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Background: Beginning in 2008, metal-on-metal prostheses have been in the spotlight owing to much higher revision rates than expected. Adverse local tissue reactions have been well described in the literature as potential complications., Methods: Between 2012 and 2013, 13 patients with metal-on-metal total hip replacements were evaluated clinically and radiologically and with laboratory samples. The same tests were repeated between 2015 and 2016 on eight patients to assess any changes. In the laboratory assessment, we searched for chromium, cobalt, molybdenum, and nickel in blood and urine samples over 24 h., Results: Clinical assessment has shown good score in all patients except one. On a second examination, between 2015 and 2016, all patients obtained results similar to those obtained in the first assessment, except a patient, who reported a recent fall. In the radiological assessment between 2012 and 2013, results were optimal, apart from a case of aseptic mobilization. The patients reassessed 3 years after the first examination showed radiological results similar to those previously obtained, apart from a patient, who showed signals of mobilization. Metal levels found in their blood decreased in most cases after 3 years. Urine levels of nickel increased in five subjects, and chromium levels increased in four, but levels of cobalt and molybdenum decreased in four patients., Conclusion: It could be hypothesized that the decreasing trend of metal ion levels is associated with a stable wear status. On the contrary, a progressive increase in metal ion levels must be considered as early proof of implant loosening.

Background: There is little reliable information on human exposure to the metals platinum (Pt), palladium (Pd) and rhodium (Rh), despite their use in enormous quantities in catalytic converters for automobile exhaust systems., Objectives: To evaluate blood concentrations of Pt (B-Pt), Pd (B-Pd) and Rh (B-Rh) in women from six European and three non-European countries, and to identify potentially influential factors. In addition, molybdenum (Mo) and strontium (Sr) were analysed., Methods: Blood from 248 women aged 47-61 was analysed by high resolution inductively coupled plasma mass spectrometry under strict quality control., Results: The medians were: B-Pt 0.8 (range <0.6-5.2), B-Pd <5 (<5-9.3), B-Rh <0.4 (<0.4-3.6)ng/L and B-Mo 2.0 (0.2-16) and B-Sr 16.6 (3.5-49) μg/L. Two women with highly elevated B-Pt (242 and 60ng/L), previously cancer treated with cis-platinum, were not included in the data analysis. All elements varied geographically (2-3 times) (B-Pd P=0.05; all other elements P<0.001); variations within each area were generally 5-10 times. Traffic was not associated with increased concentrations., Conclusions: General population blood concentrations of Pt, Pd and Rh are within or below the single digit ng/L range, much lower than in most previous reports. This is probably due to improved analytical performance, allowing for more reliable information at ultra-trace levels. In general, Mo and Sr agreed with previously reported concentrations. All elements showed geographical and inter-individual variations, but no convincing relationships with self-reported traffic intensity were found. Pt from the antineoplastic drug cis-platinum is retained in the body for years., (Copyright © 2017 The Authors. Published by Elsevier GmbH.. All rights reserved.)

Background: In recent time, metal ion debris and adverse local tissue reaction have reemerged as an area of clinical concern with the use of large femoral heads after total hip arthroplasty (THA)., Methods: Between June 2014 and January 2015, 60 patients with a noncemented THA using a titanium (titanium, molybdenum, zirconium, and iron alloy) femoral stem and a V40 trunnion were identified with a minimum 5-year follow-up. All THAs had a 32- or 36-mm metal (n = 30) or ceramic (n = 30) femoral head coupled with highly cross-linked polyethylene. Cobalt, chromium, and nickel ions were measured., Results: Patients with metal heads had detectable cobalt and chromium levels. Cobalt levels were detectable in 17 (56.7%) patients with a mean of 2.0 μg/L (range: <1.0-10.8 μg/L). Chromium levels were detectable in 5 (16.7%) patients with a mean of 0.3 μg/L (range: <1.0-2.2 μg/L). All patients with a ceramic head had nondetectable cobalt and chromium levels. Cobalt and chromium levels were significantly higher with metal heads compared to ceramic heads (P < .01). Cobalt levels were significantly higher with 36-mm metal heads compared with 32-mm heads (P < .01). Seven patients with metal femoral heads had mild hip symptoms, 4 of whom had positive findings of early adverse local tissue reaction on magnetic resonance imaging. All ceramic THA was asymptomatic., Conclusion: The incidence and magnitude of cobalt and chromium levels is higher in metal heads compared to ceramic heads with this implant system (P < .01). Thirty-six millimeter metal femoral heads result in larger levels of cobalt compared with 32-mm metal heads., (Copyright © 2016 Elsevier Inc. All rights reserved.)

In this study we determined the concentration of 9 trace elements (As, Cd, Cu, Hg, Mn, Mo, Pb, Se and Zn) in whole blood of children (n=100, 64 girls, 36 boys and median age: 36 months) using inductively coupled plasma mass spectrometry (ICP-MS). The proportion of children potentially deficient in essential elements or poisoned by toxic elements was evaluated. The aging effects on the concentration of these elements were also investigated. The median values were 3.17μg/L (As), 0.15μg/L (Cd), 1.1mg/L (Cu), 2.1μg/L (Hg), 10.4μg/L (Mn), 17.7μg/L (Mo), 8.7μg/dL (Pb), 10.7μg/L (Se) and 5.0mg/L (Zn). The concentration of many elements (As, Cd, Hg, Mn, Pb and Zn) showed significant age variations but not sex influence. Regarding levels of the essential elements (Cu, Mn, Mo, Se and Zn), B-Cu, B-Mn, B-Se and B-Zn were in the normal range, whereas exceeded levels were observed for B-Mo. None of these children was deficient in essential elements. Except B-Cd, all toxic elements showed exceeded blood levels. The proportion of children potentially poisoned by toxic elements varies from 10% (n=10) to 95% (n=95) and depends on toxic element: 95% for As, 10% for Hg and 35% for Pb. The main health concerns emerging from this study are the high As, Hg and Pb exposures of the Kinshasan children requiring further documentation, corrective actions and the implementation of appropriate regulations., (Copyright © 2013 Elsevier GmbH. All rights reserved.)

Objective: To identify exposures possibly contributing to anemia cases among hexavalent chromium medical surveillance program enrollees., Methods: An investigation encompassed metals surveillance programs, extensive workplace sampling and remediation, consultation, evaluation of laboratory accuracy, and follow-up of anemic individuals., Results: Workers had underlying medical conditions that affected surveillance results. There was a systemic error in classification based on hematocrit value. The prevalence of anemia in a workforce averaging 52 years old was 16%., Conclusions: Anemia may be more prevalent in middle-aged workers than expected. Modern laboratories generally report a calculated hematocrit value, and using hemoglobin for most classification purposes is preferred. Characteristics of a specific workforce, including age, health, hobbies, and diet, should be taken into account when interpreting medical surveillance program findings. The value of a team approach in addressing occupational health problems was demonstrated.

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 production., Methods: 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 microg/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 microg/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 resurfacing arthroplasty has undergone a recent resurgence as an alternative treatment option for young and active patients with significant osteoarthritis. The claimed advantages of metal-on-metal hip resurfacing arthroplasty include lower wear rate, preservation of bone stock for subsequent revision procedures, restoration of anatomic hip mechanics, and enhanced stability due to the larger diameter of articulation. A disadvantage, however, is that the metal-on-metal resurfacing releases large amounts of very small wear particles and metal ions. The long-term biological consequences of the exposure to these Co-Cr particles and ions remain largely unknown. The purpose of this review is to provide an overview of the current literature on the adverse periprosthetic biological reactions associated with metal-on-metal hip resurfacing arthroplasty.

The main components (Ti, V, Cr, Co, Ni, and Mo) of metallic alloys currently used in hip and knee articular prostheses have been simultaneously determined in human whole blood and urine of implanted people by a (HR)-ICP-MS method previously developed in our laboratory. The determination of those elements has been carried out in patients with knee and hip prosthesis and in a group of pre-operation patients without any metallic device in their bodies, used as controls, demonstrating the usefulness of this technique to perform multielement analysis at ppt levels in complex matrices. The concentrations of V, Cr, Co, Ni, and Mo in urine and blood of implanted people turned out to be very similar to those obtained in control patients. However, raised Ti levels could be found both in urine and blood of patients with articular prostheses made or coated with a titanium alloy (Ti(6)Al(4)V).

The aim of the study was to evaluate the serum and urine levels of cobalt (Co), chromium (Cr), manganese (Mn), molybdenum (Mo) and nickel (Ni) in patients who had undergone metal-on-metal hybrid surface arthroplasties on the supposition that a release of metals would occur due to the large head size of this type of implant. Metal levels were determined by using an analytical method based on sector field inductively coupled plasma mass spectrometry. Results showed a significant difference between patients and control subjects in mean levels of Co and Cr in serum (p<0.0001 and p=0.02, respectively) and in urine (p<0.0001 for both). No significant differences were observed in mean serum and urinary levels of Mn, Mo and Ni. Although the clinical consequences of these changes, if any, are unknown, further studies could be performed in a larger number of subjects implanted with a total surface arthroplasty at follow-up times over different periods.