title: Cobalt, chromium, and nickel concentrations in body fluids of patients with porous-coated knee or hip prostheses.
abstract: Co, Cr, and Ni concentrations were determined by electrothermal atomic absorption spectrophotometry in serum and urine specimens collected from a group of 28 patients at intervals of from 1 day to 2.5 years after total knee or hip arthroplasty with porous-coated prostheses fabricated of Co-Cr alloy (ASTM F-75-82). Two control groups were also tested: (a) 42 healthy adults and (b) 16 orthopaedic patients after total knee or hip arthroplasty with porous-coated prostheses fabricated predominantly of Ti-Al-V alloy (ASTM F-136-84). All prostheses contained polyethylene components to avoid metal-to-metal contact. Mean Co concentrations in serum and urine were slightly increased in patients with Co-Cr knee implants at 6-120 weeks after surgery, compared with (a) preoperative values, (b) corresponding values in patients with Co-Cr hip implants, and (c) corresponding values in control patients with Ti-Al-V knee and hip prostheses. Substantially increased Co levels were observed in serum and urine of two patients at 7 weeks and 22 months postarthroplasty, associated with loosening of the prostheses; one of the patients also had elevated Cr levels in serum and urine. Although ASTM F-75-82 and F-136-84 alloys contain very little Ni (less than 1.0 and less than 0.2% Ni, respectively, by wt), mean Ni concentrations in serum and urine were greatly increased at 1-2 days after implantation of Ti-Al-V and Co-Cr prostheses, diminishing by 2 weeks. The postoperative hypernickelemia and nickeluresis may reflect contamination of the operative field with Ni-containing particles from the drills, cutting jigs, and drilling jigs, or it may represent a previously unrecognized pathophysiological response to surgery.
authors.affiliation: Department of Pharmacology, University of Connecticut School of Medicine, Farmington 06032.
authors.forename: F W
authors.initials: FW
authors.lastname: Sunderman
authors.forename: S M
authors.initials: SM
authors.lastname: Hopfer
authors.forename: T
authors.initials: T
authors.lastname: Swift
authors.forename: W N
authors.initials: WN
authors.lastname: Rezuke
authors.forename: L
authors.initials: L
authors.lastname: Ziebka
authors.forename: P
authors.initials: P
authors.lastname: Highman
authors.forename: B
authors.initials: B
authors.lastname: Edwards
authors.forename: M
authors.initials: M
authors.lastname: Folcik
authors.forename: H R
authors.initials: HR
authors.lastname: Gossling
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000497:Alloys; D002857:Chromium / Q000097:blood / Q000378:metabolism* / Q000652:urine; D003035:Cobalt / Q000097:blood / Q000378:metabolism* / Q000652:urine; D005260:Female; D006622:Hip Prosthesis; D006801:Humans; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D009532:Nickel / Q000097:blood / Q000378:metabolism* / Q000652:urine; D012016:Reference Values; D013314:Stress, Mechanical; D013997:Time Factors
chemical_list: D000497:Alloys; D002857:Chromium; D003035:Cobalt; D009532:Nickel