Serum titanium level for diagnosis of a failed, metal-backed patellar component

Leopold, Seth S.; Berger, Richard A.; Patterson, Leslie; Skipor, Anastasia K.; Urban, Robert M.; Jacobs, Joshua J.

doi:10.1054/arth.2000.6632

Cited by 55 publications

(31 citation statements)

References 30 publications

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“…Leopold et al reported a failed patellar component in total knee arthroplasty, with elevated serum titanium at least 20 times higher than normal values [16,21]. The highest titanium serum concentrations of our series were found in cases of mechanical complications such as stem fixation (subsidences) or neck impingement.…”

Section: Discussionmentioning

confidence: 43%

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Clinical and biological assessment of cemented titanium femoral stems: an 11-year experience

Boyer

Lazennec

Poupon

et al. 2008

International Orthopaedics (SICOT)

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This study prospectively assessed the outcome of 134 cemented titanium stems and serum ion levels. The stems were polished (0.1 μm Ra) with circular cross section. At the end point, only one stem revision was performed for aseptic loosening, and two were planned due to subsidence greater than 5 mm. Non-progressive radiolucencies in zones 1 and 7 were observed in 16 hips at the cement-bone interface without osteolysis. Median serum titanium concentrations were below the detection limit (30 nmol/l) except in patients with failed stems. The overall stem survival rate was 97.7% at nine years, which is comparable to other series of cemented stems. The protective layer of titanium oxide coating the stem and a thick cement mantle may help resist aseptic loosening. In addition, satisfactory monitoring of the stem was reached using titanium serum level determination.Résumé Cette étude rapporte le suivi clinique prospectif d'une série de 134 tiges fémorales titane cimentées et l'évolution des taux de titane sérique. Les implants étaient en titane anodisé, lisses (0.1-microm Ra) et de section circulaire. Au recul moyen de 9 ans, le taux de survie était de 97,7%, ce qui est comparable aux autres séries de tiges cimentées. On notait une reprise pour descellement et deux révisions prévisibles pour un enfoncement supérieur à 5 mm. Des liserés non évolutifs étaient observés en zones 1 et 7 pour 16 hanches sans ostéolyse. La médiane du titane sérique était inférieure à la limite de détection (30 nmol/l) à l'exception des 3 échecs où les taux sont étaient nettement plus élevés. La couche protectrice d'oxyde de titane et l'épaisseur du manteau de ciment peuvent expliquer la résistance au descellement aseptique. Le taux de titane sérique semble intéressant pour la surveillance des tiges titanes cimentées.

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Section: Discussionmentioning

confidence: 43%

“…Several previous reports have shown significantly increased levels in cases of failed arthroplasty [4,21]. Leopold et al reported a failed patellar component in total knee arthroplasty, with elevated serum titanium at least 20 times higher than normal values [16,21].…”

Section: Discussionmentioning

confidence: 98%

Clinical and biological assessment of cemented titanium femoral stems: an 11-year experience

Boyer

Lazennec

Poupon

et al. 2008

International Orthopaedics (SICOT)

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“…Koh et al [21] reported a successful outcome in 29 of 29 knees, Chan et al [11] reported a successful outcome in 21 of 22 knees, and Kobori et al [20] reported a successful outcome in 11 of 12 knees after isolated patellar revisions for metal-backed patellar failure. In contrast, other authors have reported limited success and higher failure rates after isolated patellar component revision procedures for metalbacked patellar component failure [2,8,9,23].…”

Section: Discussionmentioning

confidence: 99%

“…Failure of the metal-backed patellar component in TKA has been well documented throughout the literature [1,3,4,7,22,23,25,26,31,32,35,36]. This high rate of failure has subsequently led to the markedly decreased use of these components [12,16,31,36].…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, the metal backing provided a porous coating for cementless fixation. Shortly after the introduction of the metal-backed patellar component into clinical use, early and frequent failures of a variety of dome-shaped metal-backed patellar components became apparent [1,3,4,7,22,23,25,26,31,32,35,36]. In contrast to these reports of metal-backed patellar failures, other authors have reported long-term successful outcomes with metal-backed patellar components of a mobile-bearing design [19].…”

Section: Introductionmentioning

confidence: 99%

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Isolated All-polyethylene Patellar Revisions for Metal-backed Patellar Failure

Garcia

Kraay

Goldberg

2008

Clinical Orthopaedics &Amp; Related Research

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The outcome of isolated patellar component revisions after metal-backed patellar failure is variable with satisfactory results reported from 78% to 100%. To supplement information in the literature we determined the failure rate and the functional outcome based on the Knee Society clinical and roentgenographic evaluation systems of isolated patellar component revisions after metal-backed patellar component failure. We retrospectively reviewed 27 patients with 28 isolated patellar component revisions for metal-backed patellar component failure performed between 1988 and 2005. Twenty-five knees in 24 patients were available for review with a minimum followup of 24 months (mean, 90 months; range, 24-210 months).

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In vitro biocorrosion of Ti‐6Al‐4V implant alloy by a mouse macrophage cell line

Lin

Bumgardner

2004

J Biomedical Materials Res

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Corrosion of implant alloys releasing metal ions has the potential to cause adverse tissue reactions and implant failure. We hypothesized that macrophage cells and their released reactive chemical species (RCS) affect the alloy's corrosion properties. A custom cell culture corrosion box was used to evaluate how cell culture medium, macrophage cells and RCS altered the Ti-6Al-4V corrosion behaviors in 72 h and how corrosion products affected the cells. There was no difference in the charge transfer in the presence (75.2 +/- 17.7 mC) and absence (62.3 +/- 18.8 mC) of cells. The alloy had the lowest charge transfer (28.2 +/- 4.1 mC) and metal ion release (Ti < 10 ppb, V < 2 ppb) with activated cells (releasing RCS) compared with the other two conditions. This was attributed to an enhancement of the surface oxides by RCS. Metal ion release was very low (Ti < 20 ppb, V < 10 ppb) with nonactivated cells and did not change cell morphology, viability, and NO and ATP release compared with controls. However, IL-1beta released from the activated cells and the proliferation of nonactivated cells were greater on the alloy than the controls. In summary, macrophage cells and RCS reduced the corrosion of Ti-6Al-4V alloys as hypothesized. These data are important in understanding host tissue-material interactions.

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Serum titanium level for diagnosis of a failed, metal-backed patellar component

Cited by 55 publications

References 30 publications

Clinical and biological assessment of cemented titanium femoral stems: an 11-year experience

Clinical and biological assessment of cemented titanium femoral stems: an 11-year experience

Isolated All-polyethylene Patellar Revisions for Metal-backed Patellar Failure

In vitro biocorrosion of Ti‐6Al‐4V implant alloy by a mouse macrophage cell line

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