Darrith B, Rahman TM, Ananthasubramaniam K, et al. - This study was undertaken to ascertain whether there is a difference in echocardiographic outcomes between individuals with metal-on-metal (MoM) vs non-MoM total hip arthroplasty (THA) and to ascertain whether a relationship exists between serum metal levels and echocardiographic outcomes. This prospective cohort study enrolled a total of 75 patients with the same modular THA, and 49 had MoM bearings. They compared serum metal concentrations and echocardiographic parameters with 2-way t-tests. Any significant predictors of echocardiographic outcomes were distinguished by multiple linear regression analyses. Associations were found between MoM THA bearings, elevated serum cobalt and chromium levels. The results revealed that individuals with MoM THAs had reduced global longitudinal strain, a measure of left ventricular function, but both groups remained within the normal range. The clinical effect of the positive relationship between serum cobalt concentration and tricuspid annular plane systolic excursion, a marker of right ventricular function, deserves future research. These data can reassure physicians and individuals that metal-induced cardiomyopathy is not typical in the setting of MoM THA.