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Hip: H. Ziaee, J. Daniel, A. K. Datta, S. Blunt, and D. J. W. McMinn Transplacental transfer of cobalt and chromium in patients with metal-on-metal hip arthroplasty: A CONTROLLED STUDY J Bone Joint Surg Br 2007; 89-B: 301-305 [Abstract] [Full text] [PDF]

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Transplacental transfer of cobalt and chromium in patients with metal-on-metal hip arthroplasty

Augusto Sarmiento   (18 May 2007)

Transplacental transfer of cobalt and chromium in patients with metal-on-metal hip arthroplasty 18 May 2007
Augusto Sarmiento, Professor and Chairman Emeritus University of Miami School of Medicine Send letter to journal: Re: Transplacental transfer of cobalt and chromium in patients with metal-on-metal hip arthroplasty asarm{at}bellsouth.net Augusto Sarmiento	Sir, I had looked forward with anticipation to reading this article. However, I am concerned over my inability to understand why the authors, after acknowledging a significantly increased level of metal in their studied patients, as well as in research done by others, insist on recommending the continued use of metal-on-metal hip implants, as if in their absence from the market the successful surgical replacement of the hip joint would come to an end.1 The use of polyethylene and ceramics, and more recently cross-linked polyethylene has given long-term satisfactory results, without the real and potential dangers associated with high quantity of metal debris. If the possibility of carcinogenic effects or chromosomal abnormalities does not represent a serious concern, what do we need to see before the trend is brought to an end? Dismissing the increased presence of metal in the blood in patients with metal-on-metal implants, simply on the basis that the increase is not statistically significant, does not stand to reason. Non-statistically significant differences often eloquently describe trends.2,3 A. Sarmiento, MD, Professor, University of Miami School of Medicine, Miami, Florida, USA. 1. Ladon D, Doherty A, Newson R, et al. Changes in metal levels and chromosomal abberations in the peripheral blood in patients after metal-on-metal hip arthroplasty. J Arthroplasty 2004;19(8 Suppl 3)78-83. 2. Case CP, Langkamer VG, Howell RT, et al. Preliminary observations on possible premalignant changes in bone marrow adjacent to worn total hip arthroplasty implants. Clin Orthop Relat Res 1996;329 Suppl:S269-79. 3. Ebramzadeh E, McKellop H, Dorey, F, Sarmiento A. Challenging the validity of conclusions based on P-values alone: a critique of contemporary clinical research design and methods. Instr Course Lect 1994;43:587-600.