Metal-on-metal bearing with THA and chronic renal failure.

Purpose: The influence of chronic renal failure on serum cobalt and serum chromium in two patients with metal-on-metal bearing (Metasul(R)) and cementless total hip arthroplasty (Alloclassic(R)) is investigated. Methods: Serum cobalt and serum chronium levels were determined in the postoperative course using atomic absorption spectrometry. Results: Maximum values are found to be more than 100-fold elevated when compared to the reported median serum cobalt concentrations in patients with the same prosthesis type and no known renal disease. Conclusion: Chronic renal failure seems to be responsible for the marked elevation of serum cobalt and serum chromium. Clinical relevance: Despite evidence of adverse health reactions, a possible effect of long-term cobalt and chromium loading cannot be neglected. in our opinion, metal-on-metal bearings in THA should not be inserted in patients with chronic renal failure. Follow-up investigations (serum cobalt, serum chromium, serum creatinine, BUN, echocardiography) should be performed at short intervals.