gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2022)

25. - 28.10.2022, Berlin

Whole blood of patients undergoing revision total hip or knee arthroplasty reveals multi-element exposure

Meeting Abstract

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  • presenting/speaker Anastasia Rakow - Universitätsmedizin Greifswald, Greifswald, Germany
  • Carsten Perka - Orthopädische Klinik, CMSC, Charité Berlin, Berlin, Germany
  • Silvan Wittenberg - Charité – Universitätsmedizin Berlin, Centrum für Muskuloskeletale Chirurgie, Berlin, Germany
  • Janosch Schoon - Universitätmedizin Greifswald, Zentrum für Orthopädie und Unfallchirurgie, Klinik für Orthopädie und Orthopädische Chirurgie, Greifswald, Germany

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2022). Berlin, 25.-28.10.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocAB12-829

doi: 10.3205/22dkou017, urn:nbn:de:0183-22dkou0172

Veröffentlicht: 25. Oktober 2022

© 2022 Rakow et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objectives: Arthroprosthetic metal exposure has been linked to systemic toxicity for years. Neurological, cardiac and thyroid dysfunctions following cobalt-chromium exposure due to implant wear and corrosion have been reported most commonly. Moreover, potential immunotoxicity, cancerogenicity and teratogenicity of cobalt and chromium species, but also of all other metals released from joint prostheses, have become a focal point of interest. Yet, evidence of systemic distribution of these 'arthroplasty metals', as a prerequisite for any proclaimed systemic effect, is largely missing. Whether and to what extent these metals enter the patient's blood may be identified by multi-element analyses (MEA). We aimed to provide a preliminary assessment regarding the systemic levels of all arthroplasty-relevant metals in patients who have a history of hip and/or knee joint replacement.

Methods: As part of our institution's diagnostic standard, whole blood MEA were conducted for any patient of any sex and age who underwent revision total hip or knee replacement at our institution between 06/2018 and 12/2020. MEA were performed with inductively coupled plasma mass spectrometry (ICP-MS) and included quantification of concentrations of aluminum, cobalt, chromium, molybdenum, nickel, niobium, tantalum, titanium, vanadium and zirconium. Demographic and implant-related data were collected retrospectively by chart-review.

Results: MEA of whole blood of 184 patients who underwent revision hip (n=97) or knee (n=87) replacement were included in this study. In 56,5% (104/184) the blood level of at least one arthroplasty metal was found to be above reference value. We confirmed that in patients with elevated systemic cobalt concentrations chromium levels were also always significantly elevated, and that systemic titanium levels might rise by several magnitudes. We found elevated niobium and vanadium levels only occurred in patients in whom titanium was significantly elevated, and that cement leakage into periprosthetic soft tissues was associated with elevated systemic concentrations of zirconium. Further, it was demonstrated that vanadium was significantly elevated in 10.3%, and that tantalum was significantly elevated in 11.3% of patients scheduled for revision hip arthroplasty. MEA did not detect any significantly elevated aluminum concentration in any of the patients included.

Conclusion: MEA of whole blood provide information on whether and to what extent systemic metal levels rise in people scheduled for revision hip or knee arthroplasty. MEA results may complement and facilitate differential diagnostics of new-onset symptoms and diseases potentially affecting different organ systems in the aftermath of joint replacement.