Elevated Serum Metal Levels from Vitamin Supplementation: A Case Report.

Abstract

Trace metal analysis, more commonly referred to as metal ion testing, was introduced as a clinical tool to evaluate metal-on-metal (MoM) implants that were used in hip replacements in the 1990s1-3. This test measures concentrations of various metals, such as cobalt and chromium, in either the serum or whole blood. It has been used with increasing frequency in the past decade as potential failures of MoM devices related to release of metal ions and debris have become better understood4-7. Elevated serum metal levels have been correlated with poor implant performance in numerous studies4-9. As a result, the Medicines and Healthcare products Regulatory Agency (MHRA) of the United Kingdom recently recommended obtaining metal ion levels in several groups of patients with MoM bearing surfaces as a method of ongoing surveillance10, and many surgeons in other parts of the world are using metal ion testing for similar purposes. In addition to metal release from MoM bearing surfaces, metal levels can also be notably elevated as a result of corrosion at modular taper junctions in patients with large-head MoM total hip arthroplasties11,12 and in patients with metal-on-polyethylene bearing surfaces13. Because metal ion levels are elevated in patients with problematic prostheses and these levels decrease after the source of metal debris is removed with revision arthroplasty surgery13,14, metal ion levels are currently being obtained on a routine basis in both clinical and research settings. Accordingly, accurate interpretation of these values is critical to the clinician, and other etiologies that could potentially affect these values should be clearly understood. We present a patient with a well-functioning total hip arthroplasty whose serum metal levels were substantially elevated secondary to dietary supplementation with vitamins; …