Association of serum metallic ion levels in patients with total joint arthroplasty with their adverse effects: a comparative cross-sectional study
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20251796Keywords:
Joint arthroplasty, Metal on metal implants, Serum metal ions, MateriovigilanceAbstract
Background: Metallic implants used in joint arthroplasty release ions gradually sometimes resulting in their toxicity. Hence, data regarding exact correlation between serum metallic ion levels and toxicity occurrence is still lacking.
Methods: A total of 90 adult subjects, each with a single total joint arthroplasty (TJA between 1 to 5 years), or without were recruited. The serum levels of Cr, Co, Ni, & Mo in above 2 groups were estimated and correlated with signs and symptoms related to Cr, Co, Ni, & Mo ion toxicity Unpaired Student's t-test, Chi-square test and Pearson correlation coefficient were used to analyses data. A p value<0.05 was considered significant.
Results: The mean serum levels of Cr (21.53±7448 µg/l vs. 19.03±0.3372 µg/l; p=0.0026), Ni (9.643±0.2486 µg/l vs. 9.303±0.2729 µg/l; p=0.83), Co (5.482±0.20 µg/l vs. 5.573±0.21 µg/l; p=0.76), and Mo (5.573±0.2159 µg/l vs. 5.290±0.2208 µg/l; p=0.36) in subjects with implants were higher than in subjects without implants. Five subjects reported six adverse effects (AE) specifically numbness in hands (4), fatigue (1), and bone pain (1), which showed no significant association or correlation with the mean serum levels of the metallic ions.
Conclusion: Results showed increased mean serum chromium levels post one year of implant surgery, while mean serum levels of Co, Ni, and Mo did not demonstrate any significant elevation. No correlation between serum levels of Cr, Co, Ni, and Mo, duration of implant, and observed AE was seen. Causality assessment between reported AE and metal ions (Cr, Co, Ni, and Mo) levels was “possible."
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References
Kremers HM, Larson DR, Crowson CS, Kremers WK, Washington RE, Steiner CA, et al. Prevalence of total hip and knee replacement in the United States. JBJS. 2015;97(17):1386-97. DOI: https://doi.org/10.2106/JBJS.N.01141
Bazaka O, Bazaka K, Kingshott P, Crawford RJ, Ivanova EP. Metallic implants for biomedical applications. 2021. DOI: https://doi.org/10.1039/9781788019828-00001
Merritt K, Brown SA. Distribution of cobalt chromium wear and corrosion products and biologic reactions. Clin Orthop. 1996;(329):233-43. DOI: https://doi.org/10.1097/00003086-199608001-00020
Chen QY, Marais T, Costa M. Metals and Mechanisms of Carcinogenesis. Annu Rev Pharmacol Toxicol. 2019;59:537–54. DOI: https://doi.org/10.1146/annurev-pharmtox-010818-021031
Wilthan B, Reschab H, Tanzer R, Schützenhöfer W, Pottlacher G. Thermophysical properties of a chromium–nickel–molybdenum steel in the solid and liquid phases. Int J Thermophy. 2008;29:434-44. DOI: https://doi.org/10.1007/s10765-007-0300-1
The use of the WHO-UMC system for standardised case causality assessment. World Health Organization. Available at: https://www.who.int/ publications/m/item/WHO-causality-assessment. Accessed on 14 August 2024.
Wilschefski SC, Baxter MR. Inductively Coupled Plasma Mass Spectrometry: Introduction to Analytical Aspects. Clin Biochem Rev. 2019;40(3):115–33. DOI: https://doi.org/10.33176/AACB-19-00024
Witzleb WC, Ziegler J, Krummenauer F, Neumeister V, Guenther KP. Exposure to chromium, cobalt and molybdenum from metal-on-metal total hip replacement and hip resurfacing arthroplasty. Acta Orthop. 2006;77(5):697–705. DOI: https://doi.org/10.1080/17453670610012863
Vendittoli PA, Mottard S, Roy AG, Dupont C, Lavigne M. Chromium and cobalt ion release following the Durom high carbon content, forged metal-on-metal surface replacement of the hip. J Bone Joint Surg Br. 2007;89(4):441–8. DOI: https://doi.org/10.1302/0301-620X.89B4.18054
Hip replacement surgery. Practice Plus Group. Available at: https://practiceplusgroup.com. Accessed on 21 January 2025.
Karlson EW, Daltroy LH, Liang MH, Eaton HE, Katz JN. Gender differences in patient preferences may underlie differential utilization of elective surgery. Am J Med. 1997;102:524-30.
Karlson EW, Daltroy LH, Liang MH, Eaton HE, Katz JN. Gender differences in patient preferences may underlie differential utilization of elective surgery. Am J Med. 1997;102(6):524-30. DOI: https://doi.org/10.1016/S0002-9343(97)00050-8
Luetzner J, Krummenauer F, Lengel AM, Ziegler J, Witzleb WC. Serum metal ion exposure after total knee arthroplasty. Clin Orthop. 2007;461:136–42. DOI: https://doi.org/10.1097/BLO.0b013e31806450ef
Reiner T, Sorbi R, Müller M, Nees T, Kretzer JP, Rickert M, et al. Blood metal ion release after primary total knee arthroplasty: A Prospective Study. Orthop Surg. 2020;12(2):396–403. DOI: https://doi.org/10.1111/os.12591
Hennig FF, Raithel HJ, Schaller KH, Döhler JR. Nickel-, chrom- and cobalt-concentrations in human tissue and body fluids of hip prosthesis patients. J Trace Elem Electrolytes Health Dis. 1992;6(4):239–43.
SeyyediBidgoli N, Mostafaii G, Akbari H, Mohammadzadeh M, Hesami Arani M, Miranzadeh M. Determination of the concentration of heavy metals in infused teas and their assessment of potential health risk in Kashan, Iran. Int J Environ Anal Chem. 2020;102:1–11. DOI: https://doi.org/10.1080/03067319.2020.1836174
Ghaderi A, Mohammadzadeh M, Banafshe HR, Mousavi SG, Mirzaei N, Parmoozeh Z, Mostafaei G, Rasouli-Azad M, Ghalerashidi HM, Fouladi-Fard R. The carcinogenic and non-carcinogenic risk assessment of heavy metals from the butts of smoked and non-smoked cigarettes. Human Ecol Risk Assessment: An Int J. 2023;29(1):187-201. DOI: https://doi.org/10.1080/10807039.2022.2150598
Min JH, Lee S, Lim HJ, Kang MK, Son H, Kim BG, et al. Characterization of nickel levels considering seasonal and intra-individual variation using three biological matrices. Environ Sci Poll Res. 2024;31(2):2546–54. DOI: https://doi.org/10.1007/s11356-023-31252-7
Centers for Disease Control and Prevention. Agency for Toxic Substances and Disease Registry/Geospatial Research, Analysis, and Services Program. CDC/ATSDR social vulnerability index. 2018.
Smolders JMH, Hol A, Rijnberg WJ, van Susante JLC. Metal ion levels and functional results after either resurfacing hip arthroplasty or conventional metal-on-metal hip arthroplasty. Acta Orthop. 2011;82(5):559–66. DOI: https://doi.org/10.3109/17453674.2011.625533
Hall DJ, Pourzal R, Jacobs JJ, Urban RM. Metal wear particles in hematopoietic marrow of the axial skeleton in patients with prior revision for mechanical failure of a hip or knee arthroplasty. J Biomed Mater Res B Appl Biomater. 2019;107(6):1930–6. DOI: https://doi.org/10.1002/jbm.b.34285
Thienpont E. Titanium niobium nitride knee implants are not inferior to chrome cobalt components for primary total knee arthroplasty. Arch Orthop Trauma Surg. 2015;135(12):1749–54. DOI: https://doi.org/10.1007/s00402-015-2320-9
Weissinger M, Grübl A, Pöll G. Serum-cobalt levels with metal-on-metal bearings in the cement-free total hip arthroplasty results covering two years; prospective study. Acta Chir Orthop Traumatol Cech. 2011;78(5):410–5. DOI: https://doi.org/10.55095/achot2011/063
Heise G, Black CM, Smith R, Morrow BR, Mihalko WM. In vitro effects of macrophages on orthopaedic implant alloys and local release of metallic alloy components. Bone Joint J. 2020;102(7):116–21. DOI: https://doi.org/10.1302/0301-620X.102B7.BJJ-2019-1556.R1
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