Release of Chromium from Orthopaedic Arthroplasties

Abstract

Many orthopaedic implants are composed of alloys containing chromium. Of particular relevance is the increasing number of Cobalt Chromium bearing arthroplasies being inserted into young patients with osteoarthritis. Such implants will release chromium ions. These patients will be exposed to the released chromium for over 50 years in some cases. The subsequent chromium ion metabolism and redistribution in fluid and tissue compartments is complex. In addition, the potential biological effects of chromium are also controversial, including DNA and chromosomal damage, reduction in CD8 lymphocyte levels and possible hypersensitivity reactions (ALVAL). The establishment of these issues and the measurement of chromium in biological fluids is the subject of this review.

Cr(VI)‐induced genotoxicity and cell cycle arrest in human osteoblast cell line MG‐63

“…In the extracellular environment, part of Cr(VI) is reduced to Cr(III) lowering its potential toxicity, as Cr(III) has lower cell membrane permeability, entering slowly into the cell by diffusion or phagocytosis (Collins et al, 2010;Zhitkovich, 2011). On the other hand, Cr(VI) is rapidly taken up into the cells through sulphate and phosphate ion channels and is reduced to Cr(V), Cr(IV) and Cr(III) by reducing enzymes (e.g., NADPH cytochrome c reductase, glutathione reductase) and non-enzymatic reductants (Afolaranmi, Tettey, Meek, & Grant, 2008). More than 95% of Cr(VI) reduction is done by alanineserine-cysteine, glutathione and cysteine, in a descending order.…”

Multicomponent Alloys for Biomedical Applications

“…Because of the increasing number of arthroplasies in young patients with osteoarthritis, the exposure time to the released chromium may be over 50 years in these cases. Cr 6+ has been labeled as a class 1 human carcinogen by the International Agency for Research on Cancer, signifying carcinogenesis as a potential long-term biological effect in patients with Cr alloy implants [15]. The subsequent chromium ion metabolism is complex.…”

“…Cr 6+ is mutagenic and carcinogenic; but its potential biological effects are controversial, as it is metabolized in the cytoplasm and cell's nucleus in Cr 3+ , which is not involved in DNA and chromosomal damage. Effects as reduction in CD8 lymphocyte levels and possible hypersensitivity reactions (ALVAL) are controversial [15].…”

“…Corrosion is an electrochemical reaction characteristic to all metals in contact with biological systems, and its consequence is the formation of metal ions which may trigger hypersensitivity reactions and affect the immune response system [15]. It characterizes the chemical reactivity of metals and alloys, which results in a visible alteration of the material and affects the function of a metallic component or of the entire ensemble [16].…”

“…Cr, Mo, Si, Fe, and Mn are the ions released from stainless steel implants, while Ti, Al, V, and Nb are released from titanium alloy implants [19]. The in situ degradation of an implant decreases its structural integrity and also releases products which may trigger an adverse biological reaction [15]. Biological risks associated with the released metal ions have been identified to include those from wear debris, colloidal organometallic complexes, free metal ions, and inorganic metal salts or resulting oxides [20].…”