Immune responses correlate with serum-metal in metal-on-metal hip arthroplasty.
Cell-mediated hypersensitivity associated with metal components may be related to levels of implant debris. We tested this hypothesis by comparing lymphocyte reactivity to soluble Co, Cr, Ni, and Ti of patients with metal-on-polyethylene and metal-on-metal arthroplasties with healthy controls, and patients with osteoarthritis. The metal-on-metal group (n=9) demonstrated significantly elevated serum Co and Cr concentrations (13- and 58-fold, P<.05, respectively) and significantly elevated lymphocyte reactivity to Co (SI>5, P<.004) and Ni (SI>2.5, P<.01) when compared to controls (n=12) and subjects with metal-on-poly implants (n=7). These elevated in vivo metal levels demonstrated positive linear correlation with lymphocyte reactivity supporting our hypothesis that lymphocyte metal-induced reactivity increases with increased metal exposure. These results represent the first direct link between in vivo metal exposure and lymphocyte reactivity. Whether this lymphocyte reactivity to metal debris is etiologically linked to poor implant performance remains uncertain.
Hallab
Nadim James
NJ
Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois 60612, USA.
Anderson
Shelley
S
Caicedo
Marco
M
Skipor
Anastasia
A
Campbell
Pat
P
Jacobs
Joshua J
JJ
D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D002857:Chromium / Q000097:blood* / Q000276:immunology*; D003035:Cobalt / Q000097:blood* / Q000276:immunology*; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008213:Lymphocyte Activation; D008297:Male; D008875:Middle Aged; D009532:Nickel / Q000097:blood / Q000276:immunology; D011474:Prosthesis Design; D014025:Titanium / Q000097:blood
D002857:Chromium; D003035:Cobalt; D009532:Nickel; D014025:Titanium