Ilona Swiatkowska1, Nicholas G Martin2, Johann Henckel3, Hugh Apthorp4, Jane Hamshere4, Alister J Hart5. 1. Institute of Orthopaedics and Musculoskeletal Science, University College London, HA7 4LP Stanmore, UK. Electronic address: ilona.swiatkowska.10@ucl.ac.uk. 2. Trace Element Laboratory, North West London Pathology, Charing Cross Hospital, W6 8RF London, UK. 3. Royal National Orthopaedic Hospital, Stanmore, HA7 4LP Stanmore, UK. 4. The Horder Centre, TN6 1XP Crowborough, UK. 5. Institute of Orthopaedics and Musculoskeletal Science, University College London, HA7 4LP Stanmore, UK; Royal National Orthopaedic Hospital, Stanmore, HA7 4LP Stanmore, UK.
Abstract
BACKGROUND: Hip implants are usually manufactured from cobalt-chromium and titanium alloys. As the implants wear and corrode, metal debris is released into the surrounding tissue and blood, providing a potential biomarker for their function. Whilst there are laboratory reference levels for blood cobalt and chromium in patients with well and poorly functioning hip implants, there are no such guidelines for titanium. This is despite the increasing use of titanium implants worldwide. PATIENTS AND METHODS: We recruited a consecutive series of 95 patients (mean age 71 years, mean time after surgery 8.5 years) with one hip implant type, inserted by the same surgeon. We assessed clinical and radiological outcome, and measured blood and plasma titanium using high resolution inductively-coupled plasma mass spectrometry. RESULTS: The upper normal reference limit for blood and plasma titanium was 2.20 and 2.56 μg L-1, respectively, and did not differ significantly between males and females. CONCLUSION: We are the first to propose a laboratory reference level for blood and plasma titanium in patients with well-functioning titanium hip implants. This is an essential starting point for further studies to explore the clinical usefulness of blood titanium as a biomarker of orthopaedic implant performance, and comes at a time of considerable controversy regarding the use of certain titanium alloys in hip arthroplasty.
BACKGROUND:Hip implants are usually manufactured from cobalt-chromium and titanium alloys. As the implants wear and corrode, metal debris is released into the surrounding tissue and blood, providing a potential biomarker for their function. Whilst there are laboratory reference levels for blood cobalt and chromium in patients with well and poorly functioning hip implants, there are no such guidelines for titanium. This is despite the increasing use of titanium implants worldwide. PATIENTS AND METHODS: We recruited a consecutive series of 95 patients (mean age 71 years, mean time after surgery 8.5 years) with one hip implant type, inserted by the same surgeon. We assessed clinical and radiological outcome, and measured blood and plasma titanium using high resolution inductively-coupled plasma mass spectrometry. RESULTS: The upper normal reference limit for blood and plasma titanium was 2.20 and 2.56 μg L-1, respectively, and did not differ significantly between males and females. CONCLUSION: We are the first to propose a laboratory reference level for blood and plasma titanium in patients with well-functioning titaniumhip implants. This is an essential starting point for further studies to explore the clinical usefulness of blood titanium as a biomarker of orthopaedic implant performance, and comes at a time of considerable controversy regarding the use of certain titanium alloys in hip arthroplasty.
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