1
|
Brennan PC, Peterson SM, O'Byrne TJ, Laporta ML, Wyles CC, Jannetto PJ, Kane GC, Vassilaki M, Maradit Kremers H. Blood metal concentrations and cardiac structure and function in total joint arthroplasty patients. World J Orthop 2024; 15:773-782. [PMID: 39165877 PMCID: PMC11331322 DOI: 10.5312/wjo.v15.i8.773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 07/19/2024] [Accepted: 07/29/2024] [Indexed: 08/13/2024] Open
Abstract
BACKGROUND There is concern regarding potential long-term cardiotoxicity with systemic distribution of metals in total joint arthroplasty (TJA) patients. AIM To determine the association of commonly used implant metals with echocardiographic measures in TJA patients. METHODS The study comprised 110 TJA patients who had a recent history of high chromium, cobalt or titanium concentrations. Patients underwent two-dimensional, three-dimensional, Doppler and speckle-strain transthoracic echocardiography and a blood draw to measure metal concentrations. Age and sex-adjusted linear and logistic regression models were used to examine the association of metal concentrations (exposure) with echocardiographic measures (outcome). RESULTS Higher cobalt concentrations were associated with increased left ventricular end-diastolic volume (estimate 5.09; 95%CI: 0.02-10.17) as well as left atrial and right ventricular dilation, particularly in men but no changes in cardiac function. Higher titanium concentrations were associated with a reduction in left ventricle global longitudinal strain (estimate 0.38; 95%CI: 0.70 to 0.06) and cardiac index (estimate 0.08; 95%CI, -0.15 to -0.01). CONCLUSION Elevated cobalt and titanium concentrations may be associated with structural and functional cardiac changes in some patients. Longitudinal studies are warranted to better understand the systemic effects of metals in TJA patients.
Collapse
Affiliation(s)
- Peter C Brennan
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, United States
| | - Stephanie M Peterson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, United States
| | - Thomas J O'Byrne
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, United States
| | - Mariana L Laporta
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | - Cody C Wyles
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, United States
| | - Paul J Jannetto
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, United States
| | - Garvan C Kane
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - Maria Vassilaki
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, United States
| | - Hilal Maradit Kremers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, United States
| |
Collapse
|
2
|
Fokter SK, Ledinek Ž, Kljaić Dujić M, Novak I. Extreme Serum Titanium Concentration Induced by Acetabular Cup Failure: Unveiling a Unique Scenario of Titanium Alloy Debris Accumulation. Bioengineering (Basel) 2024; 11:235. [PMID: 38534509 DOI: 10.3390/bioengineering11030235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/12/2024] [Accepted: 02/24/2024] [Indexed: 03/28/2024] Open
Abstract
The majority of contemporary total hip arthroplasty (THA) implants are constructed from Ti alloys, which are generally believed to generate fewer adverse local tissue reactions (ALTRs) compared to CoCr alloys. This study presents a case of unusual primary THA failure where a substantial release of Ti alloy debris was observed. A 52-year-old active male underwent THA after post-traumatic aseptic necrosis of the femoral head in 2006. Seventeen years after the procedure, the patient presented with groin pain and a restricted range of motion. X-rays revealed the protrusion of the alumina ceramic head through the Ti6Al4V acetabular cup. Trace element analysis indicated significantly elevated levels of serum Ti, Al, and V. CT and MRI confirmed Ti alloy cup failure and a severe ALTR. During revision surgery, it was found that the worn-out ceramic head was in direct contact with the acetabular cup, having protruded through a central hole it had created over time. No acetabular liner was found. Histological analysis of his tissue samples showed wear-induced synovitis with areas of multinucleated foreign body giant cells and the accumulation of numerous metal particles but no acute inflammatory response. Six months after the revision THA, the patient has experienced favourable outcomes. This case provides an instructive illustration for studying the consequences of the substantial release of Ti alloy debris from orthopedic implants.
Collapse
Affiliation(s)
- Samo K Fokter
- Clinical Department of Orthopedic Surgery, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia
- Faculty of Medicine, University of Maribor, Slomškov trg 15, 2000 Maribor, Slovenia
- Faculty of Medicine, University of Ljubljana, Kongresni trg 12, 1000 Ljubljana, Slovenia
| | - Živa Ledinek
- Department of Pathology, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia
| | - Milka Kljaić Dujić
- Department of Radiology, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia
| | - Igor Novak
- Clinical Department of Orthopedic Surgery, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia
| |
Collapse
|
3
|
Brüggemann A, Hailer NP. Concentrations of Cobalt, Chromium and Titanium and Immunological Changes after Primary Total Knee Arthroplasty-A Cohort Study with an 18-Year Follow-Up. J Clin Med 2024; 13:951. [PMID: 38398263 PMCID: PMC10889704 DOI: 10.3390/jcm13040951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Background: Total knee arthroplasty (TKA) generates elevated metal ion concentrations, but long-term changes in the concentrations of cobalt (Co), chromium (Cr) and titanium (Ti) after primary TKA and potential subsequent immune system activation-not limited to the joint but systemically-are not known. Patients and Methods: We conducted a cohort study on 26 patients with TKA (19 women; 16 with metal-backed and 10 with all-polyethylene tibial components) 18.3 years (min. 16.7, max. 20.5) after index TKA. A total of 69% of patients additionally underwent subsequent arthroplasty of the contralateral knee or either hip after the index surgery. Blood samples were analysed by inductively coupled plasma-mass spectrometry, and leukocytes were characterised by flow cytometry. Patients were clinically assessed using the Knee Society score and by plain radiography of the knee. Results: The median metal ion concentrations were 0.7 (0.1-13.0) µg/L for Co, 0.9 (0.4-5.0) µg/L for Cr, and 1.0 (0.2-13.0) µg/L for Ti. There was no relevant difference in systemic metal ion concentrations between patients exposed to single and multiple arthroplasties. The absolute count and proportion of CD3+CD4+CD8+ T cells was inversely correlated with both Co (rho -0.55, p = 0.003) and Cr concentrations (rho -0.59, p = 0.001). Conclusions: Between the first and second decades after primary TKA, in most patients, the concentrations of Co, Cr and Ti in blood samples were below the thresholds that are considered alarming. The negative correlation of Co and Cr concentrations with a subset of lymphocytes that commonly increases during immune activation is reassuring. This represents a worst-case scenario, underscoring that the investigated metal ions remain within reasonable ranges, even after additional hardware exposure.
Collapse
Affiliation(s)
| | - Nils P. Hailer
- Orthopaedics—Department of Surgical Sciences, Uppsala University, SE-751 85 Uppsala, Sweden;
| |
Collapse
|
4
|
Khandelwal G, Roychoudhury A, Bhutia O, Shariff A. Longitudinal surveillance of serum titanium ion levels in patients with indigenous 3D printed total temporomandibular joint replacement. Sci Rep 2023; 13:7275. [PMID: 37142652 PMCID: PMC10160034 DOI: 10.1038/s41598-023-33229-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 04/10/2023] [Indexed: 05/06/2023] Open
Abstract
The purpose of this longitudinal study was to surveil the serum titanium ion levels at various time intervals in patients with indigenous 3D-printed total temporomandibular joint replacement (TMJ TJR). The study was conducted on 11 patients (male: 8; female: 3) who had undergone unilateral or bilateral TMJ TJR. Blood samples were drawn preoperatively (T0), 3 months (T1), 6 months (T2), and 1 year (T3) postoperatively. Data were analyzed and a p value of < 0.05 was considered statistically significant. The mean serum titanium ion levels at T0, T1, T2, and T3 was 9.34 ± 8.70 µg/L (mcg/L), 35.97 ± 20.27 mcg/L, 31.68 ± 17.03 mcg/L, and 47.91 ± 15.47 mcg/L respectively. The mean serum titanium ion levels increased significantly at T1 (p = 0.009), T2 (p = 0.032), and T3 (p = 0.00) interval. There was no significant difference between unilateral and bilateral groups. Serum titanium ion continued to show increased levels till the last follow-up of 1 year. These initial serum titanium ion levels increase is due to the initial wear phase of the prosthesis which manifests over 1 year. Further studies with large sample sizes and long-term follow-ups are required to see the deleterious effect if any on the TMJ TJR.
Collapse
Affiliation(s)
- Garima Khandelwal
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Ajoy Roychoudhury
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Ongkila Bhutia
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - A Shariff
- Department of Anatomy, All India Institute of Medical Sciences, New Delhi, 110029, India
| |
Collapse
|
5
|
Peterson SM, O’Byrne TJ, Brennan PC, Jannetto PJ, Pavelko KD, Lewallen DG, Vassilaki M, Maradit Kremers H. Cross-sectional association between systemic metal concentrations and immune markers in patients with total joint arthroplasty. Front Immunol 2023; 14:1130209. [PMID: 36993965 PMCID: PMC10040609 DOI: 10.3389/fimmu.2023.1130209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 02/20/2023] [Indexed: 03/18/2023] Open
Abstract
Total joint arthroplasty (TJA) implants are composed of metal components. Although they are regarded safe, the long-term immunological effects of chronic exposure to the specific implant materials are unknown. We recruited 115 hip and/or knee TJA patients (mean age 68 years) who provided a blood draw for measurement of chromium, cobalt, titanium concentrations, inflammatory markers and systemic distribution of immune cells. We examined differences between the immune markers and the systemic concentrations of chromium, cobalt and titanium. CD66-b neutrophils, early natural killer cells (NK), and eosinophils were present in higher percentages in patients with chromium and cobalt concentrations greater than the median. The opposite pattern was observed with titanium where the percentages of CD66-b neutrophils, early NK, and eosinophils were higher in patients with undetectable titanium. Cobalt concentrations were positively correlated with a higher percentage of gamma delta T cells. Both chromium and cobalt concentrations were positively correlated with higher percentages of plasmablasts. Titanium concentrations were positively correlated with higher CD4 effector memory T cells, regulatory T cell count and Th1 CD4 helper cells. In this exploratory study, we observed altered distribution of immune cells in TJA patients with elevated systemic metal concentrations. Although these correlations were not strong, these exploratory findings warrant further investigation into the role of increased metals circulating in blood and its role in immune modulation.
Collapse
Affiliation(s)
- Stephanie M. Peterson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Thomas J. O’Byrne
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Peter C. Brennan
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Paul J. Jannetto
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, MN, United States
| | - Kevin D. Pavelko
- Department of Immunology, Mayo Clinic, Rochester, MN, United States
| | - David G. Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Maria Vassilaki
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Hilal Maradit Kremers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
- *Correspondence: Hilal Maradit Kremers,
| |
Collapse
|
6
|
Beba A, Peterson SM, Brennan PC, O’Byrne J, Machulda MM, Jannetto PI, Vemuri P, Lewallen DG, Kremers HM, Vassilaki M. Correlation of Blood Metal Concentrations with Cognitive Scores and Neuroimaging Findings in Patients with Total Joint Arthroplasty. J Alzheimers Dis 2023; 94:1335-1342. [PMID: 37393495 PMCID: PMC10481381 DOI: 10.3233/jad-221182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2023]
Abstract
Total joint arthroplasty (TJA) implants are composed of metals, ceramics, and/or polyethylene. Studies suggest that the debris released from metal implants may possess neurotoxic properties with reports of neuropsychiatric symptoms and memory deficits, which could be relevant to Alzheimer's disease and related dementias. This exploratory study examined the cross-sectional correlation of blood metal concentrations with cognitive performance and neuroimaging findings in a convenience sample of 113 TJA patients with history of elevated blood metal concentrations of either titanium, cobalt and/or chromium. Associations with neuroimaging measures were observed but not with cognitive scores. Larger studies with longitudinal follow-up are warranted.
Collapse
Affiliation(s)
- Alican Beba
- George Washington University, Columbian College of Arts and Sciences, Washington, DC, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Peter C. Brennan
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jamie O’Byrne
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Mary M. Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Paul I. Jannetto
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Hilal Maradit Kremers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Maria Vassilaki
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
7
|
Baker E, French C, Brian P, Thomas J, Davis CM. Impending Trunnion Failure: An Uncommon Radiographic Presentation of Total Hip Arthroplasty Failure. Arthroplast Today 2021; 7:230-234. [PMID: 33614874 PMCID: PMC7878964 DOI: 10.1016/j.artd.2020.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 01/17/2023] Open
Abstract
Trunnionosis is emerging as an early mode of failure in conventional metal-on-polyethylene total hip arthroplasty. It is defined as wear or corrosion at the trunnion, the taper at the femoral head-neck interface. Trunnion wear can result in a variety of negative sequelae and, in severe cases, necessitate revision arthroplasty. We describe a 64-year-old man with a metal-on-polyethylene total hip arthroplasty who presented with a sensation of clunking in the hip. Initial imaging and laboratory studies were inconclusive, and the decision was made to monitor. Two years later, trunnion wear was detected on radiographs, presenting as an abnormal alignment of the femoral neck relative to the femoral head. Several case reports and series describe catastrophic total hip arthroplasty failure due to trunnionosis. However, few describe the radiographic signs of wear at the trunnion before gross failure. This early presentation is important to recognize to minimize patient morbidity and aid surgical planning.
Collapse
Affiliation(s)
- Emma Baker
- Department of Radiology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
- Corresponding author. 500 University Dr, Hershey, PA 17033, USA. Tel.: +1 240 620 6937.
| | - Cristy French
- Department of Radiology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Pamela Brian
- Department of Radiology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jonelle Thomas
- Department of Radiology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Charles M. Davis
- Department of Orthopaedics and Rehabilitation, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| |
Collapse
|