Chromium concentrations in serum, blood clot and urine from patients following total hip arthroplasty

Abstract

Chromium released from implant alloys may be incorporated into organometallic complexes as Cr 3+[Cr(III)] or Cr 6+[Cr(VI)]. Since Cr(VI) is far more biologically active than Cr(III), there is considerable interest in identifying the valence state that predominates in corrosion products, either vitro or in vivo. It is known that erythrocytes display a unidirectional uptake of Cr(VI) while effectively excluding Cr(III). Thus it was felt that a study of the chromium content of blood clot in comparison to chromium concentrations in serum and urine, could shed light on the valency question. Fourteen patients who received conventional polymethylmethacrylate cemented cobalt-chromium alloy/ ultra high molecular weight polyethylene total hip replacements as well as seven control patients who underwent orthopaedic procedures without implantation were studied. Blood and urine specimens were obtained preoperatively, post-operatively and, for total hip patients, at routine early follow up. Chromium content was determined by electrothermal atomic absorption spectroscopy. A significant post-operative rise in serum chromium content was observed for total hip replacement patients, as previously reported, but not for control patients. Unexpected day-to-day variations in clot chromium content without significant increases, were also observed. Longer time studies are required to determine chromium valence states in corrosion products in this model.