Metal Release and Excretion From Cementless Titanium Alloy Total Knee Replacements

Jacobs, Joshua J.; Silverton, Craig D.; Hallab, Nadim J.; Skipor, Anastasia K.; Patterson, Leslie; Black, Jonathan; Galante, Jorge O.

doi:10.1097/00003086-199901000-00021

Cited by 131 publications

(71 citation statements)

References 31 publications

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“…Elevation of serum metal levels after primary total hip arthroplasty is well-documented 4,12,[14][15][16][17] , and several studies have investigated the serum levels of cobalt and chromium after joint arthroplasty [14][15][16]18,19 . However, there is limited information available regarding the long-term impact of primary metal-onpolyethylene total hip replacements on the serum concentrations of metals, particularly for serum titanium in titanium-containing implants 4,12,20,21 .…”

Section: Discussionmentioning

confidence: 99%

Ten-Year Outcome of Serum Metal Ion Levels After Primary Total Hip Arthroplasty

Levine

Hsu

Skipor

et al. 2013

The Journal of Bone and Joint Surgery

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101

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We previously reported on the metal ion concentrations of cobalt, chromium, and titanium that were found in the serum of patients three years after they had undergone primary total hip arthroplasty as compared with the concentrations found in the serum of control patients who did not have an implant. This study is a concise update on the serum metal levels found in a cohort of these patients ten years after the time of hip implantation. Of the original seventy-five subjects, metal ion levels were available for forty patients (53%). Ten patients (hybrid group) had received a hybrid total hip replacement that consisted of a modular cobalt-alloy femoral stem with a cobalt-alloy femoral head that had been inserted with cement and a titanium acetabular socket that had been inserted without cement. Nine patients (cobalt-chromium [CoCr] group) had received an implant with an extensively porous-coated modular cobalt-alloy femoral stem and femoral head along with a titanium acetabular socket; the femoral and acetabular components had each been inserted without cement. Eight patients (titanium group) had undergone insertion of a proximally porous-coated modular titanium-alloy femoral stem with a cobaltalloy femoral head and a titanium acetabular socket; the femoral and acetabular components had each been inserted without cement. Thirteen patients (control group) from the original control group of patients who had not received an implant served as control subjects. Serum metal levels were measured with use of high-resolution sector field inductively coupled plasma mass spectrometry. The hybrid total hip arthroplasty group had mean cobalt levels that were 3.2 times higher at 120 months than they were at baseline, and the cobalt levels in that group were significantly higher than those in the titanium total hip arthroplasty group at thirty-six, sixty, eighty-four, ninety-six, and 120 months (p < 0.01). The hybrid group had mean chromium levels that were 3.9 times higher at 120 months than they were at baseline, and the CoCr total hip arthroplasty group had chromium levels that were 3.6 times higher at 120 months than they were at baseline. The serum titanium levels were higher in the titanium group at all follow-up time intervals as compared with the levels in all other groups, and the level in the titanium group at 120 months was eighteen times higher than it was at baseline (p < 0.01). Patients with well-functioning primary metal-on-polyethylene total hip replacements had elevated serum metal levels for as many as ten years postoperatively. Furthermore, metal release at the modular femoral head-neck junctions, rather than passive dissolution from porous ingrowth surfaces, was likely the dominant source of serum cobalt and chromium.continued

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Section: Discussionmentioning

confidence: 99%

Ten-Year Outcome of Serum Metal Ion Levels After Primary Total Hip Arthroplasty

Levine

Hsu

Skipor

et al. 2013

The Journal of Bone and Joint Surgery

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101

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“…Wooley et al [48,5 1,521, have previously shown that patients with implant debris related aseptic osteolysis demonstrate elevated immune responses to metal and polyethylene particle challenge, thus dramatically extending the etiology of hypersensitivity reactions to implant materials into the realm of particulate as well as soluble debris. However, generally, the short-and long-term pharmacodynamics and bioavailability of circulating metal degradation products in vivo remains poorly characterized [5,26,29,41].…”

Section: Introductionmentioning

confidence: 99%

Lymphocyte responses in patients with total hip arthroplasty

Hallab

Anderson

Stafford

et al. 2005

Journal Orthopaedic Research

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233

145

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How lymphocyte-mediated metal sensitivity affects orthopaedic implant performance remains poorly understood. Do patients with implants exhibit elevated lymphocyte reactivity to metals and is this reactivity more generalized or more implant-alloy specific? We investigated these questions by measuring lymphocyte responses to implant metals (Cr", Cof7, Ni+' at 0.1 mM, and Ti+4 at 0.001 mM) in six subject groups: Group la = young controls, Group 1 b = age matched controls, Group 2a = subjects with osteoarthritis (OA) and no history of metal sensitivity, Group 2b = OA subjects with history of metal sensitivity, Group 3a = total hip arthroplasty (THA) subjects with no to mild radiographic osteolysis, and Group 3b = THA subjects with moderate osteolysis. Lymphocyte proliferation, using Lymphocyte Transformation Testing (LTT), and cytokine release provided quantitative reactivity measurement, where a stimulation index of >2 indicated metal sensitivity. OA subjects with a history of metal sensitivity (Group 2b) were more metal reactive to Ni than any other group, as expected (66%) incidence and Stimulation Index >20). However, THA subjects (Groups 3a & b) were >3 fold more reactive to Cr (p < 0.04), than were controls (Groups la & b) or OA subjects (Groups 2a & b). THA subjects with moderate vs mild osteolysis (Group 3b vs 3a) were more reactive to Co (43% vs 0% incidence). Only osteolytic THA subjects demonstrated increased cytokine responses with >two-fold (p < 0.05) increases in soluble interferon-y (IFN-y) and interleukin-2 (IL-2) levels in response to Cr challenge. This elevated incidence and averaged level of lymphocyte reactivity supports a metal-specific adaptive immune response and suggests involvement in the pathogenesis of poor implant performance, e.g. aseptic osteolysis.

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“…Additionally, appearance of allergic reaction limits their use as orthopedic joint prosthesis [7,8]. Release of metallic ions, as corrosion product, in the human body can reduce the lifetime of the implant leading to an additional surgical procedure [9][10][11][12]. If high amount of Ni ions is released in the tissues, development of the most common contact allergy [13,14] and cancer [15,16] can be favored.…”

Section: Outlinementioning

confidence: 99%

Up-to-Date Knowledge and Outlooks for the Use of Metallic Biomaterials: Review Paper

Peter¹,

Matekovits²,

Rosso³

2018

Biomaterials in Regenerative Medicine

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In all cases, when a material has to be used in medical applications, the knowledge of its physical, chemical and biological properties is of fundamental signiicance, since the direct contact between the biological system and the considered device could generate reactions whose long-term efects must be clearly quantiied. The class of materials that exhibits characteristics that allow their use for the considered applications are commonly called biomaterials. Patients sufering from diferent diseases generate a great demand for real therapies, where the use of biomaterials are mandatory. Commonly, metallic biomaterials are used because their structural functions; the high strength and resistance to fracture they can ofer, provide reliable performance primarily in the ields of orthopedics and dentistry.In metals, because of their particular structure, plastic deformation takes place easier, inducing good formability in manufacturing. The present paper is not encyclopaedic, but reports in the irst part some current literature data and perspectives about the possibility of use diferent class of metallic materials for medical applications, while the second part recalls some results of the current research in this ield carried out by the authors.

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Metal Release and Excretion From Cementless Titanium Alloy Total Knee Replacements

Cited by 131 publications

References 31 publications

Ten-Year Outcome of Serum Metal Ion Levels After Primary Total Hip Arthroplasty

Ten-Year Outcome of Serum Metal Ion Levels After Primary Total Hip Arthroplasty

Lymphocyte responses in patients with total hip arthroplasty

Up-to-Date Knowledge and Outlooks for the Use of Metallic Biomaterials: Review Paper

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