{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:54:43Z","timestamp":1790297683882,"version":"4.1.0"},"reference-count":24,"publisher":"British Editorial Society of Bone & Joint Surgery","issue":"10","license":[{"start":{"date-parts":[[2013,10,1]],"date-time":"2013-10-01T00:00:00Z","timestamp":1380585600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/online.boneandjoint.org.uk\/TDM"}],"content-domain":{"domain":["online.boneandjoint.org.uk"],"crossmark-restriction":true},"short-container-title":["The Bone &amp; Joint Journal"],"published-print":{"date-parts":[[2013,10]]},"abstract":"<jats:p>A retrospective study was conducted to investigate the changes in metal ion levels in a consecutive series of Birmingham Hip Resurfacings (BHRs) at a minimum ten-year follow-up. We reviewed 250 BHRs implanted in 232 patients between 1998 and 2001. Implant survival, clinical outcome (Harris hip score), radiographs and serum chromium (Cr) and cobalt (Co) ion levels were assessed.<\/jats:p>\n                  <jats:p>Of 232 patients, 18 were dead (five bilateral BHRs), 15 lost to follow-up and ten had been revised. The remaining 202 BHRs in 190 patients (136 men and 54 women; mean age at surgery 50.5 years (17 to 76)) were evaluated at a minimum follow-up of ten years (mean 10.8 years (10 to 13.6)). The overall implant survival at 13.2 years was 92.4% (95% confidence interval 90.8 to 94.0). The mean Harris hip score was 97.7 (median 100; 65 to 100). Median and mean ion levels were low for unilateral resurfacings (Cr: median 1.3 \u00b5g\/l, mean 1.95 \u00b5g\/l (&lt; 0.5 to 16.2); Co: median 1.0 \u00b5g\/l, mean 1.62 \u00b5g\/l (&lt; 0.5 to 17.3)) and bilateral resurfacings (Cr: median 3.2 \u00b5g\/l, mean 3.46 \u00b5g\/l (&lt; 0.5 to 10.0); Co: median 2.3 \u00b5g\/l, mean 2.66 \u00b5g\/l (&lt; 0.5 to 9.5)). In 80 unilateral BHRs with sequential ion measurements, Cr and Co levels were found to decrease significantly (p &lt; 0.001) from the initial assessment at a median of six years (4 to 8) to the last assessment at a median of 11 years (9 to 13), with a mean reduction of 1.24 \u00b5g\/l for Cr and 0.88 \u00b5g\/l for Co. Three female patients had a &gt; 2.5 \u00b5g\/l increase of Co ions, associated with head sizes \u2264 50 mm, clinical symptoms and osteolysis. Overall, there was no significant difference in change of ion levels between genders (Cr, p = 0.845; Co, p = 0.310) or component sizes (Cr, p = 0.505; Co, p = 0.370). Higher acetabular component inclination angles correlated with greater change in ion levels (Cr, p = 0.013; Co, p = 0.002). Patients with increased ion levels had lower Harris hip scores (p = 0.038).<\/jats:p>\n                  <jats:p>In conclusion, in well-functioning BHRs the metal ion levels decreased significantly at ten years. An increase &gt; 2.5 \u00b5g\/l was associated with poor function.<\/jats:p>\n                  <jats:p>Cite this article: Bone Joint J 2013;95-B:1332\u20138.<\/jats:p>","DOI":"10.1302\/0301-620x.95b10.32022","type":"journal-article","created":{"date-parts":[[2013,9,27]],"date-time":"2013-09-27T11:59:25Z","timestamp":1380283165000},"page":"1332-1338","update-policy":"https:\/\/doi.org\/10.1302\/crossmark-policy","source":"Crossref","is-referenced-by-count":67,"title":["Metal ion levels from well-functioning Birmingham Hip Resurfacings decline significantly at ten years"],"prefix":"10.1302","volume":"95-B","author":[{"given":"C.","family":"Van Der Straeten","sequence":"first","affiliation":[{"name":"Ghent University Hospital, Department\rof Orthopaedics and Traumatology, De Pintelaan\r185, 9000 Ghent, Belgium."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Van Quickenborne","sequence":"additional","affiliation":[{"name":"ANCA Medical Centre, Xavier\rDe Cocklaan 68\/1, B-9831 St-Martens-Latem, Belgium."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"De Roest","sequence":"additional","affiliation":[{"name":"ANCA Medical Centre, Xavier\rDe Cocklaan 68\/1, B-9831 St-Martens-Latem, Belgium."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Calistri","sequence":"additional","affiliation":[{"name":"Anca Clinic Roma, Via\rG. De Notaris 2\/B, 00197 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Victor","sequence":"additional","affiliation":[{"name":"Ghent University Hospital, Department\rof Orthopaedics and Traumatology, De Pintelaan\r185, 9000 Ghent, Belgium."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"De Smet","sequence":"additional","affiliation":[{"name":"ANCA Medical Centre, Xavier\rDe Cocklaan 68\/1, B-9831 St-Martens-Latem, Belgium."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"42","reference":[{"key":"r1","doi-asserted-by":"publisher","DOI":"10.1080\/00016470510030292"},{"key":"r2","unstructured":"Garellick G, K\u00e4rrholm J, Rogmark C, Rolfson O, Herberts P.\n                      Swedish Hip Registry: Annual Report 2011, page 80. www.shpr.se\/Files\/\u00c5rsrapport%202011%20(eng)%20webb.pdf (date last accessed 11 June 2013)."},{"key":"r3","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2008.06.015"},{"key":"r4","doi-asserted-by":"publisher","DOI":"10.1243\/095441105X68944"},{"key":"r5","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.93B2.25099"},{"key":"r6","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.H.00437"},{"key":"r7","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.H.00531"},{"key":"r8","doi-asserted-by":"publisher","DOI":"10.1177\/0954411911431397"},{"key":"r9","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-010-1383-8"},{"key":"r10","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.H.00672"},{"key":"r11","doi-asserted-by":"publisher","DOI":"10.1016\/j.ocl.2011.01.003"},{"key":"r12","unstructured":"No authors listed.\n                      Medical device alert of the Medicines and Healthcare products Regulatory Agency on all metal-on-metal (MoM) hip replacements. www.mhra.gov.uk\/Publications\/Safetywarnings\/MedicalDeviceAlerts (date last accessed 10 June 2013)."},{"key":"r13","unstructured":"No authors listed.\n                      U.S. Food and Drug Administration (FDA): FDA 522 guidance document: concerns about metal-on-metal hip implant systems. www.fda.gov\/MedicalDevices\/ProductsandMedicalProcedures\/ImplantsandProsthetics\/MetalonMetalHipImplants\/ucm241604.htm (date last accessed 11 June 2013)."},{"key":"r14","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-012-2526-x"},{"key":"r15","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-196951040-00012"},{"key":"r16","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-197510000-00021"},{"key":"r17","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2009.08.020"},{"key":"r18","unstructured":"No authors listed.\n                      Australian Orthopaedic Association National Joint Replacement Registry: annual report, 2012. https:\/\/aoanjrr.dmac.adelaide.edu.au\/annual-reports-2012 (date last accessed 10 June 2013)."},{"key":"r19","unstructured":"No authors listed.\n                      National Joint Registry for England and Wales 9th annual report, 2012. http:\/\/www.njrcentre.org.uk (date last accessed 10 June 2013)."},{"key":"r20","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.91B8.22562"},{"key":"r21","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-012-2563-5"},{"key":"r22","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmbbm.2012.08.009"},{"key":"r23","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2012.07.040"},{"key":"r24","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.92B12.24654"}],"container-title":["The Bone &amp; Joint Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/online.boneandjoint.org.uk\/doi\/pdf\/10.1302\/0301-620X.95B10.32022","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/online.boneandjoint.org.uk\/doi\/full-xml\/10.1302\/0301-620X.95B10.32022","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/online.boneandjoint.org.uk\/doi\/pdf\/10.1302\/0301-620X.95B10.32022","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,18]],"date-time":"2021-10-18T21:18:15Z","timestamp":1634591895000},"score":1,"resource":{"primary":{"URL":"https:\/\/online.boneandjoint.org.uk\/doi\/10.1302\/0301-620X.95B10.32022"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,10]]},"references-count":24,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2013,10]]}},"alternative-id":["10.1302\/0301-620X.95B10.32022"],"URL":"https:\/\/doi.org\/10.1302\/0301-620x.95b10.32022","relation":{},"ISSN":["2049-4394","2049-4408"],"issn-type":[{"value":"2049-4394","type":"print"},{"value":"2049-4408","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,10]]},"assertion":[{"value":"2013-03-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2013-06-10","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2013-10-01","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}