated acetabular revisions. Clin Orthop Relat Res 2012; 470: 3542–3548.

Smith

Schwarz

EM.

Are Biologic treatments a potential approach to wear- and corrosion-related problems?

Clin Orthop Relat Res 2014; 472: 3740–3746.

Wiley

K.F.

. et al., Incidence of pseudotumor and acute lymphocytic vasculitis associated lesion (ALVAL) reactions in metal-on-metal hip articulations: a meta-analysis. J Arthroplasty 2013; 28: 1238–1245.

Cooper

Urban

Wixson

. et al. Adverse local tissue reaction arising from corrosion at the femoral neck-body junction in a dual-taper stem with a cobalt-chromium modular neck. J Bone Joint Surg Am 2013; 95: 865–872.

Matsen Ko

Pollag

Yoo

. et al. Serum metal ion levels following total hip arthroplasty with modular dual mobility components. J Arthroplasty 2016; 31: 186–189.

10.

Nam

Salih

Brown

. et al. Metal ion levels in young, active patients receiving a modular, dual mobility total hip arthroplasty. J Arthroplasty 2017; 32: 1581–1585.

11.

Kawanaka

Yamamura

Aita

. et al. CD14+,CD16+ blood monocytes and joint inflammation in rheumatoid arthritis. Arthritis Rheum 2002; 46: 2578–2586.

12.

Chen

Lowe

Wilson

. et al. Simultaneous quantification of six human cytokines in a single sample using microparticle-based flow cytometric technology. Clin Chem 1999; 45: 1693–1694.

13.

Assi

Kheir

Samaha

. et al. Early results of total hip arthroplasty using dual-mobility cup in patients with osteonecrosis of the femoral head. SICOT J 2018; 4: 4.

14.

De Smet

De Haan

Calistri

. et al., Metal ion measurement as a diagnostic tool to identify problems with metal-on-metal hip resurfacing. J Bone Joint Surg Am 2008; 90(Suppl. 4): 202–208.

15.

Jantzen

Jørgensen

Duus

. et al. Chromium and cobalt ion concentrations in blood and serum following various types of metal-on-metal hip arthroplasties: a literature overview. Acta Orthop 2013; 84: 229–236.

16.

Hailer

Bengtsson

Lundberg

. et al. High metal ion levels after use of the asrγäó device correlate with development of pseudotumors and T cell activation. Clin Orthop Relat Res 2014; 472: 953–961.

17.

Hart

Sabah

Bandi

. et al. Sensitivity and specificity of blood cobalt and chromium metal ions for predicting failure of metal-on-metal hip replacement. J Bone Joint Surg Br 2011; 93: 1308–1313.

18.

MacInnes

Del Vescovo

Kiss-Toth

. et al. Genetic variation in inflammatory and bone turnover pathways and risk of osteolytic responses to prosthetic materials. J Orthop Res 2015; 33: 193–198.

19.

Paladini

Cocco

Potolicchio

. et al. Divergent effect of cobalt and beryllium salts on the fate of peripheral blood monocytes and T lymphocytes. Toxicol Sci 2011; 119: 257–269.

20.

Penny

JØ

Varmarken

Ovesen

. et al. Metal ion levels and lymphocyte counts: ASR hip resurfacing prosthesis vs. standard THA: 2-year results from a randomized study. Acta Orthop 2013; 84: 130–137.

21.

Hart

Hester

Sinclair

. et al. The association between metal ions from hip resurfacing and reduced T-cell counts. J Bone Joint Surg Br 2006; 88: 449–454.

22.

Ziegler-Heitbrock

The CD14+ CD16+ blood monocytes: their role in infection and inflammation. J Leukoc Biol 2007; 81: 584–592.

23.

Passlick

Flieger

Ziegler-Heitbrock

HW.

Identification and characterization of a novel monocyte subpopulation in human peripheral blood. Blood 1989; 74: 2527–2534.

24.

Ziegler-Heitbrock

Fingerle

Ströbel

. et al. The novel subset of CD14+/CD16+ blood monocytes exhibits features of tissue macrophages. Eur J Immunol 1993; 23: 2053–2058.

25.

Belge

Dayyani

Horelt

. et al. The proinflammatory CD14+CD16+DR++ monocytes are a major source of TNF. J Immunol 2002; 168: 3536–3542.

26.

Frankenberger

Sternsdorf

Pechumer

. et al. Differential cytokine expression in human blood monocyte subpopulations: a polymerase chain reaction analysis. Blood 1996; 87: 373–377.

27.

Zhang

. et al. Expansion of CD14+CD16+ peripheral monocytes among patients with aseptic loosening. Inflamm Res 2009; 58: 561–570.

28.

Granchi

Verri

Ciapetti

. et al. Bone-resorbing cytokines in serum of patients with aseptic loosening of hip prostheses. J Bone Joint Surg Br 1998; 80: 912–917.

29.

Ren

Blasier

Peng

. et al. Effect of oral erythromycin therapy in patients with aseptic loosening of joint prostheses. Bone 2009; 44: 671–677.

30.

Watters

Cardona

Menon

. et al. Aseptic lymphocyte-dominated vasculitis-associated lesion: a clinicopathologic review of an underrecognized cause of prosthetic failure. Am J Clin Pathol 2010; 134: 886–893.

31.

Catelas

Lehoux

Hurda

. et al. Do patients with a failed metal-on-metal hip implant with a pseudotumor present differences in their peripheral blood lymphocyte subpopulations? Clin Orthop Relat Res 2015; 473: 3903–3914.

32.

Chan

Cadosch

Gautschi

. et al. Influence of metal ions on human lymphocytes and the generation of titanium-specific T-lymphocytes. J Appl Biomater Biomech 2011; 9: 137–143.

33.

Rengarajan

Szabo

Glimcher

LH.

Transcriptional regulation of Th1/Th2 polarization. Immunol Today 2000; 21: 479–483.

34.

Moskal

Driesen

Koc

. et al. A modified extensile anterior approach to the acetabulum for severe acetabular defects. Orthopedics 2018; 41: e194–e201.

35.

Snir

Park

Garofolo

. et al. Revision of failed hip resurfacing and large metal-on-metal total hip arthroplasty using dual-mobility components. Orthopedics 2015; 38: 369–374.