Evaluation of Titanium Serum Levels in Patients After Spine Instrumentation: Comparison Between Posterolateral and 360º Spinal Fusion Surgery

Bances, Ignacio Fernández; Aparicio, J. Paz; Álvarez-Vega, Marco

doi:10.7759/cureus.5451

Cited by 4 publications

(6 citation statements)

References 31 publications

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“…The most commonly used materials for joint replacement devices include polymers, ceramic composites, and metals [4]. Among these metals are stainless steel (iron-based alloy), cobalt alloys, chromium alloys, nickel, titanium-based alloys (Ti-6Al-4V), molybdenum, and tungsten [5,6]. The usage of a particular material, metal or alloy, depends on the application.…”

Section: Introductionmentioning

confidence: 99%

The Mechanism of Metallosis After Total Hip Arthroplasty

Ude

Esdaille

Ogueri

et al. 2021

Regen. Eng. Transl. Med.

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Metallosis is defined as the accumulation and deposition of metallic particles secondary to abnormal wear from prosthetic implants that may be visualized as abnormal macroscopic staining of periprosthetic soft tissues. This phenomenon occurs secondary to the release of metal ions and particles from metal-on-metal hip implants in patients with end-stage osteoarthritis. Ions and particles shed from implants can lead to local inflammation of surrounding tissue and less commonly, very rare systemic manifestations may occur in various organ systems. With the incidence of total hip arthroplasty increasing as well as rates of revisions due to prosthesis failure from previous metal-on-metal implants, metallosis has become an important area of research. Bodily fluids are electrochemically active and react with biomedical implants. Particles, especially cobalt and chromium, are released from implants as they abrade against one another into the surrounding tissues. The body’s normal defense mechanism becomes activated, which can elicit a cascade of events, leading to inflammation of the immediate surrounding tissues and eventually implant failure. In this review, various mechanisms of metallosis are explored. Focus was placed on the atomic and molecular makeup of medical implants, the component/surgical associated factors, cellular responses, wear, tribocorrosion, joint loading, and fluid pressure associated with implantation. Current treatment guidelines for failed implants include revision surgery. An alternative treatment could be chelation therapy, which may drive future studies. Lay Summary Arthroplasty is an invasive procedure which disrupts surrounding joint tissues, and can greatly perturb the joint’s immune homeostasis. In some instances, this may pose a difficult challenge to implant integration. Particles released from implants into the surrounding joint tissues activate the body’s defense mechanism, eliciting a cascade of events, which leads to biotribocorrosion and electrochemical attacks on the implant. This process may lead to the release of even more particles. Besides, implant makeup and designs, frictions between bearing surfaces, corrosion of non-moving parts with modular junctions, surgical mistakes, patient factor, comorbidities, and loosened components can alter the expected function of implants. High accumulations of these ions and particulates result in metallosis, with accompanying adverse complications. Current recommended treatment for failed prosthesis is revision surgeries. However, chelation therapy as a prophylactic intervention may be useful in future efforts but more investigation is required.

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Section: Introductionmentioning

confidence: 99%

The Mechanism of Metallosis After Total Hip Arthroplasty

Ude

Esdaille

Ogueri

et al. 2021

Regen. Eng. Transl. Med.

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“…Blood titanium concentrations have been well studied in hip arthroplasty and spinal fusion. 5 15 16 17) Preoperative titanium concentrations of less than 2 µg/L were reported in several studies. 5 15) Postoperative titanium concentrations following well-functioning hip arthroplasty have been reported to range from 1 to 3 µg/L.…”

Section: Discussionmentioning

confidence: 99%

“… 5 15 16 17) Preoperative titanium concentrations of less than 2 µg/L were reported in several studies. 5 15) Postoperative titanium concentrations following well-functioning hip arthroplasty have been reported to range from 1 to 3 µg/L. 5 16 17) There were two studies with elevated titanium concentrations in wellfunctioning hip arthroplasties.…”

Section: Discussionmentioning

confidence: 99%

“…A high postoperative concentration of titanium in the whole blood indicates wear of a conventional orthopedic implant and has been well-studied in hip arthroplasty and spinal fusion. 5 15 16 17) When failure of hip or knee implants occurs, the titanium concentration can increase 10- to 100-fold, as analyzed using the HR-ICP-MS method. 21 22 23 24) Even in 3D-printed implants, such an increase can indicate implant wear.…”

Section: Discussionmentioning

confidence: 99%

“…A high concentration of titanium alloys in the whole blood indicates implant wear in conventional orthopedic implants. 5 15 16 17) Although titanium is known to be a metal with low toxicological effects, if the postoperative metal systemic concentration is too high, adverse effects may occur. It is possible that the baseline concentrations of the metal components of the 3D-printed implant may be higher than those of conventional orthopedic implants.…”

mentioning

confidence: 99%

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Whole Blood Titanium Concentration after Limb Salvage Surgery with Three-Dimensional-Printed Ti6Al4V Implants

Park,

Jung,

Yang

et al. 2023

Clin Orthop Surg

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Background Three-dimensional (3D)-printed customized implants can be fabricated and utilized for all bones with massive bone defects. The main safety issues with 3D-printed implants made of Ti6Al4V alloy are related to the release of metal debris and residual powder. In this study, we investigated the perioperative titanium concentrations in whole blood and peri-implant fluid samples of patients who underwent limb salvage surgery with a 3D-printed Ti6Al4V implant. Methods Nineteen patients who underwent limb salvage surgery with 3D-printed Ti6Al4V implants were divided into two groups: the serial samples group and the follow-up group. To observe metal distribution and clearance in the body, serial samples of blood and peri-implant fluid from the surgical drain were prospectively collected for five patients in the serial samples group. For the remaining 14 patients who were followed up for more than a year, blood samples were collected only once. Results In the serial samples group, the mean baseline titanium concentration was 0.78 µg/L (range, 0.1–2.2 µg/L): 3 patients showed peak concentration before the third postoperative month, while 2 patients still showed an increasing pattern at this point. Total titanium mass in the surgical drain showed a wash-out phenomenon in a week, with a significant uniform decrease ( p = 0.04). In 14 patients in the follow-up group, the mean titanium concentration in the whole blood was 10.8 µg/L (range, 0.3–36.6 µg/L). For the 14 patients with a long-term follow-up, the aluminum and vanadium concentrations were all negligible. Conclusions Whole blood titanium concentrations were higher after surgery using 3D-printed implants than after that using conventional orthopedic implants, but markedly lower than in patients with implant failure. None of the patients developed serious clinical adverse effects during follow-up.

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Surface Modification and Biological Approaches for Tackling Titanium Wear-Induced Aseptic Loosening

Vishnu

Manivasagam

2021

J Bio Tribo Corros

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Evaluation of Titanium Serum Levels in Patients After Spine Instrumentation: Comparison Between Posterolateral and 360º Spinal Fusion Surgery

Cited by 4 publications

References 31 publications

The Mechanism of Metallosis After Total Hip Arthroplasty

The Mechanism of Metallosis After Total Hip Arthroplasty

Whole Blood Titanium Concentration after Limb Salvage Surgery with Three-Dimensional-Printed Ti6Al4V Implants

Surface Modification and Biological Approaches for Tackling Titanium Wear-Induced Aseptic Loosening

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