Serum metal levels after minimally invasive repair of pectus excavatum.
BACKGROUND
Metal implants may wear and corrode, resulting in systemic dissemination of metallic debris that is measurable in serum. Concern exists regarding adverse health effects related to implant-derived debris. Minimally invasive repair of pectus excavatum (MIRPE) is a popular technique in which a stainless steel substernal bar is implanted to achieve deformity correction. Serum metal levels have not previously been investigated after MIRPE.


METHODS
Serum chromium, molybdenum, and nickel levels were measured in this cross-sectional study of 11 children implanted with pectus bars after MIRPE. Samples were analyzed using high-resolution inductively coupled plasma mass spectrometry.


RESULTS
Median serum chromium and nickel values were elevated 3.3-fold (P = .0003) and 2.3-fold (P = .25), respectively, compared with age-matched controls. Serum chromium and nickel levels were abnormally elevated in 6 (55%) of 11 and 5 (45%) of 11, respectively. In patients whom postexplantation metal levels were measured, previously elevated levels were lowered. Serum chromium levels in children after MIRPE are comparable with adult cohorts with hip arthroplasty implants measured 1-year postoperatively. No acute metal toxicity was observed.


CONCLUSIONS
Abnormally elevated levels of serum metal levels are measurable in children implanted with pectus bars. These findings warrant further investigation to assess the biocompatibility of this surgical implant in children.
Department of Paediatric Surgery, Women's and Children's Hospital, North Adelaide, South Australia, Australia. thomas.cundy@adelaide.edu.au
Thomas P
TP
Cundy
Christopher P
CP
Kirby
D000293:Adolescent; D001672:Biocompatible Materials; D002648:Child; D002857:Chromium / Q000097:blood* / Q000493:pharmacokinetics; D003430:Cross-Sectional Studies; D005260:Female; D005660:Funnel Chest / Q000097:blood / Q000601:surgery*; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D008982:Molybdenum / Q000097:blood* / Q000493:pharmacokinetics; D009532:Nickel / Q000097:blood* / Q000493:pharmacokinetics; D010865:Pilot Projects; D011184:Postoperative Period; D019736:Prostheses and Implants; D019651:Plastic Surgery Procedures; D013193:Stainless Steel / Q000493:pharmacokinetics
D001672:Biocompatible Materials; D002857:Chromium; D013193:Stainless Steel; D009532:Nickel; D008982:Molybdenum