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Journal of Bone and Joint Surgery - British Volume, Vol 88-B, Issue 8, 1003-1005.
doi: 10.1302/0301-620X.88B8.17870  
Copyright © 2006 by British Editorial Society of Bone and Joint Surgery
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Serum aluminium and cobalt levels after ceramic-on-ceramic and metal-on-metal total hip replacement

A. Grübl, MD, Consultant1; M. Weissinger, MD, Professor, Head of Department2; W. Brodner, MD, Professor3; A. Gleiss, MSc, PhD, Biostatistician4; A. Giurea, MD, Professor1; M. Gruber, MD, Consultant1; G. Pöll, MD, Consultant2; V. Meisinger, PhD, Senior Scientific Counsellor5; F. Gottsauner-Wolf, MD, Professor, Head of Department3; and R. Kotz, MD, Professor, Head of Department1

1 Department of Orthopaedics
2 Department of Orthopaedics, General Hospital Zwettl, Propstei 5, A-3910 Zwettl, Austria.
3 Department of Orthopaedics, General Hospital Krems, Mitterweg 10, A-3500 Krems an der Donau, Austria.
4 Core Unit for Medical Statistics and Informatics, Medical University of Vienna, Spitalgassee 23, A-1090 Vienna, Austria.
5 Clinical Department of Occupational Medicine, Department of Internal Medicine IV, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.

Correspondence should be sent to Dr A. Grübl; e-mail: alexander.gruebl{at}meduniwien.ac.at

In a randomised study, 28 patients with a mean age of 62.2 years (32 to 81) with osteoarthritis or avascular necrosis of the hip received either a ceramic-on-ceramic or a metal-on-metal total hip replacement. Apart from the liners the acetabular and femoral components were made of Ti-Al-Nb alloy. The serum aluminium and cobalt levels were measured before, and at one year after surgery.

The 15 patients in the ceramic-on-ceramic group had a median pre-operative aluminium level of 1.3 µg/l (0.25 to 8.4) and a cobalt level below the detection limit. At one year the aluminium level was 1.1 µg/l (0.25 to 2.3) and the cobalt level was 0.4 µg/l (0.15 to 0.7). The 13 patients in the metal-on-metal group had a median pre-operative aluminium level of 1.9 µg/l (0.25 to 4.4) and a cobalt level below the detection limit. At one year the median aluminium level was 0.9 µg/l (0.25 to 3.9) whereas the cobalt level was 1.4 µg/l (0.5 to 10.5). This increase in the cobalt level at one year was significant (p < 0.001).

Our findings indicate that ceramic-on-ceramic bearings do not cause elevated levels of serum aluminium in the first post-operative year.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General