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Open AccessArticle

Metal on Metal Bearing in Total Hip Arthroplasty and Its Impact on Synovial Cell Count

Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital, Charitéplatz 1, 10117 Berlin, Germany
Department of Orthopedics & Sports Medicine, Baylor College of Medicine Medical Center, Houston, TX 77030, USA
Department of Orthopaedics, Herzogin Elisabeth Hospital, 38124 Braunschweig, Germany
Author to whom correspondence should be addressed.
The authors contributed equally to this work.
J. Clin. Med. 2020, 9(10), 3349;
Received: 9 September 2020 / Revised: 15 October 2020 / Accepted: 16 October 2020 / Published: 18 October 2020
(This article belongs to the Special Issue State-of-the-Art Research on Hip and Knee Arthroplasty)
Introduction: The effect of different bearings on synovial white blood cell (WBC) count and polymorphonuclear percentage (PMN%) in aspirations remains unclear. Therefore, this study investigates the impact of aseptic Metal-on-Metal (MoM) bearing on synovial fluid. Methods: We searched our arthroplasty registry for aseptic painful THAs with MoM bearings between 2011 and 2018. Then, a case-matched control group was selected with septic and aseptic Total Hip Arthroplasty (THA) with ceramic on a polyethylene (PE) bearing. The matching criteria consisted of gender, age +/−10 years, and time of aspiration (+/−2years). Periprosthetic Joint Infection (PJI) was defined according to the Infectious Diseases Society of America (IDSA), and Musculoskeletal Infection Society (MSIS) using bacterial cultures, sonication and histology. Results: In total, 19 patients who underwent hip aspiration with MoM bearing were identified. Five patients had to be excluded due to insufficient synovial fluid obtained (n = 2) or bacterial growth after sonication that was initially negative with the standard microbiological cultures (n = 3). As such, 14 were included. These patients were matched with 14 aseptic and 14 septic THAs with ceramic on a PE bearing, which constituted the control group. The mean serum chrome level was 20.0 ± 15.5 nmol/L and cobalt level 18.4 ± 22.1 nmol/L. The synovial WBC and PMN% varied significantly between MoM bearing group and the aseptic THA ceramic PE group (both p < 0.001), as well as the septic THA group (WBC p = 0.016, PMN% p < 0.001). Furthermore, the septic THA group had significantly higher CRP values than the aseptic MoM group (p = 0.016). Conclusion: MoM bearing shows significantly higher synovial WBC and PMN% when compared to aseptic THA with ceramic on PE bearing above the MSIS cut-off. This is an important consideration when diagnosing periprosthetic joint infection using the MSIS guidelines. View Full-Text
Keywords: metal on metal; total hip arthroplasty; aspiration; infection; cell count; marker metal on metal; total hip arthroplasty; aspiration; infection; cell count; marker
MDPI and ACS Style

Bäcker, H.C.; Wu, C.H.; Krüger, D.; Gwinner, C.; Perka, C.; Hardt, S. Metal on Metal Bearing in Total Hip Arthroplasty and Its Impact on Synovial Cell Count. J. Clin. Med. 2020, 9, 3349.

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