“In the metal-on-metal group, concentrations of … increased significantly when compared with preoperative values: cobalt , 15.3-fold (95% confidence interval [CI], 9.4-21.2); chromium, 5.2-….5-7.0); nickel, 2.1-fold (CI, 1.2-3.0); and manganese , 1.6-fold (…-2.0).”