Systemic Metal Ion Concentrations in Patients With Hip and Knee Megaprostheses: A Prospective Cohort Study
Background: Local tissue and serum metal ions have been shown to be elevated in some metal-on-metal and metal-on-polyethylene joint replacements. Local elevations have been linked to adverse local tissue reactions in some patients, and systemic elevation has been less commonly implicated cardiac and...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2022-12-01
|
| Series: | Arthroplasty Today |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352344122001777 |
| _version_ | 1811295284848754688 |
|---|---|
| author | Kiki Q. de Smidt, BSc Geert Spierenburg, MD Richard E. Evenhuis, MD Sarah E. Bosma, MD, PhD Robert J.P. van der Wal, MD, PhD Demien Broekhuis, MD Michiel A.J. van de Sande, MD, PhD |
| author_facet | Kiki Q. de Smidt, BSc Geert Spierenburg, MD Richard E. Evenhuis, MD Sarah E. Bosma, MD, PhD Robert J.P. van der Wal, MD, PhD Demien Broekhuis, MD Michiel A.J. van de Sande, MD, PhD |
| author_sort | Kiki Q. de Smidt, BSc |
| collection | DOAJ |
| description | Background: Local tissue and serum metal ions have been shown to be elevated in some metal-on-metal and metal-on-polyethylene joint replacements. Local elevations have been linked to adverse local tissue reactions in some patients, and systemic elevation has been less commonly implicated cardiac and neurologic issues. Using a prospective study design, we aimed to identify the changes in serum metal ion levels after hip or knee megaprosthesis reconstruction. Furthermore, we will evaluate the occurrence of adverse effects and complications, possibly linked to metal ion elevation. Methods: Fourteen consecutive patients receiving a Modular Universal Tumor Revision System megaprosthesis were enrolled. Blood samples were collected preoperatively and postoperatively to determine the serum ion concentrations of aluminum, chromium, cobalt, and silver. To evaluate the safety of the megaprostheses and the subsequently possible related (elevated) serum metal ion concentrations, all adverse effects and complications were registered until last outpatient clinic visit at the time of this study. Results: Compared to the preoperative median serum concentrations, the postoperative median serum concentrations of chromium, silver, and cobalt increased 11-fold, 62-fold, and 64-fold, respectively. The median serum concentration of aluminum increased with 16%. Elevations were primarily noted in patients with knee prostheses. Eight patients had no adverse effects or complications during the period between preoperative and postoperative blood sampling. One adverse effect directly related to the serum metal ion concentrations, namely argyria, was observed. Conclusions: This study documents significantly elevated concentrations of the metal ions, but only one adverse effect directly related to the metal ion concentrations was observed. Future studies are needed to further assess the impact of elevated metal ion levels after megaprostheses, specifically knee implants, which are metal-on-metal. |
| first_indexed | 2024-04-13T05:30:59Z |
| format | Article |
| id | doaj.art-2d87bee8f8a44ea8b8abcb9b17eb7b16 |
| institution | Directory Open Access Journal |
| issn | 2352-3441 |
| language | English |
| last_indexed | 2024-04-13T05:30:59Z |
| publishDate | 2022-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Arthroplasty Today |
| spelling | doaj.art-2d87bee8f8a44ea8b8abcb9b17eb7b162022-12-22T03:00:27ZengElsevierArthroplasty Today2352-34412022-12-0118191201.e1Systemic Metal Ion Concentrations in Patients With Hip and Knee Megaprostheses: A Prospective Cohort StudyKiki Q. de Smidt, BSc0Geert Spierenburg, MD1Richard E. Evenhuis, MD2Sarah E. Bosma, MD, PhD3Robert J.P. van der Wal, MD, PhD4Demien Broekhuis, MD5Michiel A.J. van de Sande, MD, PhD6Corresponding author. Department of Orthopaedics, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, The Netherlands. Tel.: +3 171 526 3613.; Department of Orthopaedics, Leiden University Medical Center, Leiden, The NetherlandsDepartment of Orthopaedics, Leiden University Medical Center, Leiden, The NetherlandsDepartment of Orthopaedics, Leiden University Medical Center, Leiden, The NetherlandsDepartment of Orthopaedics, Leiden University Medical Center, Leiden, The NetherlandsDepartment of Orthopaedics, Leiden University Medical Center, Leiden, The NetherlandsDepartment of Orthopaedics, Leiden University Medical Center, Leiden, The NetherlandsDepartment of Orthopaedics, Leiden University Medical Center, Leiden, The NetherlandsBackground: Local tissue and serum metal ions have been shown to be elevated in some metal-on-metal and metal-on-polyethylene joint replacements. Local elevations have been linked to adverse local tissue reactions in some patients, and systemic elevation has been less commonly implicated cardiac and neurologic issues. Using a prospective study design, we aimed to identify the changes in serum metal ion levels after hip or knee megaprosthesis reconstruction. Furthermore, we will evaluate the occurrence of adverse effects and complications, possibly linked to metal ion elevation. Methods: Fourteen consecutive patients receiving a Modular Universal Tumor Revision System megaprosthesis were enrolled. Blood samples were collected preoperatively and postoperatively to determine the serum ion concentrations of aluminum, chromium, cobalt, and silver. To evaluate the safety of the megaprostheses and the subsequently possible related (elevated) serum metal ion concentrations, all adverse effects and complications were registered until last outpatient clinic visit at the time of this study. Results: Compared to the preoperative median serum concentrations, the postoperative median serum concentrations of chromium, silver, and cobalt increased 11-fold, 62-fold, and 64-fold, respectively. The median serum concentration of aluminum increased with 16%. Elevations were primarily noted in patients with knee prostheses. Eight patients had no adverse effects or complications during the period between preoperative and postoperative blood sampling. One adverse effect directly related to the serum metal ion concentrations, namely argyria, was observed. Conclusions: This study documents significantly elevated concentrations of the metal ions, but only one adverse effect directly related to the metal ion concentrations was observed. Future studies are needed to further assess the impact of elevated metal ion levels after megaprostheses, specifically knee implants, which are metal-on-metal.http://www.sciencedirect.com/science/article/pii/S2352344122001777Serum metal ion concentrations(MoM) MegaprosthesesAluminumCobaltChromiumSilver |
| spellingShingle | Kiki Q. de Smidt, BSc Geert Spierenburg, MD Richard E. Evenhuis, MD Sarah E. Bosma, MD, PhD Robert J.P. van der Wal, MD, PhD Demien Broekhuis, MD Michiel A.J. van de Sande, MD, PhD Systemic Metal Ion Concentrations in Patients With Hip and Knee Megaprostheses: A Prospective Cohort Study Arthroplasty Today Serum metal ion concentrations (MoM) Megaprostheses Aluminum Cobalt Chromium Silver |
| title | Systemic Metal Ion Concentrations in Patients With Hip and Knee Megaprostheses: A Prospective Cohort Study |
| title_full | Systemic Metal Ion Concentrations in Patients With Hip and Knee Megaprostheses: A Prospective Cohort Study |
| title_fullStr | Systemic Metal Ion Concentrations in Patients With Hip and Knee Megaprostheses: A Prospective Cohort Study |
| title_full_unstemmed | Systemic Metal Ion Concentrations in Patients With Hip and Knee Megaprostheses: A Prospective Cohort Study |
| title_short | Systemic Metal Ion Concentrations in Patients With Hip and Knee Megaprostheses: A Prospective Cohort Study |
| title_sort | systemic metal ion concentrations in patients with hip and knee megaprostheses a prospective cohort study |
| topic | Serum metal ion concentrations (MoM) Megaprostheses Aluminum Cobalt Chromium Silver |
| url | http://www.sciencedirect.com/science/article/pii/S2352344122001777 |
| work_keys_str_mv | AT kikiqdesmidtbsc systemicmetalionconcentrationsinpatientswithhipandkneemegaprosthesesaprospectivecohortstudy AT geertspierenburgmd systemicmetalionconcentrationsinpatientswithhipandkneemegaprosthesesaprospectivecohortstudy AT richardeevenhuismd systemicmetalionconcentrationsinpatientswithhipandkneemegaprosthesesaprospectivecohortstudy AT sarahebosmamdphd systemicmetalionconcentrationsinpatientswithhipandkneemegaprosthesesaprospectivecohortstudy AT robertjpvanderwalmdphd systemicmetalionconcentrationsinpatientswithhipandkneemegaprosthesesaprospectivecohortstudy AT demienbroekhuismd systemicmetalionconcentrationsinpatientswithhipandkneemegaprosthesesaprospectivecohortstudy AT michielajvandesandemdphd systemicmetalionconcentrationsinpatientswithhipandkneemegaprosthesesaprospectivecohortstudy |