SynthesisPloS one2013
Metal ion concentrations in body fluids after implantation of hip replacements with metal-on-metal bearing--systematic review of clinical and epidemiological studies.
Synthesis in PloS one, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 43 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
43 citing papers in PubMed, 3 syntheses or guidelines pooled it, 111 citations in OpenAlex.
- Are clinical findings of systemic titanium dispersion following implantation explained by available in vitro evidence? An evidence-based analysis.Journal of biological inorganic chemistry : JBIC : a publication of the Society of Biological Inorganic Chemistry · 2017Pooled it
- Pooled it
- Do retrieval analysis and blood metal measurements contribute to our understanding of adverse local tissue reactions?Clinical orthopaedics and related research · 2014Pooled it
- Usefulness of metal artifact reduction with WARP technique at 1.5 and 3T MRI in imaging metal-on-metal hip resurfacings.Skeletal radiology · 2015Trial
- Systemic Cobalt Toxicity Secondary to Tibial Component Malpositioning in Bilateral Primary Total Knee Arthroplasties.Arthroplasty today · 2026Article
- The Influence of the Type of Metal-on-Metal Hip Endoprosthesis on the Clinical, Biochemical, and Oxidative Balance Status-A Comparison of Resurfacing and Metaphyseal Implants.Nanomaterials (Basel, Switzerland) · 2025Article
- Article
- Functional Outcomes of Different Bearing Surfaces for Total Hip Arthroplasty: A Systematic Review and Meta-Analysis.Medical journal of the Islamic Republic of Iran · 2025Review
- The role of femoral head size in metal-on-metal hip arthroplasty: analysis of a cohort of 3813 patients with long term follow-up.Archives of orthopaedic and trauma surgery · 2024Article
- Prosthetic Metals: Release, Metabolism and Toxicity.International journal of nanomedicine · 2024Review
- Mid-term clinical and radiographic outcome of metal-on-metal hip resurfacing through an anterolateral approach.Musculoskeletal surgery · 2023Article
- Hyaluronic acid-British anti-Lewisite as a safer chelation therapy for the treatment of arthroplasty-related metallosis.Proceedings of the National Academy of Sciences of the United States of America · 2023Article
- Serum cobalt and chromium concentration following total hip arthroplasty: a Bayesian network meta-analysis.Scientific reports · 2023Article
- Radiation impacts on toxicity of cobalt-chromium (CoCr) implant debris.Nanotoxicology · 2023Article
- Periarticular metal hypersensitivity complications of hip bearings containing cobalt-chromium.EFORT open reviews · 2022Article
- Psychiatric Disorders and Genotoxicity Following Primary Metal on Polyethylene Total Hip Arthroplasty and Their Correlation to Cobalt/Chromium Levels.Drug, healthcare and patient safety · 2022Article
- Cobalt-induced cardiomyopathy - do circulating cobalt levels matter?Bone & joint research · 2021Article
- Course of Metal Ions after a Revision of Malfunctioning Metal-on-Metal Total Hip Prostheses.Medicina (Kaunas, Lithuania) · 2021Article
- Predictive factors affecting long-term survivorship of ASR metal-on-metal total hip arthroplasty.SICOT-J · 2021Article
- Metal Ion Release, Clinical and Radiological Outcomes in Large Diameter Metal-on-Metal Total Hip Arthroplasty at Long-Term Follow-Up.Diagnostics (Basel, Switzerland) · 2020Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThe use of metal-on-metal (MoM) total hip arthroplasty (THA) increased in the last decades. A release of metal products (i.e. particles, ions, metallo-organic compounds) in these implants may cause local and/or systemic adverse reactions. Metal ion concentrations in body fluids are surrogate measures of metal exposure.
objectiveTo systematically summarize and critically appraise published studies concerning metal ion concentrations after MoM THA.
methodsSystematic review of clinical trials (RCTs) and epidemiological studies with assessment of metal ion levels (cobalt, chromium, titanium, nickel, molybdenum) in body fluids after implantation of metalliferous hip replacements. Systematic search in PubMed and Embase in January 2012 supplemented by hand search. Standardized abstraction of pre- and postoperative metal ion concentrations stratified by type of bearing (primary explanatory factor), patient characteristics as well as study quality characteristics (secondary explanatory factors).
resultsOverall, 104 studies (11 RCTs, 93 epidemiological studies) totaling 9.957 patients with measurement of metal ions in body fluids were identified and analyzed. Consistently, median metal ion concentrations were persistently elevated after implantation of MoM-bearings in all investigated mediums (whole blood, serum, plasma, erythrocytes, urine) irrespective of patient characteristics and study characteristics. In several studies very high serum cobalt concentrations above 50 µg/L were measured (detection limit typically 0.3 µg/L). Highest metal ion concentrations were observed after treatment with stemmed large-head MoM-implants and hip resurfacing arthroplasty. DISCUSSION: Due to the risk of local and systemic accumulation of metallic products after treatment with MoM-bearing, risk and benefits should be carefully balanced preoperatively. The authors support a proposed "time out" for stemmed large-head MoM-THA and recommend a restricted indication for hip resurfacing arthroplasty. Patients with implanted MoM-bearing should receive regular and standardized monitoring of metal ion concentrations. Further research is indicated especially with regard to potential systemic reactions due to accumulation of metal products.
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Registered trials
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