Metal Concentrations in the Serum and Hair of Patients With Titanium Alloy Spinal Implants

Kasai, Yuichi; Iida, Ryu; Uchida, Atsushi

doi:10.1097/01.brs.0000065482.41115.b4

Cited by 82 publications

(75 citation statements)

References 25 publications

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“…Leopold et al reported a failed patellar component in total knee arthroplasty, with elevated serum titanium at least 20 times higher than normal values [16,21]. The highest titanium serum concentrations of our series were found in cases of mechanical complications such as stem fixation (subsidences) or neck impingement.…”

Section: Discussionmentioning

confidence: 48%

“…In our study, medians were constant in range up to a mean follow-up of nine years in both unilateral and bilateral hip replacement groups and were always under the DL. The low serum concentrations observed are reassuring with regard to some concerns about potential titanium toxicity [16]. Although titanium is considered safe except for its potential osteolytic activity, it circulates throughout the body and particles have been found in hair, lungs, brain, urine and serum [16].…”

Section: Discussionmentioning

confidence: 96%

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Clinical and biological assessment of cemented titanium femoral stems: an 11-year experience

Boyer

Lazennec

Poupon

et al. 2008

International Orthopaedics (SICOT)

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This study prospectively assessed the outcome of 134 cemented titanium stems and serum ion levels. The stems were polished (0.1 μm Ra) with circular cross section. At the end point, only one stem revision was performed for aseptic loosening, and two were planned due to subsidence greater than 5 mm. Non-progressive radiolucencies in zones 1 and 7 were observed in 16 hips at the cement-bone interface without osteolysis. Median serum titanium concentrations were below the detection limit (30 nmol/l) except in patients with failed stems. The overall stem survival rate was 97.7% at nine years, which is comparable to other series of cemented stems. The protective layer of titanium oxide coating the stem and a thick cement mantle may help resist aseptic loosening. In addition, satisfactory monitoring of the stem was reached using titanium serum level determination.Résumé Cette étude rapporte le suivi clinique prospectif d'une série de 134 tiges fémorales titane cimentées et l'évolution des taux de titane sérique. Les implants étaient en titane anodisé, lisses (0.1-microm Ra) et de section circulaire. Au recul moyen de 9 ans, le taux de survie était de 97,7%, ce qui est comparable aux autres séries de tiges cimentées. On notait une reprise pour descellement et deux révisions prévisibles pour un enfoncement supérieur à 5 mm. Des liserés non évolutifs étaient observés en zones 1 et 7 pour 16 hanches sans ostéolyse. La médiane du titane sérique était inférieure à la limite de détection (30 nmol/l) à l'exception des 3 échecs où les taux sont étaient nettement plus élevés. La couche protectrice d'oxyde de titane et l'épaisseur du manteau de ciment peuvent expliquer la résistance au descellement aseptique. Le taux de titane sérique semble intéressant pour la surveillance des tiges titanes cimentées.

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Section: Discussionmentioning

confidence: 48%

Section: Discussionmentioning

confidence: 96%

Clinical and biological assessment of cemented titanium femoral stems: an 11-year experience

Boyer

Lazennec

Poupon

et al. 2008

International Orthopaedics (SICOT)

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“…Studies of metal ion levels in patients with spinal implants are less numerous. There have been only a few retrospective reports of metal ion levels in patients with stainless steel [18][19][20][21][22] and titanium [23,24] posterior spinal instrumentation. Less is known for metalon-metal total disc arthroplasty [25][26][27].…”

Section: Introductionmentioning

confidence: 99%

Prospective study on serum metal levels in patients with metal-on-metal lumbar disc arthroplasty

et al. 2012

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Purpose Metal-on-metal total disc replacement is a recent alternative treatment for degenerative disc disease. Wear and corrosion of these implants can lead to local and systemic transport of metal debris. This prospective longitudinal study examined the serum chromium and cobalt levels in 24 patients with cobalt-chromium alloy metal-onmetal lumbar disc replacements. Methods Serum was assayed for chromium (Cr) and cobalt (Co) using high-resolution inductively-coupled plasma-mass spectrometry. Detection limits were 0.015 ng/ mL for Cr and 0.04 ng/mL for Co. Results Median serum Co levels at pre-op, 3, 6, 12, 24, and 36-months post-op were 0.10, 1.03, 0.96, 0.98, 0.67, and 0.52 ng/mL, respectively. Median serum Cr levels were 0.06, 0.49, 0.65, 0.43, 0.52, and 0.50 ng/mL, respectively. Conclusion In general, these results indicated that serum Co and Cr levels are elevated at all postoperative time points and are of the same order of magnitude as those observed in well-functioning metal-on-metal surface replacements of the hip and in metal-on-metal total hip replacements at similar postoperative time points.

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“…For hand applications the irritation of overlying free gliding tendons in contact with the plate is also of concern (Nazzal et al, 2006). Furthermore, the negative influence of metal ions and salts on adjacent tissues and organs is well documented (Case et al, 1994: Kasai et al, 2003: Keegan et al, 2007Summer et al, 2007). Device extraction in children can further cloud the matter (Rosson and Shearer, 1991;Kahle, 1994;Alzahrani et al, 2003;Kim et al, 2005;Peterson, 2005;Busam et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

Surface polishing positively influences ease of plate and screw removal

Hayes

Seidenglanz²,

Pearce³

et al. 2010

eCM

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Difficulties removing temporary fracture fixation devices due to excessive bony on-growth results in extended surgical time leading to excessive blood loss, debris contamination and potentially refracture. Commercially available locking plates and screws are manufactured for clinics with a micro-rough surface, which contributes to the excessive bony on-growth reported. We have applied polishing technology to commercially pure titanium locking compression plates (LCP) and titanium-6%aluminium-7%niobium (TAN) plates and screws to assess if it can alleviate problems with strong bony overgrowth. Samples were implanted for 6, 12 and 18 months in a bilateral sheep tibia non fracture model and assessed for screw removal torque, percentage of bone contact and tissue-material response. Both electropolishing (p=0.001) and paste polishing (p=0.010) of TAN screws significantly reduced the mean torque required for removal compared to their micro-rough counterparts. This was accompanied by a trend for a lower percentage of bone contact for polished screws. This difference in bone contact was significant for paste polished TAN screws (p<0.001) but not electropolished TAN screws (p=0.066). Ex vivo, soft tissue removal was much easier (~five minutes) for polished constructs, which was difficult and at least four times longer for standard micro-rough constructs. We suggest that polishing of locked plate/screw systems will improve ease of removal and reduce implant related removal complications encountered due to excessive strong bony on-growth while maintaining biocompatibility and implant stability. Future studies aim to assess the potential of this technology in the next level of complication, a fracture model.

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Metal Concentrations in the Serum and Hair of Patients With Titanium Alloy Spinal Implants

Abstract: Approximately one third of patients with titanium alloy spinal implants exhibited abnormal serum or hair metal concentrations at a mean time of mean 5.1 years after surgery. Titanium or aluminum may travel to distant organs after dissolution of metals from the spinal implants.

Cited by 82 publications

References 25 publications

Clinical and biological assessment of cemented titanium femoral stems: an 11-year experience

Clinical and biological assessment of cemented titanium femoral stems: an 11-year experience

Prospective study on serum metal levels in patients with metal-on-metal lumbar disc arthroplasty

Surface polishing positively influences ease of plate and screw removal

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