Abstract
The aim of this study was to evaluate the levels of As, Be, Bi, Cd, Co, Cr, Cu, Hg, Mn, Ni, Pb, Se, Tl, V, and Zn, by inductively coupled plasma-mass spectrometry (ICP-MS) in the urine of two groups of patients with two different types of metal-on-metal (MoM) total hip prostheses (ASR DePuy®, group A, 25 patients; total Met-Met System Lima®, group B, 28 patients). The determination of metals reflected a steady-state release (group A: 9 years after surgery and group B: 6 years after surgery). The results obtained confirmed the increase of Co and Cr urinary levels in both group when compared with the reference values for the general population adopted by the Italian Society of Reference Values (SIVR). In particular, Co and Cr levels exceeded the threshold values in urine, respectively, of 30 μg and 21 µg, adjusted to creatinine based on the threshold in whole blood of 7 μg/L proposed by the Medicines and Healthcare Products Regulatory Agency (MHRA). Regarding the other investigated metals, significantly higher values were found in Group A than in Group B. These differences could be due to the type of hip prosthesis implanted, the longer period of time since the implantation, as well as many other factors such as diet, age, drug consumption, physical activity, or presence of dental fillings. The continuous monitoring over the years of metal concentrations in patients carrying a prosthesis could be useful to better identify the sources of these metals.
Highlights
Hip prosthesis implants are widely used in orthopedic surgery
Since various ionic species present in low concentrations in the alloys used for hip prostheses could be released and have adverse effects in patients, we investigated whether such metals were effectively released in our patients due to wear of the MoM hip replacement after a long period of implantation
New designs and innovative materials have been investigated in order to obtain more efficient and durable devices, increased concentrations of circulating metals have been reported in hip prosthesis bearers [14,15,16,17], causing a mounting concern regarding adverse local and systemic effects of elevated metal levels released form hip prosthesis implants
Summary
Hip prosthesis implants are widely used in orthopedic surgery. most metal-on-metal (MoM) hip replacements are successful, some patients could suffer from serious secondary adverse effects due to their malfunctioning.Metallosis is a post-surgical complication that results from the surface deterioration of MoM bearings in orthopedic implants accompanied by an inflammatory response that can involve both macrophage-induced cytotoxicity, stimulated by metal debris, and a type IV delayed hypersensitivity reaction to metal particles. Hip prosthesis implants are widely used in orthopedic surgery. Most metal-on-metal (MoM) hip replacements are successful, some patients could suffer from serious secondary adverse effects due to their malfunctioning. Metallosis is a post-surgical complication that results from the surface deterioration of MoM bearings in orthopedic implants accompanied by an inflammatory response that can involve both macrophage-induced cytotoxicity, stimulated by metal debris, and a type IV delayed hypersensitivity reaction to metal particles. There are numerous factors that can affect hip prosthesis malfunction and consequent erosion with release of metal particles, such as the type of implant, different construction materials, surgery procedure, angle of inclination of the acetabular components, increased physical activity. The release of metallic particles, mainly cobalt (Co) and chromium (Cr) as components of metal alloys, into the surrounding tissues causes the phenomenon called adverse reaction to metal debris (ARMD). Very high concentrations of Co and Cr in biological fluids due to malfunction of hip prostheses in some patients are associated with serious systemic symptoms including neurological
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