title: Metal ion levels in maternal and placental blood after metal-on-metal total hip arthroplasty.
abstract: There is concern regarding elevated metal ion levels in the blood during pregnancy and the potential fetal effects in women with metal-on-metal (MOM) implants. We obtained maternal and umbilical cord blood samples from 3 patients with a MOM hip arthroplasty and 7 control subjects without any metallic implants. Serum metal ion levels including chromium, cobalt, titanium, and nickel were tested using high-resolution sector-field inductively-coupled plasma-mass spectrometry. Mothers with MOM-bearing implants had significantly elevated levels of serum cobalt and chromium compared with control-group mothers, and umbilical cord blood from mothers with MOM implants also had significantly higher serum metal ion levels compared with control-group mothers. The results of this study show that circulating serum levels of metal ion degradation products from MOM bearings cross the placenta and expose the fetus to metal ions. However, the placenta exerts a modulatory effect on cord blood, resulting in decreased levels compared with maternal samples (approximately 15% of maternal chromium and 50% of maternal cobalt). Physicians and women of child-bearing age should be aware of this potential effect when considering the use of MOM-bearing implants.
authors.forename: Clifford C
authors.initials: CC
authors.lastname: Novak
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Hsu
authors.forename: Craig J
authors.initials: CJ
authors.lastname: Della Valle
authors.forename: Anastasia K
authors.initials: AK
authors.lastname: Skipor
authors.forename: Patricia
authors.initials: P
authors.lastname: Campbell
authors.forename: Harlan C
authors.initials: HC
authors.lastname: Amstutz
authors.forename: William A
authors.initials: WA
authors.lastname: Jiranek
authors.forename: Aham
authors.initials: A
authors.lastname: Onyike
authors.forename: Xavier F
authors.initials: XF
authors.lastname: Pombar
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL. joshua.jacobs@rushortho.com.
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Jacobs
mesh_terms: D000328:Adult; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D002857:Chromium / Q000097:blood; D003035:Cobalt / Q000097:blood; D005260:Female; D005312:Fetal Blood; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D007231:Infant, Newborn; D061825:Metal-on-Metal Joint Prostheses / Q000009:adverse effects*; D008670:Metals / Q000097:blood*; D009532:Nickel / Q000097:blood; D010920:Placenta / Q000502:physiology; D011247:Pregnancy; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D014025:Titanium / Q000097:blood; D055815:Young Adult
chemical_list: D008670:Metals; D002857:Chromium; D003035:Cobalt; D009532:Nickel; D014025:Titanium