Serum Chromium Concentrations Research Articles

Chromium and cobalt ion concentrations in blood and serum following various types of metal-on-metal hip arthroplasties

Background and purpose Widely different metal ion concentrations in blood and serum have been reported with metal-on-metal (MoM) implants. We reviewed the literature on blood and serum ion concentrations of chromium (Cr) and cobalt (Co) following various MoM hip arthroplasties.Methods Studies were searched for in the Medline database, Embase, and the Cochrane Database of Systematic Reviews. Highest mean or median ion concentrations of Cr and Co after a minimum of 1 year of follow-up were extracted and grouped according to sample- and articulation type, and average values were calculated.Results 43 studies were included and 16 different MoM implants were identified. For the different types of bearings, average ion concentrations and range were calculated from the mean or median ion concentration. The average Cr concentration ranged between 0.5 and 2.5 μg/L in blood and between 0.8 and 5.1 μg/L in serum. For Co, the range was 0.7–3.4 μg/L in blood and 0.3–7.5 μg/L in serum.Interpretation When the average blood ion concentrations calculated for the different implants, together with the concentrations measured in the individual studies, were compared with the upper acceptable limit for Cr and Co in blood, no clear pattern was recognized. Furthermore, we were unable to detect any clear difference in ion concentrations between different types of implants (THA and resurfacing).

Does chromium (+3) decrease the glucose concentration in epileptic children?

Epilepsy is a common neurological disorder. It affects 50 million people worldwide, over half of which are children. Many children who suffer from epilepsy are also affected by metabolic disorders, characterized by obesity as well as intolerance and deficient transport of glucose. Recently, many researchers have indicated chromium (+3) as an essential trace mineral which probably plays an important role in metabolism of glucose and insulin. There are no data about chromium alterations in the body of epileptic patients. The purpose of this study was to find possible correlation between chromium (+3) concentration and the glucose level in children with epilepsy. Material and methods: Twenty-three untreated epileptic children with idiopathic generalized tonic-clonic seizures (9 girls and 14 boys) aged 13.4±2.7 years and 25 healthy children (sex-age-matched) served as a control were recruited to this study. The chromium blood and serum concentrations were determined as well as serum glucose level. Results: There were no statistically significant differences between epileptic and healthy children in the mean chromium (+3) blood concentration as well as according to sex in both analyzed groups of children. The mean serum chromium concentration in epileptic children was significantly lower than in healthy subjects generally (p<0.001), as well as in boys group (p<0.001) and girls (p<0.001). Although, the negative statistically significant correlation between serum glucose and chromium concentrations was found in epileptic children (p<0.01), we have not found so associations in whole blood and in healthy children. Conclusions: Our research has shown that during epilepsy the concentration of serum chromium was lower than in healthy subjects what was associated

Serum Metal Ion Concentration: Comparison Between Small and Large Head Metal-on-Metal Total Hip Arthroplasty

The purpose of this study was to compare serum metal ion concentrations (chromium and cobalt) in 3 groups, 2 with metal-on-metal articulations and a control metal-on-polyethylene group. Forty-six patients with good to well-functioning hips were recruited for the study. Serum ion levels of all patients were drawn, and Harris Hip Score, University of California, Los Angeles activity score, and radiographs were performed. Serum chromium concentrations were significantly lower in the large head group compared with the small head group ( P = .013). There was no difference in the cobalt concentrations between the 2 groups ( P = .087). There was a significant difference between both metal-on-metal groups when compared with controls for both chromium and cobalt levels ( P = .0005 and P = .0004, control vs small; P = .001 and P = .0001, control vs large, respectively).

The way of serum chromium utilization may contribute to cardiovascular risk factors in centrally obese persons.

IntroductionObesity-related disturbances are considered to be risk factors for cardiovascular disease (CVD). Chromium is shown to improve carbohydrate and lipid metabolism. Conflicting data on effects of chromium supplementation in humans are published. The aim of the study was to assess the concentrations of serum chromium during the 75-g oral glucose tolerance test (OGTT) in obese persons.Material and methodsFourty-eight centrally obese Caucasians, apparently healthy, using neither special diet nor mineral supplementation, were enrolled in the study. During the OGTT, 0-min and 120-min concentrations of plasma glucose (G 0’, G 120’), serum insulin (Ins 0’, Ins 120’) and chromium (Cr 0’, Cr 120’) were determined. Plasma lipids, apolipoproteins A and B, and serum uric acid were measured at 0 min only. For parameters assessed during the OGTT, the difference D = [(120’ concentration) – (0’ concentration)] was calculated. Contradictory tendencies of Cr 120’ were observed; thus the difference of serum chromium concentrations, DCr = [(Cr 120’) – (Cr 0’)], was used to establish the positive DCr group with DCr > 0 (PosDCr: n= 24; 9 male/15 female) and the negative DCr group with DCr < 0 (NegDCr: n= 24; 8 male/16 female).ResultsThe studied groups were comparable as far as their metabolic parameters are concerned, except higher G 120’ (p= 0.043) and DG (p = 0.048), and lower Cr 120’ (p < 0.000), which were observed in the NegDCr group. The NegDCr persons showed inverse correlations between Cr 0’ and systolic and diastolic blood pressure.ConclusionsWe suggest that the studied centrally obese persons differed in chromium metabolism. In subjects “consuming” Cr during the OGTT, chromium status may be associated with increased risk for CVD.

Do Ion Levels In Hip Resurfacing Differ From Metal-on-metal THA at Midterm?

Metal-on-metal Birmingham hip resurfacing (MOM-BHR) is an alternative to metal-on-metal total hip arthroplasty (MOM-THA), especially for young and/or active patients. However, wear resulting in increased serum ion levels is a concern. We asked whether (1) serum chromium (Cr), cobalt (Co), and molybdenum (Mo) concentrations would differ between patients with either MOM-BHR or MOM-THA at 5 years, (2) confounding factors such as gender would influence ion levels; and (3) ion levels would differ at 2 and 5 years for each implant type. Ions were measured in two groups with either MOM-BHR (n = 20) or MOM-THA (n = 35) and a mean 5-year followup, and two groups with either MOM-BHR (n = 15) or MOM-THA (n = 25) and a mean 2-year followup. Forty-eight healthy blood donors were recruited for reference values. At 5 years, there were no differences in ion levels between patients with MOM-BHR or MOM-THA. Gender was a confounding factor, and in the MOM-BHR group at 5 years, Cr concentrations were greater in females compared with those of males. Mean ion levels were similar in patients with 2 and 5 years of followup for each implant type. Ion levels in patients were sevenfold to 10-fold higher than in controls. As the metal ion concentrations in the serum at 5 years were in the range reported in the literature, we do not believe concerns regarding excessive metal ion levels after MOM-BHR are justified. Level III, therapeutic study. See the Guidelines for Authors for a complete description of level of evidence.

Acetabular Cup Malalignment After Total Hip Resurfacing Arthroplasty: A Case for Elective Revision?

This article describes the clinical course of a patient with a resurfacing implant in a poor cup position in combination with elevated serum metal ions prior to implant failure. Following resurfacing, the patient had substantial improvement from baseline in pain and functional status. Postoperative radiographs indicated the acetabular cup in an abducted and excessively anteverted position. The acetabular component ultimately failed after 4.5 years and a traditional total hip arthroplasty revision was performed. Serum cobalt (Co) and chromium (Cr) concentrations had been collected postoperatively of the index procedure at 6 months, 1 year, 2 years, 3 years, and pre- and postoperatively at the time of implant revision. Serum cobalt and chromium ion levels were progressively elevated to approximately 400 times more than the expected range at all time points prior to revision. Elective revision had been considered due to acetabular malalignment and elevated metal ion levels, but not performed since the patient was doing well clinically. A recent study has shown a correlation between increased cup inclination and increased serum cobalt or chromium levels and this patient's levels were >40 times greater than that typically observed with this device. Early revision should be strongly considered if component malpositioning is noted, and abnormally elevated ion concentrations should signal the need for revision regardless of the patient's clinical status. The relationship of a malpositioned cup and uncharacteristically elevated metal ion levels is related to the metal-on-metal bearing coupling and likely applies to conventional metal-on-metal total hip prostheses as well.

Seven Years of Chronological Changes of Serum Chromium Levels After Metasul Metal-On-Metal Total Hip Arthroplasty

Although many authors have reported the serum concentrations of metal ions in patients who had metal-on-metal coupling prostheses, most of the studies were not longitudinal, and the follow-up periods were short. We evaluated the longitudinal changes of serum chromium levels in 44 patients who had undergone unilateral metal-on-metal total hip arthroplasty for a minimum of 7 years postoperatively. Although there was a consistent increase in the mean serum chromium level until 3 years after implantation, there was little difference in the levels from years 3 to 7 postoperatively. Although the serum chromium concentration was low throughout postoperative follow-up for 7 years in about 25% of patients, the serum chromium level stayed high or showed gradual elevation in 16.3% of our patients.

Blood metal ion concentrations after hip resurfacing arthroplasty

There have been no large comparative studies of the blood levels of metal ions after implantation of commercially available hip resurfacing devices which have taken into account the effects of femoral size and inclination and anteversion of the acetabular component. We present the results in 90 patients with unilateral articular surface replacement (ASR) hip resurfacings (mean time to blood sampling 26 months) and 70 patients with unilateral Birmingham Hip Resurfacing (BHR) implants (mean time 47 months). The whole blood and serum chromium (Cr) and cobalt (Co) concentrations were inversely related to the size of the femoral component in both groups (p < 0.05). Cr and Co were more strongly influenced by the position of the acetabular component in the case of the ASR, with an increase in metal ions observed at inclinations > 45 degrees and anteversion angles of < 10 degrees and > 20 degrees. These levels were only increased in the BHR group when the acetabular component was implanted with an inclination > 55 degrees. A significant relationship was identified between the anteversion of the BHR acetabular component and the levels of Cr and Co (p < 0.05 for Co), with an increase observed at anteversion angles < 10 degrees and > 20 degrees. The median whole blood and serum Cr concentrations of the male ASR patients were significantly lower than those of the BHR men (p < 0.001). This indicates that reduced diametral clearance may equate to a reduction in metal ion concentrations in larger joints with satisfactory orientation of the acetabular component.

“Nearly a stairway to heaven” – severe dichromate intoxication in a young man

A 22-year-old man presented with dichromate intoxication in a suicidal attempt. He exhibited signs of liver and renal toxicity and very high serum chromium levels. Since it has been reported in the literature that hemodialysis and hemoperfusion are not sufficient to remove chromium, we tried plasmapheresis considering the fact that chromium salts bind to protein. Five plasmapheresis treatment sessions significantly lowered his serum and urinary chromium concentrations. The patient survived without organ damage despite ingestion of a lethal dichromate dose and high serum chromium concentration. Thus, plasmapheresis should be considered as a potential therapeutic option to reduce chromium concentrations.

Chromium Chloride Administration Causes a Substantial Reduction of Coronary Lipid Deposits, Aortic Lipid Deposits, and Serum Cholesterol Concentration in Rabbits

This experiment was carried out to test the null hypothesis that intramuscular trivalent chromium administration would not remove lipids from the heart and ascending aorta of the hyoercholesterolemic rabbits and would not lower their serum cholesterol levels. A novel computer-based method, previously described, was used to assess the sizes of the intracardiac and aortic lesions. Clinical chemistry and histopathology were performed through routine methods. The sizes of the lipid deposits in the coronary vasculature of the hypercholesterolemic rabbits were greatly reduced as a result of the intramuscular chromium chloride injections. Lipid deposits in the ascending aorta were similarly reduced, as well as the serum cholesterol concentrations. The terminal serum chromium concentrations in the chromium-treated group were in the range of 3,258-4,513 microg/L, whereas, in the untreated animals, the concentrations were 3.2 to 6.3 microg/L. The general condition of the chromium-treated animals was good and they were continuing to gain weight up to the time they were killed. However, it was found that their liver function tests had become abnormal even though there was no evidence of hepatic histopathological lesions specifically affecting the chromium-treated group. The kidney function tests and histopathology were normal. These findings suggest that a more aggressive approach than those tried hitherto might be useful in treating atherosclerotic human patients with chromium.

Determination of serum levels of cobalt and chromium in 17 patients undergoing metal-on-metal THR

To assess cobalt and chromium concentrations in serum and urine in 17 patients that underwent total hip replacement (THR) with a metal-on-metal bearing and to determine their correlation with radiographical findings. Cobalt and chromium concentrations were measured in 17 patients by means of atomic absorption spectrophotometry before implantation of a metal-on-metal THR, between the first and second year post-op and between the third and fourth year post-op. Cobalt and chromium concentrations in urine were also determined at the end of follow-up. The post-op radiological study was compared with that carried out at the end of follow-up. Mean patient age was 57 ± 6 years and mean follow-up was 31 ± 9 months. Mean cobalt concentration did not rise during the first and second year post-op with respect to the mean preop concentration, but it did increase between the third and fourth year. Mean chromium concentration rose between the first and second year and they went on to drop slightly between the third and fourth year post-op. No relationship was found between the appearance of radiolucent lines or a varus or valgus position of the stem and the cobalt and chromium levels in serum and urine. Eighty-five percent of cups with an inclination > 56° showed cobalt and chromium concentrations in serum in excess of the mean pre-op value. The increase in mean serum cobalt and chromium concentrations detected in our study was lower than that shown by other authors. This increase occurred mainly between the first and second year post-op. The series under study shows that the more vertically the cup is placed the higher the cobalt and chromium levels present. Valorar los niveles de cobalto y cromo en suero y orina en 17 pacientes tras el implante de una prótesis total de cadera (PTC) con par de fricción metal-metal y su correlación con los hallazgos radiológicos. Se determinaron en 17 pacientes, mediante espectrofotometría de absorción atómica, las concentraciones de cobalto y cromo en suero antes de la implantación de una PTC metal-metal, entre el primer y segundo año, y entre el tercer y cuarto año tras la intervención, y las concentraciones de cobalto y cromo en orina al final del seguimiento. Se comparó el estudio radiológico postoperatorio con el realizado al final de seguimiento. La edad media de los pacientes fue de 57 ± 6 años, y el tiempo medio de seguimiento de 31 ± 9 meses. La concentración media de cobalto no se elevó durante el primer y segundo año tras la intervención respecto a la concentración media preoperatoria, y sí lo hizo entre el tercer y cuarto año. La concentración media de cromo se elevó durante el primer y segundo año, para descender ligeramente entre el tercer y cuarto año tras la intervención. No se evidenció ninguna relación entre la aparición de líneas de radiolucencia o la colocación del vástago en varo o valgo con los niveles de cobalto y cromo en suero y orina. El 85% de los cotilos con una inclinación superior a 56° presentaron concentraciones de cobalto y cromo en suero por encima de la media preoperatoria. El incremento de las concentraciones medias de cobalto y cromo en suero detectado en nuestra serie fue menor respecto a otros estudios. Este incremento se produjo principalmente entre el primer y segundo año tras la intervención. En la serie estudiada se aprecia un incremento de los niveles de cobalto y cromo en relación con la verticalización del cotilo.

Serum Ion Level After Metal-on-metal THA in Patients With Renal Failure

We retrospectively reviewed cementless THAs with metal-on-metal bearings in five patients with chronic renal failure and investigated the relations between renal failure and elevated serum cobalt and chromium levels and the side effects of these elevations. Serum cobalt and chromium levels were measured by atomic absorption spectrophotometry at a minimum followup of 2.7 years (mean, 3.9 years; range, 2.7-6.2 years) in five patients with chronic renal failure and in six patients with normal renal function after THA. Mean serum cobalt concentration was 12.5 microg/L in patients with chronic renal failure; this was more than 100-fold higher than in patients with the same prosthesis type and similar followup period, but with no known renal disease. However, the mean serum chromium concentration was 5.1 microg/L, which was within the normal range in all 11 study patients. Side effects related to elevation of serum cobalt or serum chromium concentration were not identified and overall clinical results were good 4 years after surgery. The serum cobalt level was higher in patients with chronic renal failure. Longer followup is necessary to determine any clinical effects.

Levels of systemic metal ions in patients with intramedullary nails

Background It is being increasingly recognized that orthopedic implants are associated with adverse tissue responses, mediated by degradation products. Recent interest has been focused on the production of metal ions from hip arthroplasty. Few studies have reviewed fracture fixation devices and their metal ion productionMethods 61 subjects were enlisted into the study, with 3 subgroups. 21 subjects had Russell-Taylor intramedullary tibial nails in situ for 26 (21–32) months (316LVm stainless steel), 20 subjects had TriGen intramedullary tibial nails in situ for 43 (35–51) months (Ti-6Al-4V titanium alloy), and the remaining 20 subjects did not have any implant in situ and served as controls. Blood samples were taken and serum chromium, molybdenum, titanium, aluminium, and vanadium concentrations were measured using inductively coupled plasma (ICP) techniques.Results The 3 groups were matched for age, sex, and BMI. The subjects with Russell-Taylor nails had elevated levels of chromium (0.10 µg/L) with median concentrations 2.5 times higher than those of the control group. The subjects with TriGen nails had less significantly elevated levels of titanium (6.5 µg/L).Interpretation Stainless steel implants show significant differences from titanium implants in the dissemination of metal ions. Although the levels of chromium were elevated, the overall levels were modest when compared to published data regarding metal ion release and hip arthroplasty. Intramedullary nails are, however, often used in younger patients. If not removed, they may result in prolonged exposure to metal ions.

Metal-on-metal hip implants: do they impair renal function in the long-term? A 10-year follow-up study

The aim of our study was to investigate a potential influence of elevated serumcobalt and serumchromiumlevels on renal function at minimum 10 years after implantation of a metal-on-metal hip. Between November 1992 and June 1994 98 patients (44 m, 54 f) with an average age of 56 (22-79) years received a metal-on-metal bearing Metasul. At the time of the 10-year follow-up, 15 patients had died and 8 were lost to follow-up. The remaining 75 patients had laboratory analysis including serumcreatinine and full blood cell count as well as chromium and cobalt serum levels. Ten years postoperatively the median serumcreatinine level was 0.86 (0.55-1.51) mg/dl, the serumcreatinine clearance Ccr was in the normal range. The hemogram did not differ from that measured at the time of surgery. The median serumcobalt concentration was 0.75 (0.3-50.10) microg/l and the serumchromium concentration was 0.95 (0.3-58.6) mug/l, 10 years postoperatively. Our long-term data do not show any influence of serum cobalt or chromium concentrations on renal function following total hip arthroplasty.

RELATIONSHIP BETWEEN LATE PREGNANCY AND SERUM CHROMIUM CONCENTRATION IN PATIENTS WITH DIABETES MELLITUS

Chromium is essential element in human nutrition. Serum concentration of chromium are not well characterized during pregnancy or in gestational diabetes mellitus. Fifty females were involved in this study, all of them were in the third trimester, twenty without diabetes mellitus and thirty with diabetes mellitus. The aims of our study were to detect the alteration in the serum chromium levels in late pregnancy in women suffering from diabetes mellitus type 1 and those with gestational diabetes mellitus, and the association of altered serum chromium concentration with lipid concentration. The results of this study show that low serum concentrations of chromium are associated with hyperglycemia and hypetriglycerdemia. There were no significant differences in serum chromium in patients with type 1 D.M. and those with gestational D.M.

Serum Metal Levels and Bearing Surfaces in Total Hip Arthroplasty

This study evaluates steady-state serum metal levels in patients with 4 different combinations of fixation modalities, materials, and bearing couples. Forty patients with a minimum of 5 years of follow-up and with well-functioning primary total hip arthroplasty were recruited to have serum metal levels measured. Serum chromium and cobalt levels in the metal-on-metal cohort were significantly higher ( P < .05) than the other 3 cohorts. The noncemented ceramic-polyethylene cohort had significantly lower ( P < .05) serum chromium levels compared to cemented and noncemented metal-polyethylene cohorts and significantly higher serum titanium levels compared to the cemented metal-polyethylene cohort which had no titanium-containing implants. Debris generated at the metal head/neck modular junction likely accounts for the significantly lower serum chromium concentration in ceramic-polyethylene bearing couples.

Midterm Results of Metasul Metal-on-Metal Total Hip Arthroplasty

We assessed 106 total hip arthroplasties performed with a new metal-on-metal hip system; the patients were monitored for at least 5 years. The average Harris Hip Score of the patients was 39.5 points before surgery and 87.8 points at final follow-up evaluation. Radiographically, the acetabular component was stable in 103 hips and possibly unstable in 3 hips. The femoral component was bone ingrown in 97 hips and stable and fibrous in 9. After surgery, 6 hips dislocated. The polyethylene liner dissociated in one patient. No patient exhibited clear signs of loosening, migration, or osteolysis. Distal femoral cortical hypertrophy was seen in 35.8% of the cases. Survival at the mean follow-up point (6.4 years) was 99.1%. There was no significant difference in serum chromium concentration between metal-on-metal bearings and polyethylene-on-metal bearings (control subjects). This study found that metal-on-metal total hip arthroplasty produces excellent midterm results.

Chromium Treatment Has No Effect in Patients With Poorly Controlled, Insulin-Treated Type 2 Diabetes in an Obese Western Population

Chromium treatment has been reported to improve glycemic control and insulin sensitivity in specific populations of patients with type 2 diabetes. The aim of this study was to determine the effect of chromium treatment on glycemic control in a Western population of insulin-dependent patients with type 2 diabetes. In this 6-month double-blind study, patients with an HbA(1c) (A1C) >8% and insulin requirements of >50 units/day were randomly assigned to receive treatment with placebo or 500 or 1,000 mug chromium daily in the form of chromium picolinate. The primary efficacy parameter was a change in A1C. Secondary end points were changes in lipid profile, BMI, blood pressure, and insulin requirements. In this per-protocol analysis (n = 46), the decrease in A1C was approximately equal across the three groups (0.4%). All patients had a BMI >25 kg/m(2). No differences were found in the secondary end points. We found a weak relationship between an increasing serum chromium concentration and improvement of the lipid profile. There is no evidence that high-dose chromium treatment is effective in obese Western patients with type 2 diabetes.

Effects of dietary chromium picolinate supplementation on serum glucose, cholesterol and minerals of rainbow trout (Oncorhynchus mykiss)

The effect of chromium (chromium picolinate, CrPic) supplementation at various levels (0, 400, 800 or 1600 μg Cr/kg diet) on serum concentrations of glucose and cholesterol and on serum and liver concentrations of Cr, Zn, Cu and Fe of rainbow trout (Oncorhynchus mykiss) was evaluated. One-year-old rainbow trout (n=120) were randomly assigned to four treatment groups, each with two replicates of 15 fish. The fish were fed either a control diet or the control diet supplemented with either 400, 800 or 1600 μg Cr/kg diet. Serum glucose and cholesterol concentrations decreased (p=0.001) with higher dietary chromium supplementation. Increasing dietary chromium supplementation linearly increased serum chromium and zinc concentrations (p=0.001). Serum copper and iron concentrations did not change (p>0.10) as dietary chromium supplementation increased. Liver chromium and zinc concentrations linearly increased (p=0.001). Also, liver Cu and Fe concentrations did not change (p>0.10) as dietary chromium supplementation increased. The results of present study conclude that supplemental chromium to the diet of rainbow trout influences serum and liver Cr and Zn concentrations, thus most probably functions of the organs as well as the welfare of raibow trout.

Chronological changes of serum chromium levels after modern metal-on-metal total hip arthroplasty.

We determined changes in serum chromium concentration every 6 months up to 3 years after implantation in 44 patients (mean age 63 (49-79) years, 35 women) who underwent modern metal-on-metal total hip arthroplasty (Metasul). The serum chromium levels increased between the first and second year after implantation (1 year: 1.05 (SD 0.76) microg/L, 2 years: 1.46 (SD 0.91) microg/L). A small increase was observed during the third year (1.61 (SD 1.31) microg/L). The clinical relevance of this finding is uncertain and should be determined in long-term studies on a large scale.