Metal Ions Study

Journal of Bone and Joint Surgery - British Volume, Vol 89-B, Issue 2, 169-173.
doi: 10.1302/0301-620X.89B2.18519
Copyright © 2007 by British Editorial Society of Bone and Joint Surgery

Blood and urine metal ion levels in young and active patients after Birmingham hip resurfacing arthroplasty

J. Daniel, FRCS, Director of Research1, H. Ziaee, BSc(Hons), Biomedical Scientist1, C. Pradhan, FRCS, Staff Orthopaedic Surgeon1, P. B. Pynsent, PhD, Director2 and D. J. W. McMinn, FRCS, Consultant Orthopaedic Surgeon1

1 The McMinn Centre, 25 Highfield Road, Edgbaston, Birmingham B15 3DP, UK.
2 Research and Teaching Centre, Royal Orthopaedic Hospital, Northfield, Birmingham B31 2AP, UK.

Correspondence should be sent to Mr J. Daniel; e-mail:

This is a longitudinal study of the daily urinary output and the concentrations in whole blood of cobalt and chromium in patients with metal-on-metal resurfacings over a period of four years.

Twelve-hour urine collections and whole blood specimens were collected before and periodically after a Birmingham hip resurfacing in 26 patients. All ion analyses were carried out using a high-resolution inductively-coupled plasma mass spectrometer. Clinical and radiological assessment, hip function scoring and activity level assessment revealed excellent hip function.

There was a significant early increase in urinary metal output, reaching a peak at six months for cobalt and one year for chromium post-operatively. There was thereafter a steady decrease in the median urinary output of cobalt over the following three years, although the differences are not statistically significant. The mean whole blood levels of cobalt and chromium also showed a significant increase between the pre-operative and one-year post-operative periods. The blood levels then decreased to a lower level at four years, compared with the one-year levels. This late reduction was statistically significant for chromium but not for cobalt.

The effects of systemic metal ion exposure in patients with metal-on-metal resurfacing arthroplasties continue to be a matter of concern. The levels in this study provide a baseline against which the in vivo wear performance of newer bearings can be compared.