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This study aimed to investigate the long-term serum metal ion levels of patients who received metal-on-metal hip resurfacing arthroplasty (MoM HRA). We conducted a retrospective study of 99 patients (110 hips) from March 2006 to May 2017 who underwent MoM HRA. The Harris Hip Score (HHS) and the University of California at Los Angeles (UCLA) activity score were measured, and the patients underwent clinical and radiological management. Serum levels of cobalt (Co), chromium (Cr), and molybdenum (Mo) were measured using inductively coupled plasma mass spectrometry (ICPMS) at 1, 6, and 12 months, and each year follow-up after prosthesis implantation. Patients were followed up from 1 to 156 months, with a mean of 98 months. No complications occurred. Metal ion analysis revealed significantly elevated levels compared to preoperative levels. The metal ions levels increased and reached a peak after surgery, and then the levels began to decline gradually. Approximately 84-108 months after surgery, the metal ion levels increased again to approximately peak levels. Then, up to 156 months after surgery, the metal ions levels will drop approximately to preoperative levels. The serum levels of Cr in women were higher than those in men, with the difference being statistically significant. Patients with a body mass index (BMI) of ≥24.9 kg/m2 Co levels were significantly higher than those of normal-weight patients. The serum levels of metal ions showed no significant differences between the prostheses. The use of the MoM HRA was clinically effective, and the Co, Cr, and Mo levels increased significantly after HRA; however, upon long-term follow-up, serum metal ion levels tended to decrease to preoperative levels. Longer follow-up periods and larger study samples are needed to establish the long-term outcome of patients undergoing HRA with MoM bearings. Level IV, Therapeutic Study.

Background: Welders are exposed to a number of metallic elements during work. Bioaccessability, that is important for element uptake, has been little studied. This study addresses bioaccessability and uptake of chromium (Cr), molybdenum (Mo), tungsten (W) and vanadium (V) among welders., Methods: Bioaccessability of Cr, Mo, V and W was studied in airborne particulate matter collected by personal sampling of the workroom air among shipyard welders by using the lung lining fluid simulant Hatch solution. Associations between concentrations of Hatch soluble and non-soluble elements (Hatch sol and Hatch non-sol ) and concentrations of the four elements in whole blood, serum, blood cells and urine were studied., Results: Air concentrations of the four elements were low. Only a small fraction of Cr, V and W was Hatch sol , while similar amounts of Mo were Hatch sol and Hatch non-sol . Welders (N=70) had statistically significantly higher concentrations of all four elements in urine and serum when compared to referents (N=74). Highly statistically significant associations were observed between urinary W and Hatch sol W (p<0.001) and serum V and Hatch sol V (p<0.001), in particular when air samples collected the day before collection of biological samples were considered., Conclusions: Associations between Hatch sol elements in air and their biological concentrations were higher than when Hatch non-sol concentrations were considered. Associations were generally higher when air samples collected the day before biological sampling were considered as compared to air samples collected two days before., (Copyright © 2017 Elsevier GmbH. All rights reserved.)

Background: Recent registry data reveal that modular-neck hip prostheses are associated with increased revision rates compared to fixed-neck stems. Poor implant survival has been associated to corrosion at the neck-stem junction, inducing metal ion release and subsequently adverse local tissue reactions. Data on metal ion release on the neck-stem junction of such stems are scarce. The purpose of this study was to evaluate corrosion at this interface by determining metal ion release., Methods: Serum and whole blood metal ion levels of 40 patients after 1 year of implantation of a modular-neck stem (titanium stem and cobalt-chromium neck) were compared with 10 patients with a monobloc version of the stem (all titanium) and 10 patients having no implant at all., Results: Seven of 40 patients (18%) with a modular-neck stem had cobalt or chromium concentrations >2 μg/L. These patients underwent magnetic resonance imaging using metal artifact reduction sequences, which revealed a pseudotumor in 1 patient., Conclusion: Corrosion at the neck-stem junction of modular-neck stems is a reported phenomenon, which is in part reflected by elevated systemic ion levels. The use of such implants should be restricted to a minimum, and screening algorithms of patients with such implants must be developed., (Copyright © 2016 Elsevier Inc. All rights reserved.)

This study aimed to evaluate the influence of exposure to aluminum, nickel, thallium and uranium on the metabolism of essential elements in humans, as well as the relationship between uranium, thallium, nickel, and aluminum and essential elements (Ca, Mg, Zn, Se, Mn, Co, Cr, and Mo) in the whole blood and blood serum of healthy men who were occupationally exposed. This study included 97 healthy men, 31-64 years age, including 70 workers in a thermo power plant and 27 control subjects. The results showed that chronic, moderate exposure of trace elements (Al, Ni, Tl, and U) lead to decreased serum chromium (SCr) and blood molybdenum levels (BMo), whereas by the results achieved in terms of correlations between non-essential and essential elements, non-essential elements such as uranium, thallium, nickel, and aluminum, despite their concentration within the reference values, are strongly competitive with essential elements in biochemical processes.

Metal-on-metal resurfacing arthroplasty of the hip has been used increasingly over the last 10 years in younger active patients. The dissolution of the metal wear particles results in measurable increases in cobalt and chromium ions in the serum and urine of patients with a metal-on-metal bearing. We measured the cobalt, chromium, and molybdenum ion levels in urine; serum; and breast milk in a young and active patient with a metal-on-metal hip prosthesis after a pathologic fracture of the femoral neck. Metal-on-metal hip prosthesis leads to increasing levels of molybdenum in breast milk in the short-term follow-up. There are no increasing levels of chromium and cobalt ions in breast milk. Besides the already known elevated concentrations in serum of chromium and cobalt after implantation of a metal-on-metal hip prosthesis, we found no increasing levels of chromium and cobalt in urine., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: Metal implants may wear and corrode, resulting in systemic dissemination of metallic debris that is measurable in serum. Concern exists regarding adverse health effects related to implant-derived debris. Minimally invasive repair of pectus excavatum (MIRPE) is a popular technique in which a stainless steel substernal bar is implanted to achieve deformity correction. Serum metal levels have not previously been investigated after MIRPE., Methods: Serum chromium, molybdenum, and nickel levels were measured in this cross-sectional study of 11 children implanted with pectus bars after MIRPE. Samples were analyzed using high-resolution inductively coupled plasma mass spectrometry., Results: Median serum chromium and nickel values were elevated 3.3-fold (P = .0003) and 2.3-fold (P = .25), respectively, compared with age-matched controls. Serum chromium and nickel levels were abnormally elevated in 6 (55%) of 11 and 5 (45%) of 11, respectively. In patients whom postexplantation metal levels were measured, previously elevated levels were lowered. Serum chromium levels in children after MIRPE are comparable with adult cohorts with hip arthroplasty implants measured 1-year postoperatively. No acute metal toxicity was observed., Conclusions: Abnormally elevated levels of serum metal levels are measurable in children implanted with pectus bars. These findings warrant further investigation to assess the biocompatibility of this surgical implant in children., (Copyright © 2012 Elsevier Inc. All rights reserved.)

The article deals with the characteristics of alterations of mineral metabolism indicators in children of various age with chronic diseases ofgastrointestinal tract and having body mass of normal and different surplus degrees. The sample consisted of 127 children aged from 6 to 15 years with chronic gastroduodenitis, pancreatitis and cholecystitis. The concentration of bioelements in plasma was determined using the technique of mass spectrometry with inductively coupled plasma. The study established the increase of concentration of molybdenum 4.3 times, chrome--8.4 times and selenium--1.36 times. The revealed bioelemental misbalance impacts the overall health of children and course of disease and hence has to be accounted in case of application of treatment targeted to the correction of mineral metabolism.

Metal-on-metal hip replacement implants generate wear debris and release ions both locally and systemically in patients. To investigate dissemination of metal, we determined blood and organ levels of cobalt (Co), chromium (Cr), and molybdenum (Mo) following the implantation of Co-Cr alloy wear debris in mice using skin pouches as a model system. We observed increased metal levels in blood for up to 72 h; the levels of Co were highest and remained elevated for 7 days. Co levels were elevated in all organs studied (liver, kidney, spleen, lung, heart, brain, and testes), with the peak at 48 h; highest levels were measured in liver and kidney (838.9 ± 223.7 ng/g in liver, and 938.8 ± 131.6 ng/g in kidney). Organ Cr levels were considerably lower than Co levels, for example, Cr in kidney was 117.2 ± 12.6 ng/g tissue at 48 h. Co is more mobile than Cr, reaching higher levels at earlier time points. This could be due to local tissue binding of Cr. Exposure to Co-Cr particles in vivo altered antioxidant enzyme expression and activities. We observed induction of catalase protein in the liver and glutathione reductase (GR) and peroxidase (GPx) proteins in the spleen. Activities of catalase and GPx in the liver were significantly increased while that of GR was decreased in the kidney. Organs of mice with Co-Cr particle implantation were exposed to increased metal levels capable of inducing reactive oxygen species scavenging enzymes, suggesting the tissue may be subjected to oxidative stress; however, the overall antioxidant defence system was not markedly disturbed., (Copyright © 2012 Wiley Periodicals, Inc.)

Background: Metal ion toxicity, metal hypersensitivity, and metal carcinogenicity are causes for concern for patients with metal-on-metal hip replacements. Thus, understanding the biological fate of metal ions, and consequently their long-term systemic effects, is of great interest to patients and surgeons alike., Methods: Inductively coupled plasma mass spectrometry was used to measure the levels of cobalt, chromium, and molybdenum ions in the blood of control patients (preoperative control pre-resurfacing patients), patients with a metal-on-polyethylene total hip prosthesis, patients with a metal-on-metal total hip prosthesis with either a 28 or 36-mm femoral head, and patients with a hip resurfacing prosthesis. Since cobalt and chromium ions have the potential to induce oxidative stress through irreversible biochemical damage to macromolecules, the levels of ions were correlated to the concentration of three oxidative stress markers in the plasma of these patients., Results: The median cobalt level was significantly lower (p < 0.001) in the 36-mm metal-on-metal total hip arthroplasty group (1.8 parts per billion [1.8 microg/L]) compared with the 28-mm metal-on-metal total hip arthroplasty group (2.5 parts per billion [2.5 microg/L]) and the hip resurfacing group (2.3 parts per billion [2.3 microg/L]) at six months postoperatively. The median chromium level was also significantly lower (p < 0.01) in the 36-mm metal-on-metal total hip arthroplasty group (0.25 parts per billion [0.25 microg/L]) compared with the 28-mm metal-on-metal total hip arthroplasty group (0.35 parts per billion [0.35 microg/L]) and the hip resurfacing group (0.50 parts per billion [0.50 microg/L]) at six months postoperatively. However, neither the median cobalt levels nor the median chromium levels were significantly different among the three metal-on-metal groups at one year. The median levels of molybdenum were not significantly different among the three groups at either six months or one year. In addition, there was no significant difference in the plasma concentration of oxidative stress markers in patients with metal-on-metal bearings compared with that in control patients., Conclusions: The blood metal ion levels in the hip resurfacing group were similar to those in the 28 and 36-mm-head metal-on-metal total hip arthroplasty groups. This study suggests that the increased metal ion levels had no effect on oxidative stress markers in the blood of these patients.

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).

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 microg/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 microg/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.

Objective: Hip fractures are disabling accidents in the elderly. The purpose of this prospective study was to investigate systemic exposure to metals from hip implants used for fracture fixation., Material and Methods: Serum levels of Cr, Ni and Mo in patients with compression hip screws (n = 22) or cervical fracture screws (n = 23) were measured by inductively coupled plasma mass spectrometry. Blood samples were collected before surgery and at 3 and 12 months postoperatively., Results: At 3 months, patients with compression hip screws showed higher concentrations of Cr and Ni than did those with cervical screws. Both types of screws led to a 2-fold increase in serum Mo, which was not expected for the freestanding cervical screws. After 12 months, the levels had decreased, but the compression hip screw was still associated with higher values for Cr and Mo., Conclusions: The difference between the screws is most likely due to the potential for fretting and crevice corrosion between components in the compression hip screws. The apparent short-term systemic elevation of stainless steel elements in patients with hip screws does not support routine removal of asymptomatic hip fracture implants.

Purpose of the Study: Component wear and dissemination of wear debris, particularly with metal-on-metal combinations, is the predominant long-term complication of total hip arthroplasty. The purpose of our work was to search for metal pArticles released when using the metal-on-polyethylene combination by analyzing serum levels of chromium (Cr), cobalt (Co), nickel (Ni), and molybdium (Mo) in patients with a metal-on-polyethylene chromium-cobalt total hip arthroplasty. We compared the observed levels with those observed in a control population and studied changes as a function of signs of loosening., Material and Methods: During a thirty-Month period, 53 patients with degenerative hip disease underwent total hip arthroplasty. The same implant, PVL, being used for all hips. Forty-eight patients were available for analysis at a minimum follow-up of 32 Months. Results of the clinical and radiological examination of the operated hip were recorded. Serum metal levels were assayed by mass spectrometry on total blood samples. Patient activity was determined with the Devane classification and hip function with the Postel-Merle-d'Aubligné score; walking distance was recorded in kilometers. Signs of prosthetic loosening were identified on plain radiograms (AP and lateral views) searching for femoral and/or acetabular lucent lines, cement fracture, granuloma. The control group included 56 patients scheduled for total hip arthroplasty. Non-parametric statistical analysis was used to search for correlations between the clinical, radiological, and biological parameters., Results: At mean 44 Months follow-up, 17% of the patients had a fair or mediocre function score and 37% had radiological signs of femoral component loosening. Serum cobalt increased significantly in the implanted group (serum cobalt >or=0.60 microg/L in 50% of patients) compared with the control group (serum cobalt >or=0.60 microg/L in 9%) (P<0.001, Mann-Whittney test). Increased serum cobalt was highest in patients with radiographic signs of loosening. This significant difference was not found for other metals. Patient activity, hip function, and follow-up were not correlated with serum levels., Discussion: Serum cobalt appears to be a good biological marker of prosthetic function although intra- and inter-individual variations are influenced by assay technique, metal ion solubility, and metal dissemination in the organism. The metal-on-metal combination does not appear to be the only friction couple which increases the serum level of metal ions. Our results do not allow defining a time of latency between onset of radiographic signs and increased serum levels.

An artificial knee joint made of a cobalt alloy (Cr 27-38%, Mo 5-7%, others 9%, Co balance) failed in an orthopaedic patient with severe tissue reaction. Samples of synovial fluid and blood were analyzed for cobalt, chromium and molybdenum concentration using graphite furnace atomic absorption spectrophotometry (GFAAS). NIST SRM 909 Human Serum containing 91.3 micrograms/L chromium was used as the Cr Standard. To obtain reliable values for cobalt and molybdenum, three different independent analytical methods were employed to analyze each sample: 1) dilution of the samples with Triton TX-100 solution, followed by GFAAS; 2) microwave decomposition of the samples, followed by GFAAS; 3) classic nitric-perchloric acid decomposition of the samples, followed by GFAAS. The two decomposition methods were used to control the accuracy of the dilution method. The results showed that the non-decomposition method gave comparable results to the decomposition techniques for analysis of synovial fluid and blood. The data revealed that the patient had elevated levels of Co, Cr and Mo in both synovial fluid and blood with the values being 2-3 orders of magnitude higher in the synovial fluid from the affected knee.