Serum ion levels after ceramic-on-ceramic and metal-on-metal total hip arthroplasty: 8-Year minimum follow-up

Lucia Savarino, Giovanni Padovani, Massimo Ferretti, Michelina Greco, Elisabetta Cenni, Giorgio Perrone, Francesco Greco, Nicola Baldini, Armando Giunti

Research output: Contribution to journalArticlepeer-review


Alternative bearing surfaces for total hip arthroplasty, such as metal-on-metal and ceramic-on-ceramic, offer the potential to reduce mechanical wear and osteolysis. In the short and medium term, the second generation of metal-on-metal bearings demonstrated high systemic metal ion levels, whereas ceramic-on-ceramic bearings showed the lowest ones. We aimed to verify whether the long-term ion release in metal-on-metal subjects was still relevant at a median 10-year follow-up, and whether a fretting process at the modular junctions occurred in ceramic-on-ceramic patients and induced an ion dissemination. Serum levels were measured in 32 patients with alumina-onalumina implants (group A), in 16 subjects with metal-on-metal implants (group B), and in 47 healthy subjects (group C). Group B results were compared with medium-term findings. Cobalt and chromium levels were significantly higher in metal-on-metal implants than in ceramic-on-ceramic ones and controls. Nevertheless, ion levels showed a tendency to decrease in comparison with medium-term content. In ceramic-on-ceramic implants, ion values were not significantly different from controls. Both in groups A and B, aluminum and titanium release were not significantly different from controls. In conclusion, negligible serum metal ion content was revealed in ceramic-on-ceramic patients. On the contrary, due to the higher ion release, metal-on-metal coupling must be prudently considered, especially in young patients, in order to obtain definitive conclusions.

Original languageEnglish
Pages (from-to)1569-1576
Number of pages8
JournalJournal of Orthopaedic Research
Issue number12
Publication statusPublished - Dec 2008


  • Alternative bearing
  • Arthroplasty
  • Ceramic-on-ceramic
  • Metal ions
  • Metal-on metal

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

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