Nickel release from stainless steels

Abstract

In 1994, a study of nickel release and allergic contact dermatitis from nickel-plated metals and stainless steels was published in this journal. It was shown that low-sulfur stainless steel grades like AISI 304, 316L or 430 (S < or = 0.007%) release less than 0.03 microgram/cm2/week of nickel in acid artificial sweat and elicit no reactions in patients already sensitized to nickel. In contrast, nickel-plated samples release around 100 micrograms/cm2/week of Ni and high-sulfur stainless steel (AISI 303-S approximately 0.3%) releases about 1.5 micrograms/cm2/week in this acid artificial sweat. Applied on patients sensitized to nickel, these metals elicit positive reactions in 96% and 14%, respectively, of the patients. The main conclusion was that low-sulfur stainless steels like AISI 304, 316L or 430, even when containing Ni, should not elicit nickel contact dermatitis, while metals having a mean corrosion resistance like a high-sulfur stainless steel (AISI 303) or nickel-plated steel should be avoided. The determining characteristic was in fact the corrosion resistance in chloride media, which, for stainless steels, is connected, among other factors, to the sulfur content. Thus, a question remained concerning the grades with an intermediate sulfur content, around 0.03%, which were not studied. They are the object of the study presented in this paper. 3 tests were performed: leaching experiments, dimethylglyoxime and HNO3 spot tests, and clinical patch tests; however, only stainless steels were tested: a low-sulfur AISI 304 and AISI 303 as references and 3 grades with a sulfur content around 0.03%: AISI 304L, AISI 304L added with Ca, AISI 304L+Cu. Leaching experiments showed that the 4 non-resulfurised grades released less than 0.5 microgram/cm2/week in acid sweat while the reulfurized AISI 303 released around or more than 0.5 microgram/cm2/week. This is explained by the poorer corrosion resistance of the resulfurized grade. Yet all these grades had the same reaction to the DMG test (negative result), which shows again its lack of sensitivity. In contrast, the HNO3 spot test distinguished AISI 303 from the non-resulfurized grades. Clinical patch tests again showed that some patients (4%) were intolerant to AISI 303, while none were intolerant to the other grades. Thus, this study confirms that non-resulfurized stainless steels (S < or = 0.03%) like Ni-containing 304 and 304L should not elicit Ni contact dermatitis, while the resulfurized grades (S > 0.1%) should be avoided.

Lymphocyte responses in patients with total hip arthroplasty

“…cell-mediated hypersensitivity) associated with metal components may be partly responsible for this differential reactivity. The most common orthopaedic soluble metal (ions) sensitizers include nickel, Ni, [16,23,30,35] cobalt, Co, [35] and chromium, Cr, [35] while occasional responses have been reported to tantalum, Ta, [ 11 titanium, Ti, [33,43] and vanadium, V [l]. Nickel is the most common metal sensitizer in humans followed by Co and Cr [2,16,23,30] and cross reactivity between Ni and Co is common [2].…”

“…The most common orthopaedic soluble metal (ions) sensitizers include nickel, Ni, [16,23,30,35] cobalt, Co, [35] and chromium, Cr, [35] while occasional responses have been reported to tantalum, Ta, [ 11 titanium, Ti, [33,43] and vanadium, V [l]. Nickel is the most common metal sensitizer in humans followed by Co and Cr [2,16,23,30] and cross reactivity between Ni and Co is common [2]. The incidence of metal sensitivity among the general population is approximately 10% and among patients with well functioning and poorly functioning implants is approximately 25% and 6O%, respectively, in reported compiled analyses of numerous investigations [ 191. What remained poorly characterized were the specific metals that mediate implant related metal hypersensitivity reactions, the incidence of THA metal hypersensitivity using modern immunological testing methods and the relation of metal hypersensitivity to implant performance.…”

The future of spinal arthroplasty: a biomaterial perspective

“…These toxicities result from extremely high circulating concentrations of the elements or their inhalation, and it is unlikely that such levels would result from prosthetic implant degradation. 37,38,46,49,56,57,61,62 There is no study to date that demonstrates a cause and effect relationship between arthroplasty devices and toxic levels of metal release, but these data should not be forgotten.…”

“…In larger amounts than has ever been documented to be associated with surgical arthroplasty, nickel leads to dermatitis and is carcinogenic. 37,38,46,49 Cobalt is known to cause polycythemia, thyroid dysfunction, cardiomyopathy, and is carcinogenic. 56,59 Chromium and vanadium can cause both cardiac and renal dysfunction as well as psychosis.…”

“…When this degradative process is severe enough it can damage the structural integrity of the implant, and corrosion products are potentially toxic. 1,[5][6][7]9,14,16,18,24,33,37,46,49,50,56,57,[59][60][61][62][63][64]70 Disc replacement designs incorporate cobalt-chromium-molybdenum alloy endplates that are externally coated with titanium for bone ingrowth. The metallic endplates are fixed to polymeric cores and motion takes place between articulating polymer surfaces.…”