Serum Titanium Research Articles

Titanium serum levels may remain elevated despite hip revision surgery for wear-through of an acetabular component Erhöhter Titan-Serumspiegel trotz Revisionsoperation bei abriebpartikelinduzierter Pfannenlockerung

A 62-year-old female patient showed radiographic signs of severe linear wear of the acetabular component six years after cementless total hip arthroplasty. This suggested wear-through of the acetabular liner with secondary wear of the titanium shell. At revision surgery wear-through of both the inlay and the acetabular shell were confirmed. Despite meticulous debridement serum titanium levels remained elevated for more than 12 months. Wear-through of a polyethylene acetabular liner with secondary wear of the titanium shell can lead to increased titanium serum levels. Titanium serum levels can remain highly elevated despite revision surgery.

Urinary and Serum Titanium: Assessment as an Indicator of Exposure to Ammonium Citratoperoxotitanate (IV) and Its Influence on Renal Function

Ammonium citratoperoxotitanate IV (TAS-FINE) is a water-soluble titanium complex used to synthesize a photocatalytic titanium(IV) oxide film. This study was aimed to investigate the LD50, dose-response, time-course response, and renal toxicity of TAS-FINE using an animal model. Serum titanium (S-Ti) and its 24-h urinary excretion (U-Ti) were determined by inductively coupled plasma-argon emission spectrometry (ICPAES) after a single oral TAS-FINE administration to male Wistar rats. The LD50 of TAS-FINE was 7.97 g/kg body weight in 24 h, and its half-life was 3.78+/-1.28 d for S-Ti and 2.19+/-0.09 d for U-Ti. Although TAS-FINE was not easily absorbed in the gastrointestinal tract, it was distributed into the bloodstream in a dose-dependent manner. Within 24 h, 0.189% of administrated Ti was excreted via urine. It was speculated that TAS-FINE formed conjugates with serum constituents that resulted in nephrotoxicity resulting from an allergic reaction. The observed indices in this study were revealed to be good indicators for TAS-FINE exposure. The analytical method and animal model described in this study will help to further elucidate details about human exposure to TAS-FINE, which in recent times has become an occupational and environmental toxicant of concern.

Biomonitoring of titanium, mercury, platinum, rhodium and palladium in dental health care workers

In dentistry, titanium, mercury, platinum, rhodium and palladium are used to produce dental fillings. Therefore, dental workers who apply such materials may be exposed to these metals. The study concerned 40 healthy subjects-20 controls and 20 dental health care workers-to determine serum and urinary levels of the aforementioned metals by inductively coupled plasma mass spectrometry. Mean urinary and serum titanium did not reveal statistically significant differences in the two groups. The very low urinary and serum levels of mercury, platinum, rhodium and palladium prevented us from making a statistical evaluation between the two groups. We did not find a significant increase in serum and urinary titanium levels in dental health care workers. Measurement of mercury, platinum, rhodium and palladium in urine and serum was not useful in determining occupational exposure.

Metal concentrations in the serum and hair of patients with titanium alloy spinal implants.

A retrospective study of serum and hair metal concentrations in patients with titanium alloy spinal implants was performed. To determine the incidence and possible causes of abnormal metal concentrations. Several studies have demonstrated that metal debris are present in the tissues surrounding titanium alloy spinal implants. However, few studies suggest that metals dissolve, circulate in the body fluid, and accumulate in remote organs. Titanium, aluminum, and vanadium concentrations in serum and hair were measured after surgery in 46 patients with titanium alloy spinal implants (12 patients in the implant failure group and 34 patients in the no implant failure group) and 20 patients without spinal implants (control group). All the subjects were examined again 1 year after the first examination or implant removal. Of the 46 patients with titanium alloy spinal implants, 16 patients (34.8%) exhibited abnormal serum metal concentrations and 11 patients (23.9%) exhibited abnormal hair metal concentrations. In the control group, three patients (15%) exhibited only abnormal serum and metal aluminum concentrations at the first examination. In both of the two patients who exhibited abnormal serum titanium concentrations and then had their spinal implants removed, the serum and hair titanium levels decreased to beneath the reference value limit in 1 year after the removal. Comparison of the implant failure and no implant failure groups showed no significant differences in the incidence of abnormal serum concentrations of titanium, aluminum, or both metals. Therefore, serum metal concentrations did not seem to be a useful indicator of hardware loosening or implant failure. Approximately one third of patients with titanium alloy spinal implants exhibited abnormal serum or hair metal concentrations at a mean time of mean 5.1 years after surgery. Titanium or aluminum may travel to distant organs after dissolution of metals from the spinal implants.

Serum titanium level for diagnosis of a failed, metal-backed patellar component

A case is presented in which an elevated serum titanium level was used to make the diagnosis of a failed metal-backed patellar component. The preoperative serum titanium level was 536.8 ppb, which was 98 times higher than the patient's previous level (taken 1 year earlier, when he was asymptomatic) and 2 orders of magnitude higher than the expected level with a well-functioning implant of this type. Revision surgery confirmed that the polyethylene portion of the patellar component had worn through, leaving the titanium portion of the patellar implant to articulate with the femoral component. Wear-through was not evident on preoperative radiographs or clinical examination. As knowledge about the expected ranges for serum metal ion levels after total joint arthroplasty continues to increase, the diagnostic utility of serum metal ion testing in the evaluation of joint arthroplasty function will continue to improve.

Metal Release and Excretion From Cementless Titanium Alloy Total Knee Replacements

Concentrations of titanium, aluminum, and vanadium were measured in the serum and urine of patients with titanium alloy cementless primary total knee arthroplasty components. Patients were categorized in one of five groups. In Group 1, the patellar and tibial articulating surfaces were made of carbon fiber reinforced ultrahigh molecular weight polyethylene. In Group 2, the patellar and tibial surfaces were made of ultrahigh molecular weight polyethylene. In Group 3, the femoral titanium alloy articulating surface was nitrogen ion implanted with ultrahigh molecular weight polyethylene patellar and tibial articulating surfaces. Patients in Group 4 had failed patellar components, and Group 5 was comprised of age and gender matched control subjects without implants. Serum concentrations of titanium were approximately 50 times greater in patients with failed patellar components (Group 4) and approximately 10 times greater in patients with carbon fiber reinforced polyethylene bearing surfaces (Group 1) when compared with Groups 2 and 3 and the control subjects (Group 5). For aluminum and vanadium, no detectable differences were observed among any of the groups. In addition, analysis of 24-hour urine samples showed no significant differences in titanium, aluminum, or vanadium concentrations among any of the groups. Elevated serum titanium levels may serve as a marker of patellar component failure or accelerated femoral component wear in total knee replacements with titanium alloy bearings. The toxicologic ramifications of these findings are unknown.