Content of distinct metals in periprosthetic tissues and pseudosynovial joint fluid in patients with total joint arthroplasty

Abstract

This prospective study examined the content of metals released from total joint arthroplasty into joint fluid, whole blood and periprosthetic tissues. We determined the levels of Ti, V, Nb, Co, Cr, and Mo, using inductively coupled plasma mass spectrometry, in samples from patients who underwent reoperation of total hip or knee arthroplasty. All of the patients (n = 117) included in the study had either metal on polyethylene or ceramic on polyethylene-bearing pairs. First, our results conclusively showed that the majority of released metals were deposited in periprosthetic tissues. In this context, the bloodstream turned out to be an ineffective biomarker of the effects occurring in local tissues. Second, there was a clear time-dependent nature of metallic accumulation. Based on our extensive dataset, we found significantly elevated levels of the released metals in joint fluid and periprosthetic tissues originating from loosened implants compared to stable ones, as well as recognizable differences between the groups with stable implants and aseptic loosening. Finally, it was proved that the concentrations of metals decreased dependent on the distance of the tissue from the implant. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2018.

Analysis of Cellular Activity and Induction of Inflammation in Response to Short-Term Exposure to Cobalt and Chromium Ions in Mature Human Osteoblasts

“…For the experiments, we used Co(2+), Cr(3+) and Ni(2+) ions derived from metal salts. The tested concentrations were similar to those found in periprosthetic soft tissue [18] but lower than those reported for mineralized bone tissue [22]. The authors explained the relative high values in the mineralized bone tissue with the fact that the tissue was derived from the immediate vicinity, i.e., within a few millimeters, of the implant.…”

“…Based on previous studies by Scharf et al (2014) and Drynda et al (2018) we used ion concentrations between 10 µM and 500 µM [6,23]. These concentrations correspond to 0.59–29.47 ppm Co and 0.52–26.00 ppm Cr and are similar to those reported in periprosthetic tissue by Kuba et al (2019) [18], but lower than those in bone tissue [22]. However, due to the analytical methodology it is difficult to specify whether the determined metal concentration originated from metal particles or metal ions.…”

“…Scharf et al [6] measured an average of 0.17 ppm for cobalt and 1.60 ppm for chromium in tissue surrounding of total hip implants with metal on metal (MoM) bearings in nine patients with revisions due to adverse local tissue reactions [6]. In a more recent publication by Kuba et al (2019) revision patients with long-term surviving implants displayed mean values of 6.52 ± 16.38 ppm for cobalt and 8.88 ± 26.88 ppm for chromium in periprosthetic tissue—concentrations in joint fluid were around 0.048 ppm for Co and 0.167 ppm for Cr [18]. However, in the rare cases, where wear and loosening led to acute poisoning, local concentrations of 41 ppm Co [16] up to 397.8 ppm Co and 236.0 ppm Cr [19] in periprosthetic tissue, or 76 ppm Co and 126.5 ppm Cr in locally aspirated liquid [14], were reported.…”

The number of lymphocytes increases in the periprosthetic tissues with increasing time of implant service in non-metal-on-metal total joint arthroplasties: A role of metallic particles?

“…The determination of Co, Cr, Ti and V in tissue samples was carried out by Inductively Coupled Plasma Mass Spectrometry (ICP-MS) after microwave digestion with a mixture of HNO 3 and H 2 O 2 . The detailed measurement procedure including sample pretreatment and measures taken to assure quality of results is described in detail in our previous study 12 . A.…”

“…Metals are released from all metallic implants by the mechanism of corrosion or tribocorrosion 7,10,11 . Several studies reported concentrations of selected metals in the periprosthetic tissues, joint fluid, or peripheral blood range [12][13][14][15] . The character of the tissue response to the presence of metals has been also studied [16][17][18] .…”