Effects of metal ions on white blood cells of patients with failed total joint arthroplasties

Abstract

In this study twenty-two patients who had revision surgery for aseptic loosening of joint prostheses were examined. The concentration in serum of soluble products of corrosion from the implant, that is, chromium (Cr), cobalt (Co), and nickel (Ni) ions, and the number of white blood cells (leucocytes, myeloid cells, lymphocyte subpopulations) were measured. Twenty patients with no implants were used as controls. The patients who had revision surgery showed normal Ni concentration whereas by statistical analysis that same patient group was shown to have serum Cr and Co levels significantly higher than those of the control. By flow cytometry, a significant decrease of leucocytes, myeloid cells, lymphocytes, and CD16 populations as found in patients versus controls whereas CD3, CD4, CD8, and CD20 positive cells were decreased, but not significantly. In the arthroplasty patients the Cr concentrations were inversely correlated with some of the immunologic parameters while no significant correlation was found between Co levels and decreased lymphocyte subpopulations. Only in revision surgery patients with high Cr concentrations did we find a significant decrease of lymphocytes, namely of CD4 and CD16 positive cells; revision surgery patients with normal Cr concentrations did not show a significant decrease of lymphocyte subpopulations. These data suggest that the presence of metal ions, especially chromium, released from prosthesis components could be associated with changes of lymphocyte subpopulations in patients with loosening of joint prostheses.

Exposure to chromium, cobalt and molybdenum from metal-on-metal total hip replacement and hip resurfacing arthroplasty

“…These findings are important since there is concern that chronic increases in serum chromium and cobalt may result in long-term adverse biological effects such as immune modulation, chromosomal damage and carcinogenesis (Vahey et al 1995, Visuri et al 1996, Savarino et al 1999, Granchi et al 2000. On the other hand, cobalt, chromium and molybdenum are cofactors for a number of enzymes and are essential trace metals, but can become toxic after a minimal increase in concentration (Rae 1981, Vyskocil andViau 1999).…”

The John Charnley Award: Metal-on-Metal Hip Resurfacing versus Large-diameter Head Metal-on-Metal Total Hip Arthroplasty

“…The rationale for the use of metal-on-metal articulation is that it produces less volumetric wear debris than metal-on-polyethylene and therefore may result in a decreased incidence of osteolysis-induced failure, particularly in young active patients who are expected to have a long life expectancy [12,27]. The widespread acceptance of metal-on-metal articulations has been tempered by concerns of increased metal ion production from these devices compared to standard total hip arthroplasty [14,18,19,25,31]. To date, there are no published clinical data to suggest that there are adverse health consequences related to the type of ion production associated with these devices; however, a recent paper suggest that pseudotumors may result from a reaction to high metal wear debris [29].…”

Effect of chromium and cobalt ions on primary human lymphocytesin vitro

“…These implants can release metal ions, metal complexes, or particulate metal following electrochemical or mechanical corrosion (Savarino et al, 1999). They mainly release chromium (Cr 6+ ) and cobalt (Co 2+ ) ions (Merritt and Brown, 1995;Shettlemore and Bundy, …”