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J Trace Elem Med Biol. 2018 Mar;46:128-137. doi: 10.1016/j.jtemb.2017.12.007. Epub 2017 Dec 23.

Synchrotron analysis of human organ tissue exposed to implant material.

Author information

1
Institute of Orthopaedics and Musculoskeletal Science, University College London, HA7 4LP Stanmore, UK. Electronic address: zccaga9@live.ucl.ac.uk.
2
Diamond Light Source, Harwell Science and Innovation Campus, OX11 0DE Didcot, UK.
3
Mayo Clinic, 200 1st Street SW, Rochester, MN, USA.
4
Royal National Orthopaedic Hospital, HA7 4LP Stanmore, UK.
5
Trace Element Laboratory, Department of Clinical Chemistry, Charing Cross Hospital, Imperial College NHS Healthcare Trust, W6 8RF London, UK.
6
Departament of Chemistry, University College London, WC1H 0AJ London, UK.
7
Institute of Orthopaedics and Musculoskeletal Science, University College London, HA7 4LP Stanmore, UK; Royal National Orthopaedic Hospital, HA7 4LP Stanmore, UK.

Abstract

BACKGROUND:

Orthopaedic implants made of cobalt-chromium alloy undergo wear and corrosion that can lead to deposition of cobalt and chromium in vital organs. Elevated cardiac tissue cobalt levels are associated with myocardial injury while chromium is a well-established genotoxin. Though metal composition of tissues surrounding hip implants has been established, few investigators attempted to characterize the metal deposits in systemic tissues of total joint arthroplasty patients.

METHODS:

We report the first use of micro-X-ray fluorescence coupled with micro-X-ray absorption spectroscopy to probe distribution and chemical form of cobalt, chromium and titanium in postmortem samples of splenic, hepatic and cardiac tissue of patients with metal-on-polyethylene hip implants (n = 5).

RESULTS:

Majority of the cobalt was in the 2+ oxidation state, while titanium was present exclusively as titanium dioxide, in either rutile or anatase crystal structure. Chromium was found in a range of forms including a highly oxidised, carcinogenic species (CrV/VI), which has never been identified in human tissue before.

CONCLUSIONS:

Carcinogenic forms of chromium might arise in vital organs of total joint arthroplasty patients. Further studies are warranted with patients with metal-on-metal implants, which tend to have an increased release of cobalt and chromium compared to metal-on-polyethylene hips.

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