Scientific Articles   |    
Cobalt and Chromium Levels in Blood and Urine Following Hip Resurfacing Arthroplasty with the Conserve Plus Implant
Paul R. Kim, MD, FRCSC1; Paul E. Beaulé, MD, FRCSC1; Michael Dunbar, MD, FRCSC2; Joshua K.L. Lee, MBChB, FRCS(Tr&Orth)1; Nicholas Birkett, MD, MSc3; Michelle C. Turner, MSc4; Nagarajkumar Yenugadhati, MBBS, MSc4; Vic Armstrong, PhD4; Daniel Krewski, PhD, MHA3
1 Division of Orthopedics, The Ottawa Hospital–General Campus, Room W1650, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada. E-mail address for P.R. Kim: pkim@ottawahospital.on.ca
2 Division of Orthopaedic Surgery, QEII Health Sciences Centre, 1278 Tower Road, Halifax, NS B3H 3A7, Canada
3 Department of Epidemiology and Community Medicine, University of Ottawa, Room 3105, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada
4 McLaughlin Centre for Population Health Risk Assessment, Institute of Population Health, University of Ottawa, 1 Stewart Street, 3rd Floor, Ottawa, ON K1N 6N5, Canada
View Disclosures and Other Information
Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from Wright Medical Technology. In addition, one or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Stryker).

Investigation performed at The Ottawa Hospital—General Campus, Ottawa, Ontario, Canada

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 May 04;93(Supplement 2):107-117. doi: 10.2106/JBJS.J.01721
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case



The purpose of the present study was to determine cobalt and chromium ion levels in the blood and urine of patients in whom a modern-generation metal-on-metal hip resurfacing device had been implanted.


A total of ninety-seven patients with a Conserve Plus metal-on-metal hip resurfacing implant were followed prospectively for two years. Cobalt and chromium levels in erythrocytes, serum, and urine were measured preoperatively as well as three, six, twelve, and twenty-four months postoperatively.


The median serum cobalt and chromium ion levels were 1.04 µg/L (range, 0.31 to 7.42 µg/L) and 2.00 µg/L (range, 0.28 to 10.49 µg/L), respectively, at one year after surgery and 1.08 µg/L (range, 0.44 to 7.13 µg/L) and 1.64 µg/L (range, 0.47 to 10.95 µg/L), respectively, at two years after surgery. The corresponding mean levels (and standard deviations) of serum cobalt and chromium were 1.68 ± 1.66 µg/L and 2.70 ± 2.22 µg/L, respectively, at one year after surgery and 1.79 ± 1.66 µg/L and 2.70 ± 2.37 µg/L, respectively, at two years after surgery.


These levels compare favorably with other published ion results for metal-on-metal hip resurfacing and replacement implants. No pseudotumors or other adverse soft-tissue reactions were encountered in our study population. Further research is needed to determine the clinical importance of increased cobalt and chromium ion levels in serum and urine following metal-on-metal hip resurfacing.

Level of Evidence: 

Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org


    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe

    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    PubMed Articles
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    California - UCLA/OH Department of Orthopaedic Surgery