Serum Chromium Levels Research Articles

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.

Serum chromium levels sampled with steel needle versus plastic IV cannula. Does method matter?

Modern metal-on-metal (MoM) joint articulations releases metal ions to the body. Research tries to establish how much this elevates metal ion levels and whether it causes adverse effects. The steel needle that samples the blood may introduce additional chromium to the sample thereby causing bias. This study aimed to test that theory. We compared serum chromium values for two sampling methods, steel needle and IV plastic cannula, as well as sampling sequence in 16 healthy volunteers. We found statistically significant chromium contamination from the steel needle with mean differences between the two methods of 0.073 ng/mL, for the first sample, and 0.033 ng/mL for the second. No difference was found between the first and second plastic sample. The first steel needle sample contained an average of 0.047 ng/mL more than the second. This difference was only borderline significant. The chromium contamination from the steel needle is low, and sampling method matters little in MoM populations. If using steel needles we suggest discarding the first sample.

“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.

Outcome and serum ion determination up to 11 years after implantation of a cemented metal-on-metal hip prosthesis

Background and purpose Little is known about the long-term outcome of cemented metal-on-metal hip arthroplasties. We evaluated a consecutive series of metal-on-metal polyethylene-backed cemented hip arthroplasties implanted in patients under 60 years of age.Methods 109 patients (134 joint replacements) were followed prospectively for mean 9 (7–11) years. The evaluation included clinical score, radiographic assessment, and blood sampling for ion level determination.Results At the final review, 12 hips had been revised, mainly because of aseptic loosening of the socket. Using revision for aseptic loosening as the endpoint, the survival rate at 9 years was 91% for the cup and 99% for the stem. In addition, 35 hips showed radiolucent lines at the bone-cement interface of the acetabulum and some were associated with osteolysis. The median serum cobalt and chromium levels were relatively constant over time, and were much higher than the detection level throughout the study period. The cobalt level was 1.5 μg/L 1 year after implantation, and 1.44 μg/L 9 years after implantation.Interpretation Revisions for aseptic loosening and radiographic findings in the sockets led us to halt metal-on-metal-backed polyethylene cemented hip arthroplasty procedures. If the rigidity of the cemented socket is a reason for loosening, excessive release of metal ions and particles may be involved. Further investigations are required to confirm this hypothesis and to determine whether subluxation, microseparation, and hypersensitivity also play a role.

Correlation between inclination of the acetabular component and metal ion levels in metal-on-metal hip resurfacing replacement

We examined the relationships between the serum levels of chromium and cobalt ions and the inclination angle of the acetabular component and the level of activity in 214 patients implanted with a metal-on-metal resurfacing hip replacement. Each patient had a single resurfacing and no other metal in their body. All serum measurements were performed at a minimum of one year after operation. The inclination of the acetabular component was considered to be steep if the abduction angle was greater than 55 degrees. There were significantly higher levels of metal ions in patients with steeply-inclined components (p = 0.002 for chromium, p = 0.003 for cobalt), but no correlation was found between the level of activity and the concentration of metal ions. A highly significant (p < 0.001) correlation with the arc of cover was found. Arcs of cover of less than 10 mm were correlated with a greater risk of high concentrations of serum metal ions. The arc of coverage was also related to the design of the component and to size as well as to the abduction angle of the acetabular component. Steeply-inclined acetabular components, with abduction angles greater than 55 degrees, combined with a small size of component are likely to give rise to higher serum levels of cobalt and chromium ions. This is probably due to a greater risk of edge-loading.

Characterization of the Running-in Period in Total Hip Resurfacing Arthroplasty: An in Vivo and in Vitro Metal Ion Analysis

Metal-on-metal total hip resurfacing arthroplasty is increasingly being performed in young and active patients. Preclinical in vitro testing of implants is usually performed with use of hip simulators, and the serum metal ion concentration is determined for the purpose of monitoring the patients. The goal of this study was to characterize the early running-in period in vivo and in vitro by characterizing metal ion levels. A well-functioning total hip resurfacing prosthesis was implanted in fifteen consecutive patients, and the serum metal ion concentrations in these patients were then determined preoperatively and at intervals during the first postoperative year (at one, six, twelve, twenty-four, and fifty-two weeks). The number of walking cycles was measured with use of a computerized accelerometer in order to compare walking cycles to hip simulator cycles. In vitro, five similar components were investigated for 3 million cycles with use of a hip simulator. Serum samples were obtained at different time points, and wear was measured by quantifying wear particles and ions in the samples. All patient and simulation serum samples were analyzed with use of inductively coupled plasma-mass spectrometry. One simulator implant was investigated with use of scanning electron microscopy. The serum chromium and cobalt levels of the patients continuously increased during the first six months and showed an insignificant decrease thereafter. The molybdenum concentration was unchanged compared with preoperative values. In contrast, the simulator measurements showed a different wear pattern with a high-wear running-in period and a low-wear steady-state phase. The running-in period was delayed by 300,000 cycles and lasted up to 1 million cycles. Scanning electron microscopic analysis showed a carbon-rich protein film predominantly in the early phases of simulation. Scratches were detected originating from pits filled with aluminum oxide and silicon oxide and from pulled-out carbides that were causing third-body wear. The simulator study allowed an exact characterization of the running-in period and showed a delayed onset of running-in wear. In contrast, the clinical data showed a slow increase in measured ion concentrations. These different wear patterns are probably due to the effects of distribution, accumulation, and excretion of particles and ions in vivo.

Aqueous Humor and Serum Levels of Chromium in Cataract Patients with and without Diabetes Mellitus

Purpose: To evaluate the aqueous humor and serum levels of chromium (Cr) in cataract patients with and without diabetes mellitus. Methods: Levels of Cr were measured using atomic absorption spectrometry in the serum from 20 patients and aqueous humor aspirates taken during anterior segment surgery from 20 eyes of 20 patients who had diabetic cataracts and from 20 eyes of 20 patients who had senile cataract only. Results: The mean aqueous humor Cr concentration in eyes with diabetes cataract was significantly lower than that from eyes with senile cataract (p < 0.001). There was also a statistically significant difference between the serum Cr concentrations of the diabetic group and the control group (p < 0.001). Conclusion: The aqueous humor and serum Cr levels are decreased in eyes with diabetic cataract.

Serum Chromium Levels Before and After Revision Surgery for Loosened Metal-On-Metal Total Hip Arthroplasty

We investigated the changes of serum chromium levels before and after revision surgery in 10 patients (1 male and 9 females) who underwent exchange of a metal-on-metal articulation for a metal-on-polyethylene component because of aseptic loosening of a metal-on-metal total hip prosthesis. Of the 10 patients, 2 had bilateral metal-on-metal total hip arthroplasty. In the 8 patients who had no residual metal articulation, the mean serum chromium levels before and after revision surgery were 2.53 μg/L and 0.46 μg/L, respectively. In the 2 patients who still had a metal articulation on the contralateral side, the mean serum chromium levels before and after revision surgery were 2.85 μg/L and 1.90 μg/L, respectively. Moderate serum chromium levels in patients with metal-on-metal total hip arthroplasty show a decrease after removal of the metal-on-metal articulation.

Serum Chromium and Gestational Diabetes

To prospectively assess if chromium levels are different in gestational diabetics than in nondiabetic pregnant women. Therapeutic options could exist if levels are different. We conducted a 2-year prospective, gestational cohort study. The cohort included newly diagnosed pregnant patients. Two blood samples were taken, the first at consent, the second at the time of diabetes screening. Five hundred eighty patients entered the cohort. One hundred fifty-five were lost to follow up and 425 patients completed the study (396 nondiabetics and 29 diabetics). The patients with gestational diabetes were significantly older, with a family history of gestational diabetes, and were significantly more likely to have been a gestational diabetic in a previous pregnancy (P < 05). There was no significant difference between the 2 groups for chromium levels both at enrollment (0.15 +/- 0.06 ng/mL vs 0.14 +/- 0.03 ng/mL; P = .28) and during the second trimester (0.14 +/- 0.06 ng/mL vs 0.14 +/- 0.04 ng/mL; P = .82). Serum chromium levels do not exhibit any significant variation between gestational diabetic women and nondiabetic women when assessed prospectively.

Second generation of metal-on-metal cemented total hip replacements: 12 years of clinical and biological follow-up

The second generation of metal-on-metal prostheses appeared at the end of the 1980’s as a serious alternative to metal on polyethylene bearing couples. Short-term clinical results were promising; however certain questions remain concerning clinical, radiological and biological aspects. Release of chromium and cobalt from the bearing couple is one of these aspects. The aim of this study is to analyse the results of a series of 97 cemented total hip prostheses comprising a titanium femoral stem and the Metasul® metal-metal bearing couple. Mean follow-up was nine years (7–12 years). Complications were marked by 12 revisions, out of which two were for recurrent early dislocations, eight for clinical and radiological failure, and two for worrying radiological alterations. During these revisions, we observed a serious infiltration of metal debris four times, leading to an alternative strategy using an alumina-alumina bearing couple. Three more revisions are planned for rapidly evolving radiological alterations. Thirty implants showed radiological signs of preoccupying deterioration on the acetabular side. Eight segmentary femoral osteolysis have been observed. Twelve patients suffer from recurrent subluxation. Concerning the global evolution of metal serum levels, cobalt remains stable after five years. The values are three to four times above those of a non-exposed subject, but largely below toxic ratios. The evolution of serum chromium levels is similar to cobalt. Implantation of two prostheses in one same patient leads to significant increase in serum metal ratios. This series raises questions concerning the reliability of the metal-on-metal bearing couple. Osteolysis is an unsolved problem. Today, cemented fixation is debatable although this series doesn’t allow this parameter to be held directly responsible. Nothing points to any shortcomings concerning the taper fixation or the metallurgy of the femoral stem. The study of the serum metal levels seems a good indicator of the impingement situations and the functioning of the bearing couple.

Serum Metal Ion Exposure after Total Knee Arthroplasty

All metal implants release metal ions because of corrosion. This has been studied and debated, especially in metal-on-metal total hip arthroplasties. Total knee arthroplasty implants have large metal surface areas and therefore substantial potential for corrosion. We determined changes in serum levels of metal ions in 41 patients after cemented unconstrained total knee arthroplasty without patellar resurfacing, 18 with unilateral total knee arthroplasty (median, 66 months after surgery) and 23 patients with bilateral total knee arthroplasties (75 and 50 months after first and second surgeries, respectively). Serum concentrations of chromium, cobalt, and molybdenum were analyzed and related to the number of total knee arthroplasties and compared with those of 130 control patients without implants. The median chromium, cobalt, and molybdenum concentrations were 0.92, 3.28, and 2.55 microg/L, respectively, in the unilateral total knee arthroplasty sample and 0.98, 4.28, and 2.40 microg/L, respectively, in the bilateral total knee arthroplasty sample. We observed no difference between the serum levels in patients with unilateral and bilateral arthroplasties, but the serum levels of chromium and cobalt of both study groups were greater than those of the control group (less than 0.25 microg/L). The patients who had total knee arthroplasty had molybdenum profiles that were similar to those of the control group (median, 2.11 microg/L).

THE ROLE OF CD40 LIGAND IN EARLY DETECTION OF CHROMIUM-INDUCED IMMUNOTOXIC EFFECTS AMONG EXPOSED WORKERS

Objective: the immunological effect of chromium exposure among workers in tanning industry was assessed by studying the incidence of structural chromosomal aberrations in lymphocytes. Early monitoring of immunotoxicity and possibility ofcarcinogenecity using the CD40 ligand member of the tumor necrosis superfamily of trans-membrane proteins was evaluated. Methods: levels of chromium in blood (S-Cr) and urine (U-Cr) were measured using the graphite furnace atomic absorption spectrophotometer. The CD40 Ligand (CD40L) was determined using ELISA. Whole blood was treated and chosen metaphases were recorded and scored for morphological aberrations and rearrangements.Results: the study was carried out on 30 workers exposed to chromium in chrome-tanning for 17.13 ± 8.09 years, and a matched group of 28 administrative workers. The mean serum chromium levels (S-Cr) were 4.35 ± 1.46 and 1.89 ± 1.31 μg/dl among exposed and control groups, respectively, and the difference was statistically significant, P<0.00±. The CD40L assessment revealed decreased levels among the exposed population, difference was statistically non-significant. The genotoxic changes in the form of chromosomal and chromatid gaps and breaks as well as dicen-actitricchanges were significantly higher among exposed workers, correlating significantlywith the levels of chromium in both serum and urine after correction for creatinine.A significant negative correlation was reported for the deletions with the level of CD40 ligand. The effect of age, smoking and cumulative exposure indices were dealt with.Conclusion: the use of cytogenetic monitoring of human populations exposed to chemicals has proved to be a useful tool for detecting the chemical's mutagenic effects.CD40L, which is a member of the tumor necrosis factor, may be used as an additional marker to assess the presence of chronic inflammation, an early warning indication of potentially adverse genetic and somatic effects.

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.

Metal ion levels in a triathlete with a metal-on-metal resurfacing arthroplasty of the hip

A prospective study of serum and urinary ion levels was undertaken in a triathlete who had undergone a metal-on-metal resurfacing arthroplasty of the hip four years previously. The one month study period included the final two weeks of training, the day of the triathlon, and the two weeks immediately post-race. Serum cobalt and chromium levels did not vary significantly throughout this period, including levels recorded on the day after the 11-hour triathlon. Urinary excretion of chromium increased immediately after the race and had returned to pre-race levels six days later. The clinical implications are discussed.

Metal levels in corrosion of spinal implants

Corrosion affects spinal instrumentations and may cause local and systemic complications. Diagnosis of corrosion is difficult, and nowadays it is performed almost exclusively by the examination of retrieved instrumentations. We conducted this study to determine whether it is possible to detect corrosion by measuring metal levels on patients with posterior instrumented spinal fusion. Eleven asymptomatic patients, with radiological signs of corrosion of their stainless steel spinal instrumentations, were studied by performing determinations of nickel and chromium in serum and urine. Those levels were compared with the levels of 22 patients with the same kind of instrumentation but without evidence of corrosion and to a control group of 22 volunteers without any metallic implants. Statistical analysis of our results revealed that the patients with spinal implants without radiological signs of corrosion have increased levels of chromium in serum and urine (P < 0.001) compared to volunteers without implants. Corrosion significantly raised metal levels, including nickel and chromium in serum and urine when compared to patients with no radiological signs of corrosion and to volunteers without metallic implants (P < 0.001). Metal levels measured in serum have high sensibility and specificity (area under the ROC curve of 0.981). By combining the levels of nickel and chromium in serum we were able to identify all the cases of corrosion in our series of patients. The results of our study confirm that metal levels in serum and urine are useful in the diagnosis of corrosion of spinal implants and may be helpful in defining the role of corrosion in recently described clinical entities such as late operative site pain or late infection of spinal implants.

CHROMOSOMAL ABERRATIONS IN WORKERS OCCUPATIONALLY EXPOSED TO CHROMIUM, NICKEL AND COBALT

Introduction: Combined exposure to chromium, nickel and cobalt occurs in many occupations as dental laboratory technicians, electroplating workers and welders. Dental laboratory technicians whom are the main concern in our study are exposed to chromium, nickel and cobalt metal alloys during casting, finishing and polishing of dental prosthesis (e.g. bridges, crowns, partial and complete dentures) and also to small amount of molybdenum, silica beryllium, boron and carbon. The objective of this work was to evaluate the magnitude of exposure to these metals among dental laboratory technicians and their genotoxic effects.Subjects and methods: The study included 30 dental technicians (24 male & 6females) and 20 comparable control subjects (15 male and 5 females) selected from outpatient clinic and nursing staff in Kasr ElAini hospital. Both groups were subjected to a prepared questionnaire including present, occupational, past and family history , measurement of serum chromium, nickel and cobalt levels, assessment of the chromosomal aberrations in the peripheral blood lymphocytes and measurements of the air levels of the chromium, nickel and cobalt at the work place.

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.

Exposure to chromium, cobalt and molybdenum from metal-on-metal total hip replacement and hip resurfacing arthroplasty

Background All metal implants—and metal-on-metal bearings in particular—corrode and cause a release of metal ions. Because cobalt and chromium have been shown to be carcinogenic and mutagenic in human and animal models, systemic toxicity and cancer risk are considered to be possible disadvantages of the metal-on-metal articulation.This study was designed to investigate the serum concentration profiles of chromium, cobalt and molybdenum after implantation of a Birmingham hip resurfacing arthroplasty (BHR) and a cementless total hip replacement with a 28-mm Metasul articulation (MTHR), over the first 2 years after implantation.Methods We analyzed profiles of metal ion serum levels in 111 patients implanted with a BHR, in 74 patients implanted with an MTHR, and in 130 implant-free probands control subjects using atomic absorption spectrophotometry.Results Chromium and cobalt concentrations (in μg/L) of all BHR and MTHR patients differed significantly from those of control subjects (chromium: < 0.25; cobalt: 0.25). The median chromium and cobalt concentrations in BHR patients had increased to 5.1 and 4.3 μg/ L 2 years after surgery. Concentrations in BHR patient exceeded those in the unilateral MTHR patients. Molybdenum serum concentrations hardly changed over time in either group and were not significantly different from the concentrations seen in the control subjects.Interpretation During the first 2 years after surgery, the Birmingham hip resurfacing arthroplasty leads to a significantly greater increase in serum chromium and cobalt levels than the 28-mm metal-on-metal MTHR. Observation of patients over a longer period will be necessary in order to evaluate any chronic adverse effects to the system due to elevated chromium and cobalt serum concentrations.

The Relationship Between Activity and Ions in Patients with Metal-on-Metal Bearing Hip Prostheses

Total hip replacements with metal-on-metal bearings are frequently implanted in young, active patients. The relationship between patient activity and cobalt and chromium ion levels has not been investigated, to our knowledge. Seven patients with well-functioning metal-on-metal bearing hip prostheses and one control subject (no implants), all with normal renal function, were monitored during a two-week-long activity protocol. Lower-extremity activity was continuously assessed with use of a computerized, two-dimensional accelerometer. During the first week, the subjects were requested to limit physical activity. The subjects then completed an hour-long treadmill test followed by a week in which they were encouraged to be as physically active as practically possible. Serum levels of cobalt and chromium ions and urine levels of chromium were assessed at ten time-points during these two weeks. Regardless of activity, the serum ion levels for a given patient were essentially constant and no correlation was found between patient activity and serum levels of cobalt or chromium, or urine levels of chromium. A mean increase in activity of 28% during the week of high-intensity activity was associated with a mean decrease of 2.7% in the serum cobalt level and a mean increase of 2.0% in the serum chromium level. During the treadmill test, a mean increase in activity of 1621% was associated with a mean increase of 3.0% in the serum cobalt level and a mean increase of 0.8% in the serum chromium level. These results fall within the variability for the measurement accuracy of these tests. For these patients, serum cobalt and chromium ion levels were not acutely affected by patient activity. Periodic measurements of serum ion levels could be used to monitor the tribologic (lubrication, friction, and wear) performance of a metal-on-metal bearing without adjusting for patient activity. Additional research is needed into the kinetics of ion production, transport, and excretion.

Serum Levels of Nickel and Chromium After Instrumented Posterior Spinal Arthrodesis

Cross-sectional study of 37 patients to measure serum levels of nickel and chromium after posterior spinal arthrodesis using stainless steel implants. To investigate the relationship between factors such as age, gender, pain, time from surgery, length of arthrodesis, and level of arthrodesis to serum metal ion levels after instrumented spinal arthrodesis. Measurable levels of metal ions in the serum can be detected after the use of stainless steel implants. There is some evidence to suggest that long-term exposure can potentially be toxic. Posterior spinal arthrodesis with stainless steel implants is a common procedure to treat spinal deformity in the adolescent population; however, the extent of metal ion exposure after posterior spinal arthrodesis is unknown. Patients that underwent posterior instrumented spinal arthrodesis with more than 6 months follow-up were recruited for this study. Patients with altered neurologic function were excluded. Serum levels of nickel and chromium were measured using inductively coupled plasma mass spectrometry. Pain was assessed using the Oswestry questionnaire. Spine radiographs were used to look for evidence of pseudarthrosis. Forty-five patients were approached, and 37 agreed to the questionnaire and blood test. Ten patients were men and 27 were women. Mean age at surgery was 14 years with mean follow-up of 6 years. Statistical correlations between serum metal ion levels and age at surgery, time from surgery, gender, number of segments fused, spinal instrument interfaces, pain, and instrumentation type were assessed. Abnormally high levels of nickel and chromium above normal levels (0.3 ng/mL for nickel, 0.15 ng/mL for chromium) could be detected in serum after posterior spinal arthrodesis using stainless steel implants. There was a significant inverse correlation between serum nickel (r = -0.61, P < 0.001) and chromium (r = -0.64, P < 0.001) levels and time from surgery. When patients were grouped based on lengths of time from surgery, 0 to 2 years (n = 7), 2 to 4 years (n = 11), and >4 years (n = 8), the mean +/- SD for nickel (ng/mL) was 3.8 +/- 2.6, 1.3 +/- 1.1, and 0.9 +/- 0.8, respectively. Analysis ofvariance revealed significant group differences (P =0.004). Similarly, the chromium levels were 2.7 +/- 2.7, 0.6 +/- 0.4, and 0.3 +/- 0.3, respectively (P = 0.018). Only time from surgery was a significant multivariate predictor of nickel and chromium serum levels. Pseudarthrosis was not seen in this cohort. Elevated levels of nickel and chromium can be measured after posterior instrumented spinal arthrodesis. The levels diminish rapidly with time from surgery but still remained above normal levels 4 years after surgery. Long-term implication of this metal ion exposure is unknown and should be studied further.