Metal Ion Levels: How Can They Help Us?

Ion levels have been shown to reliably predict abnormal function of the bearing surface with increased wear, but ion levels should not be used alone as a trigger for when to proceed with revision surgery with metal–metal articulations. Risk stratification strategies help determine which patients should be monitored more closely with serial ion levels, cross-sectional imaging with a MARS MRI, or proceed on to revision. Based on the current data available, an ion level greater than 4.5 ppb (Cr or Co) may serve as a threshold for when abnormal wear is occurring, and is suggested as a trigger for a MARS MRI scan.