Clinical usefulness of blood metal measurements to assess the failure of metal-on-metal orthopaedic implants.
Author(s)
Sampson
Hart
Type
Journal Article
Abstract
In April 2010, a Medicines and Healthcare Products Regulatory Agency safety alert concerning all metal-on-metal (MOM) hip
replacements recommended measuring chromium and cobalt concentrations when managing patients with painful
prostheses. The need for this review is illustrated by the recent surge in requests for these blood tests from orthopaedic
surgeons following this alert. The aim is to provide guidance to laboratories in assessing these requests and advising
clinicians on interpretation. First, we summarize the basic terminology regarding the types of hip replacements, with emphasis
on the MOM type. Second, we describe the clinical concerns over implant-derived wear debris in the local tissues and distant
sites. Analytical aspects of the measurement of the relevant metal ions and what factors affect the levels measured are
discussed. The application of inductively coupled plasma mass spectrometry techniques to the measurement of these metals
is considered in detail. The biological effects of metal wear products are summarized with local toxicity and systemic
biological effects considered, including carcinogenicity, genotoxicity and systemic toxicity. Clinical cases are used to illustrate
pertinent points.
replacements recommended measuring chromium and cobalt concentrations when managing patients with painful
prostheses. The need for this review is illustrated by the recent surge in requests for these blood tests from orthopaedic
surgeons following this alert. The aim is to provide guidance to laboratories in assessing these requests and advising
clinicians on interpretation. First, we summarize the basic terminology regarding the types of hip replacements, with emphasis
on the MOM type. Second, we describe the clinical concerns over implant-derived wear debris in the local tissues and distant
sites. Analytical aspects of the measurement of the relevant metal ions and what factors affect the levels measured are
discussed. The application of inductively coupled plasma mass spectrometry techniques to the measurement of these metals
is considered in detail. The biological effects of metal wear products are summarized with local toxicity and systemic
biological effects considered, including carcinogenicity, genotoxicity and systemic toxicity. Clinical cases are used to illustrate
pertinent points.
Date Issued
2012-03-01
Date Acceptance
2011-07-26
Citation
Annals of Clinical Biochemistry, 2012, 49 (2), pp.118-131
ISSN
0004-5632
Publisher
SAGE Publications (UK and US)
Start Page
118
End Page
131
Journal / Book Title
Annals of Clinical Biochemistry
Volume
49
Issue
2
Copyright Statement
This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 License (http://www.creativecommons.org/licenses/by-nc/3.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page(http://www.uk.sagepub.com/aboutus/openaccess.htm).
Publication Status
Published