title: Difference in metallic wear distribution released from commercially pure titanium compared with stainless steel plates.
abstract: BACKGROUND
  Stainless steel and commercially pure titanium are widely used materials in orthopedic implants. However, it is still being controversially discussed whether there are significant differences in tissue reaction and metallic release, which should result in a recommendation for preferred use in clinical practice.
  
  
  METHODS
  A comparative study was performed using 14 stainless steel and 8 commercially pure titanium plates retrieved after a 12-month implantation period. To avoid contamination of the tissue with the elements under investigation, surgical instruments made of zirconium dioxide were used. The tissue samples were analyzed histologically and by inductively coupled plasma atomic emission spectrometry (ICP-AES) for accumulation of the metals Fe, Cr, Mo, Ni, and Ti in the local tissues. Implant corrosion was determined by the use of scanning electron microscopy (SEM).
  
  
  RESULTS
  With grades 2 or higher in 9 implants, steel plates revealed a higher extent of corrosion in the SEM compared with titanium, where only one implant showed corrosion grade 2. Metal uptake of all measured ions (Fe, Cr, Mo, Ni) was significantly increased after stainless steel implantation, whereas titanium revealed only high concentrations for Ti. For the two implant materials, a different distribution of the accumulated metals was found by histological examination. Whereas specimens after steel implantation revealed a diffuse siderosis of connective tissue cells, those after titanium exhibited occasionally a focal siderosis due to implantation-associated bleeding. Neither titanium- nor stainless steel-loaded tissues revealed any signs of foreign-body reaction.
  
  
  CONCLUSIONS
  We conclude from the increased release of toxic, allergic, and potentially carcinogenic ions adjacent to stainless steel that commercially pure Ti should be treated as the preferred material for osteosyntheses if a removal of the implant is not intended. However, neither material provoked a foreign-body reaction in the local tissues, thus cpTi cannot be recommend as the 'golden standard' for osteosynthesis material in general.
authors.affiliation: Department of Traumatology, Hand and Reconstructive Surgery, University of Ulm, Steinhövelstr. 9, 89075, Ulm, Germany. gert.krischak@medizin.uni-ulm.de
authors.forename: G D
authors.initials: GD
authors.lastname: Krischak
authors.forename: F
authors.initials: F
authors.lastname: Gebhard
authors.forename: W
authors.initials: W
authors.lastname: Mohr
authors.forename: V
authors.initials: V
authors.lastname: Krivan
authors.forename: A
authors.initials: A
authors.lastname: Ignatius
authors.forename: A
authors.initials: A
authors.lastname: Beck
authors.forename: N J
authors.initials: NJ
authors.lastname: Wachter
authors.forename: P
authors.initials: P
authors.lastname: Reuter
authors.forename: M
authors.initials: M
authors.lastname: Arand
authors.forename: L
authors.initials: L
authors.lastname: Kinzl
authors.forename: L E
authors.initials: LE
authors.lastname: Claes
mesh_terms: D000273:Adipose Tissue / Q000737:chemistry* / Q000473:pathology*; D000328:Adult; D001706:Biopsy; D001860:Bone Plates; D016022:Case-Control Studies; D003343:Corrosion; D020878:Device Removal; D005260:Female; D050723:Fractures, Bone / Q000601:surgery; D006801:Humans; D008297:Male; D008855:Microscopy, Electron, Scanning; D008875:Middle Aged; D011475:Prosthesis Failure; D012806:Siderosis / Q000473:pathology; D013193:Stainless Steel; D014025:Titanium / Q000032:analysis; D014131:Trace Elements / Q000032:analysis
chemical_list: D014131:Trace Elements; D013193:Stainless Steel; D014025:Titanium