ArticleThe Journal of arthroplasty2021
Synovial Fluid Metal Ion Levels are Superior to Blood Metal Ion Levels in Predicting an Adverse Local Tissue Reaction in Failed Total Hip Arthroplasty.
Article in The Journal of arthroplasty, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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.
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Who cites it
4 citing papers in PubMed, 10 citations in OpenAlex.
- Inflammatory Pseudotumor After Total Hip Arthroplasty-An Increasingly Recognized Complication.Orthopaedic surgery · 2026Review
- Systemic Cobalt Toxicity Secondary to Tibial Component Malpositioning in Bilateral Primary Total Knee Arthroplasties.Arthroplasty today · 2026Article
- The AAHKS Surgical Techniques and Technologies Award: Synovial Fluid Metal Ion Levels as a Biomarker for Aseptic Loosening Following Cemented Total Knee Arthroplasty: A Prospective Study.The Journal of arthroplasty · 2025Article
- [Particle disease and its effects on periarticular tissue].Orthopadie (Heidelberg, Germany) · 2023Review
Corrections and comments
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Authors and funding
6 authors at 1 institution in 1 country.
Funding
Abstract
backgroundAdverse local tissue reactions (ALTR) are associated with total hip arthroplasty (THA) failure in patients with metal-on-metal bearings and/or taper corrosion, which can also occur in metal-on-polyethylene articulations. Patients are monitored with blood cobalt (Co) and chromium (Cr) concentrations which do not always correlate with the degree of soft tissue reaction at revision THA. The purpose of this study was to determine how the blood and prosthetic hip synovial fluid levels of Co and Cr correlate with one another, and determine which concentration is more predictive of ALTR.
methodsSynovial fluid and blood samples were collected at the time of revision THA in patients with (n = 26) and without ALTR (n = 27). Whole blood, serum, and synovial fluid metal ion concentrations were correlated with one another and clinical findings.
resultsThe ratio of synovial fluid to whole blood Co concentration in ALTR and non-ALTR hips was 120:1 and 18:1 (P = .006). The mean ratio of synovial fluid to whole blood Cr concentration in ALTR and non-ALTR hips was 414:1 and 24:1 (P = .01). The mean synovial fluid Co/Cr concentrations were elevated in patients with ALTR compared with those without (2007.3 vs. 12.4 ppb, P = .007) and (3188.2 vs. 10.3 ppb, P = .02). The synovial fluid Co concentration was the most accurate test for detecting ALTR (cut off: 19.75 PPB, AUC 0.973).
conclusionIn patients with ALTR, synovial fluid Co and Cr levels were 120 times higher and 414 times higher than whole blood Co and Cr levels. Synovial fluid Co ion concentration was the most accurate in predicting ALTR. LEVEL OF EVIDENCE: Diagnostic level II.
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