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Hip: P.-A. Vendittoli, S. Mottard, A. G. Roy, C. Dupont, and M. Lavigne Chromium and cobalt ion release following the Durom high carbon content, forged metal-on-metal surface replacement of the hip J Bone Joint Surg Br 2007; 89-B: 441-448 [Abstract] [Full text] [PDF]

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Pascal-Andre Vendittoli, Muthu Ganapathi, Sophie Mottard, Martin Lavigne   (22 August 2007)

Titanium release from the Durom Hip Resurfacing

Joseph Daniel, Hena Ziaee and Derek JW. McMinn   (3 August 2007)

Authors' reply: 22 August 2007
Pascal-Andre Vendittoli, MD, MSc, FRCS Maisonneuve-Rosemont Hospital, Department of surgery: Montreal University, Muthu Ganapathi, Sophie Mottard, Martin Lavigne Send letter to journal: Re: Authors' reply: pa.vendittoli{at}videotron.ca Pascal-Andre Vendittoli, et al.	Sir, We thank Mr Daniel for his interest in our paper. The aim of our paper was to assess the performance of the Durom hip resurfacing chrome cobalt bearing surfaces, reporting the pre-operative and post-operative chromium and cobalt concentrations in whole blood, serum and erythrocytes in 64 patients with unilateral hip resurfacing. There should be few concerns regarding the possibility of third body wear due to titanium debris as the chromium and cobalt concentrations reported in our paper are by far the lowest in the literature for large metal-on-metal bearings. These favourable levels may be the result of its well adjusted clearance, high carbon content and forged alloy, unlike most other metal-on-metal bearings which are manufactured by casting. At the moment, we are preparing the report on the minimum two year follow-up of a randomised control trial (RCT) comparing metal ion levels (Cr, Co, and Ti) after Durom metal-on-metal resurfacing and uncemented metal-on-metal (Metasul 28 mm) total hip replacement (THR) with Ti components (as noted by Mr Daniel, the preliminary results were recently presented).1 Besides wear of bearing surfaces, passive corrosion of exposed metallic surface is also a factor influencing metal ion concentration in individuals having a prosthetic device implanted. Few in vivo studies have been published on this subject.2-4 The advantages of an RCT study design are mainly to avoid selection bias but also to obtain a valuable control group to allow us to compare and put in perspective the ion levels found in the study group. P.-A. Vendittoli MD, MSc, FRCS, M. Gunapathi, S. Mottard, M. Lavigne, Maisonneuve-Rosemont Hospital, Department of Surgery: Montreal University, Montreal, Canada. 1. Lavigne M, Vendittoli P-A, Roy AG. Early results of an RCT comparing conventional and resurfacing total hip arthroplasty. International Symposium on Resurfacing of the Hip Joint Zurich, April 21-22, 2005. 2. Jacobs JJ, Skipor AK, Patterson LM, et al. Metal release in patients who have had a primary total hip arthroplasty. A prospective, controlled, longitudinal study. J Bone Joint Surg [Am] 1998;80-A:1447-58. 3. Luetzner J, Krummenauer F, Lengel AM, Ziegler J, Witzleb WC. Serum Metal Ion Exposure After Total Knee Arthroplasty. Clin Orthop Relat Res In press (2007). 4. Rasquinha VJ, Ranawat CS, Weiskopf J, et al. Serum metal levels and bearing surfaces in total hip arthroplasty. J Arthroplasty 2006;21(Suppl 2):47-52.
Titanium release from the Durom Hip Resurfacing 3 August 2007
Joseph Daniel The McMinn Centre, Birmingham. UK, Hena Ziaee and Derek JW. McMinn Send letter to journal: Re: Titanium release from the Durom Hip Resurfacing josephdaniel{at}mcminncentre.co.uk Joseph Daniel, et al.	Sir, It was interesting to read this paper. In common with other metal-on-metal devices the authors report elevation of blood chromium and cobalt concentrations. However, unlike any other metal-on-metal device, one of the authors has previously reported that blood titanium concentrations were elevated following insertion of the Durom resurfacing device.1 We understand this elevation originated from the titanium plasma spray surface coating on the fixation surface of the cup. This may represent a potentially serious problem indicating either galvanic corrosion from dissimilar metals on the external surface of the cup, or dislodged particles from the external surface entering the bearing and generating third body wear. Both these phenomena can be detrimental to the bearing in the long term. We were surprised not to see any mention of titanium levels in the paper. Perhaps the authors could explain why they omitted presenting titanium results. 1. Lavigne M, Vendittoli P-A, Roy AG. Early results of an RCT comparing conventional and resurfacing total hip arthroplasty. International Symposium on Resurfacing of the Hip Joint. Zurich, April 21-22, 2005.