High blood metal ion levels in 19 of 22 patients with metal-on-metal hinge knee replacements

Laitinen, Minna; Nieminen, Jyrki; Reito, Aleksi; Pakarinen, Toni-Karri; Suomalainen, Piia; Pamilo, Konsta; Parkkinen, Jyrki; Lont, Tõnis; Eskelinen, Antti

doi:10.1080/17453674.2017.1283846

Cited by 15 publications

(19 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This hypothesis is supported by several studies that show considerably elevated metal ion levels related to hinged TKA: Laitinen et al reported elevated Co-and Cr-ion levels of > 5 ppb in whole-blood samples of 19/22 patients with a MUTARS ® prosthesis applying a MoM coupling. In the control group with a MUTARS ® prosthesis using a metal-on-polyetheretherketone (PEEK) coupling, only 1 of 12 patients showed a similarly elevated Co-ion level [12]. Klasan et al found > 5 ppb Co-and Cr-ions in the blood serum of 16/23 patients with a MoM hinge knee design [28].…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, problems occurring with respect to the coupling mechanism do not seem to be overcome. Bushing wear has still been reported, as well as elevated blood cobalt and chromium levels related to the MoM coupling [9,12]. Even though exchange of the bushing itself is a standard procedure not requiring other parts of the system to be replaced, it affects the patient's life as an additional surgery.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Retrieval Analysis of Modern Knee Tumor Megaendoprosthesis Shows Considerable Volumetric Metal Wear Generated at the Rotating Hinge

et al. 2020

View full text Add to dashboard Cite

Frequently occurring damage, as well as elevated blood metal ion levels, are reported in relation to a tumor and revision system for total knee arthroplasty (TKA), which applies a rotating hinge coupling with a metal-on-metal (MoM) articulation. As the patient collective for this specific system is small, there is no data on wear generated from the couplings. In this study, wear volume and influencing parameters were investigated at 44 retrieved TKAs with MoM couplings. A scoring system rating frequently occurring abrasive wear between 0 (no wear) and 3 (distinct wear) was established. The wear score was correlated to time in vivo, bone resection length, patient weight and polyethylene inlay damage. Volumetric wear was estimated applying coordinate measurements. An elevated wear score of two or higher was found in 43% of cases. The mean wear rate accounted to 7.8 mm3/year. The main influencing coefficient for the extent of wear is time in vivo. We found a tendency for higher wear scores with higher inlay degradation scores. Patient weight and bone resection length did not impact coupling wear. Assessment of wear damage by a semi-quantitative scoring system has proven to be a reliable option for non-destructive coupling evaluation. The generated wear volume is high.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Retrieval Analysis of Modern Knee Tumor Megaendoprosthesis Shows Considerable Volumetric Metal Wear Generated at the Rotating Hinge

et al. 2020

View full text Add to dashboard Cite

show abstract

“…An association between cobalt and/or chromium concentrations, ranges from 2.5-10.0 µg L -1 in different cohorts and the development of pseudotumors has been suggested [246][247][248][249][250][251]. Although, the evidence that patients with pseudotumors have significantly greater metal ion levels, ranges from 2.2-11.0 µg L -1 in different cohorts, is not strong and remains controversial [252][253][254][255][256][257][258]. Moreover, the results do not, however, demonstrate whether Co and Cr have a causal role in the generation of pseudotumors.…”

Section: Pseudotumorsmentioning

confidence: 99%

Potentially toxic metallic wear nanoparticles and trace metal ions release from metal-on-metal orthopedic implants in the human biological specimens: An Overview of in vivo and ex vivo clinical studies

Matusiewicz¹,

Richter²

2020

World J. Adv. Res. Rev.

View full text Add to dashboard Cite

The use of metallic biomaterials in the medical implant devices has become increasingly prevalent over the past few decades. Patients find themselves being exposed to metals in a variety of ways, ranging from external exposure to instruments such as medical devices to internal exposure via surgical devices being implanted in their bodies. In situ generation of metallic wear nanoparticles, corrosion products and in vivo trace metal ions release from metal and metallic alloys implanted into the body in orthopedic surgery is becoming a major cause for concern regarding the health and safety of patients. The chemical form, particulate vs. ionic, of the metal species in the bodily fluids and tissues is a key to the local nanotoxicity effects arising in the body. Potential health risks are associated with metallic wear debris in the form of nanoparticles in situ generation and the release of in vivo trace metal ions into human biological specimen's circulation. This overview explores how migration of metallic wear nanoparticles and ultratrace metal ions in the area of metal-on-metal orthopedic implants influences the surrounding tissues and bodily fluids, and what the toxicological consequences of this process may be. Specifically, the present article is more informative of indicative multilevel in situ/in vivo/ex vivo analytical/clinical methodologies which will be helpful in a way to plan, understand and lead the analytical innovations in the area of nano-analysis to improve patient outcomes.

show abstract

“…In arthroplasty, cobalt is the main constituent (mass fraction > 60 %) of CoCrMo alloys that are used for bearing surfaces, but also for nonarticulating components, such as modular neck-stem taper junctions of (revision) hip prostheses. Systemic exposure to cobalt has been repeatedly demonstrated for all bearing surface combinations in patients with hip and/or knee joint replacements (▶ Table 1) [12][13][14]. Toxicologically relevant cobalt levels have, however, been primarily reported as sequelae of hip replacements with metal-on-metal bearings or following the use of metal heads in revision of fractured ceramic heads or articulations [4,15].…”

Section: Cobaltmentioning

confidence: 99%

Systemic Effects of Metals Released from Arthroplasty Implants – a Brief Summary

Rakow

Schoon

2020

Z Orthop Unfall

View full text Add to dashboard Cite

In recent years, increasing concern has been raised regarding potential systemic toxicity of metals released from arthroplasty implants. A lack of valid metal thresholds for human (organ) toxicity and the prospect of multi-decade survival of modern hip and knee replacements pose special challenges. Indeed, evidence of systemic effects of metals released from such implants is largely missing. Systemic cobalt exposure has repeatedly been associated with cardiotoxic and neurotoxic effects, and also with thyroid dysfunction. The toxic potential of chromium is considered less pronounced. Yet, in arthroplasty there is usually a co-exposure to chromium and cobalt which complicates evaluation of element-specific effects. Toxicity of titanium dioxide nanoparticles has been subject to debate among international regulatory authorities. Their wide use in a variety of products in everyday life, such as toothpaste, cosmetics and food colorants, hampers the assessment of an arthroplasty-induced systemic titanium exposure. To date there is no clear evidence for systemic complications due to titanium dioxide released from arthroplasty implants. Release of further metals such as tantalum, niobium, nickel, vanadium and zirconium from hip and knee replacement implants has been described occasionally, but systemic effects of respective long-term exposure scenarios are unknown. Generally, the characterization of all released metals regarding their chemical and physical specifications is critical for the evaluation of potential systemic risks. Systematic studies investigating the accumulation of metals relevant in arthroplasty in different organs/organ systems and the biological consequences of such accumulations are urgently needed.

show abstract

High blood metal ion levels in 19 of 22 patients with metal-on-metal hinge knee replacements

Cited by 15 publications

References 22 publications

Retrieval Analysis of Modern Knee Tumor Megaendoprosthesis Shows Considerable Volumetric Metal Wear Generated at the Rotating Hinge

Retrieval Analysis of Modern Knee Tumor Megaendoprosthesis Shows Considerable Volumetric Metal Wear Generated at the Rotating Hinge

Potentially toxic metallic wear nanoparticles and trace metal ions release from metal-on-metal orthopedic implants in the human biological specimens: An Overview of in vivo and ex vivo clinical studies

Systemic Effects of Metals Released from Arthroplasty Implants – a Brief Summary

Contact Info

Product

Resources

About