Blood and plasma titanium levels associated with well-functioning hip implants

Abstract

Background: Hip implants are usually manufactured from cobalt-chromium and titanium alloys. As the implants wear and corrode, metal debris is released into the surrounding tissue and blood, providing a potential biomarker for their function. Whilst there are laboratory reference levels for blood cobalt and chromium in patients with well and poorly functioning hip implants, there are no such guidelines for titanium. This is despite the increasing use of titanium implants worldwide. Patients and methods: We recruited a consecutive series of 95 patients (mean age 71 years, mean time after surgery 8.5 years) with one hip implant type, inserted by the same surgeon. We assessed clinical and radiological outcome, and measured blood and plasma titanium using high resolution inductively-coupled plasma mass spectrometry. Results: The upper normal reference limit for blood and plasma titanium was 2.20 and 2.56 g L-1 , respectively, and did not differ significantly between males and females. Conclusion: We are the first to propose a laboratory reference level for blood and plasma titanium in patients with well-functioning titanium hip implants. This is an essential starting point for further studies to explore the clinical usefulness of blood titanium as a biomarker of orthopaedic implant performance, and comes at a time of considerable controversy regarding the use of certain titanium alloys in hip arthroplasty.

A Case of Titanium Pseudotumor and Systemic Toxicity After Total Hip Arthroplasty Polyethylene Failure

“…In the context of joint arthroplasty, baseline titanium levels in patients who underwent THA have only recently been explored. In one series of 95 patients undergoing THA, Swiatkowska et al report a mean plasma titanium level of 2.5 micrograms/L to be indicative of a well-functioning implant at 8.5-year follow-up [15]. Savarino et al similarly report an upper limit of normal for serum titanium in these patients to be 4.5 mcg/L at 10 years and 5.1 mcg/L at 2-to 7year follow-up, respectively [16,17].…”

“…In one series of 95 patients undergoing THA, Swiatkowska et al. report a mean plasma titanium level of 2.5 micrograms/L to be indicative of a well-functioning implant at 8.5-year follow-up [ 15 ]. Savarino et al.…”

Benefits and Biosafety of Use of 3D-Printing Technology for Titanium Biomedical Implants: A Pilot Study in the Rabbit Model

“…Most studies agree on the level of titanium between the ranges of 50-150 µg/kg although in our study and for the reasons alluded to above, the levels are much higher even in the unoperated control group. We can only compare the levels of the printed implant group to that the gold standard milled implant group as a measure of safety [86][87][88].…”

Management of patients with magnetically controlled growth rods amidst the global COVID-19 pandemic

“…As an additional consideration, there is evidence of titanium debris being released from the devices due to the failure modes described above [4]. It is proposed that measures of titanium levels in blood samples from MAGEC patients may be a useful additional monitoring tool if it is practically possible and the appropriate collection, storage and analysis protocols can be utilised without impacting any resources required for the management of the pandemic [5]. This, however, requires further research to better understand the sensitivity and specificity of this measure.…”