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Metal Ion Levels in Maternal and Placental Blood Following Metal-on-Metal Arthroplasty
e54 The Journal of Arthroplasty Vol. 25 No. 3 April 2010
Poster #9 Metal Ion Levels in Maternal and Placental Blood Following Metal-on-Metal Arthroplasty Clifford C. Novak, MD, Craig J. Della Valle, MD, Anastasia K. Skipor, MS, Susan Shott, PhD, Patricia Campbell, PhD, Harlan C. Amstutz, MD, William A. Jiranek, MD, Xavier Pombar, DO, Joshua J. Jacobs, MD Introduction: There has been a resurgence in the interest and use of metal-on-metal (MOM) bearing surfaces in hip arthroplasty. Concerns, however, still remain regarding elevated metal ion levels in blood and urine. The carcinogenicity of elevated metal ions is still unknown. Moreover, it is unclear if elevated metal ion levels adversely affect the fetus or pregnant female patients with MOM surfaces. Our study evaluates metal ion concentrations in maternal and fetal serum. Methods: Maternal and umbilical cord blood was obtained from 3 patients with a MOM hip arthroplasty and 7 patients without implants who served as controls. Maternal and placental serum metal ion levels were tested using inductively coupled plasma mass spectrometry (ICP-MS). The serum concentrations of titanium, nickel, cobalt, and chromium were measured. Intergroup comparisons were made independent of the means with use of the Wilcoxon-Mann-Whitney test. Correlations were established with use of the Spearman rank-order correlation test. Results: Mean serum levels of metal ions in control mothers are (ng/mL): titanium (Ti) 0.15, chromium (Cr) 0.161, cobalt (Co) 0.205, and nickel (Ni) 0.145. Mean serum levels in control babies are (ng/mL): Ti 0.144, Cr 0.0922, Co 0.17, and Ni 0.202. Comparison of metal ion levels between control mothers and control babies revealed no statistical difference. Mean serum levels of metal ions in implant mothers were (ng/mL): Ti 0.656, Cr 1.87, Co 0.972, and Ni 0.136. Mean serum concentrations in implant babies were (ng/mL): Ti 0.366, Cr 0.288, Co 0.486, and Ni 0.304. Mothers with implants have higher serum Cr and Co levels than control mothers (P b .05). Babies from mothers with implants have higher serum Co (P b .05) and Cr (P = .053) levels than control babies. Conclusion: The Cr and Co serum levels obtained from both mothers with implants and the offspring of mothers with implants are elevated in comparison to the control maternal and offspring levels. Therefore, we have concluded that Co and Cr cross the placental barrier. The FDA has not cleared the following medical device (Conserve Plus, Wright Medical Technology) for the use described in this presentation.
Poster #9 Metal Ion Levels in Maternal and Placental Blood Following Metal-on-Metal Arthroplasty Clifford C. Novak, MD, Craig J. Della Valle, MD, Anastasia K. Skipor, MS, Susan Shott, PhD, Patricia Campbell, PhD, Harlan C. Amstutz, MD, William A. Jiranek, MD, Xavier Pombar, DO, Joshua J. Jacobs, MD Introduction: There has been a resurgence in the interest and use of metal-on-metal (MOM) bearing surfaces in hip arthroplasty. Concerns, however, still remain regarding elevated metal ion levels in blood and urine. The carcinogenicity of elevated metal ions is still unknown. Moreover, it is unclear if elevated metal ion levels adversely affect the fetus or pregnant female patients with MOM surfaces. Our study evaluates metal ion concentrations in maternal and fetal serum. Methods: Maternal and umbilical cord blood was obtained from 3 patients with a MOM hip arthroplasty and 7 patients without implants who served as controls. Maternal and placental serum metal ion levels were tested using inductively coupled plasma mass spectrometry (ICP-MS). The serum concentrations of titanium, nickel, cobalt, and chromium were measured. Intergroup comparisons were made independent of the means with use of the Wilcoxon-Mann-Whitney test. Correlations were established with use of the Spearman rank-order correlation test. Results: Mean serum levels of metal ions in control mothers are (ng/mL): titanium (Ti) 0.15, chromium (Cr) 0.161, cobalt (Co) 0.205, and nickel (Ni) 0.145. Mean serum levels in control babies are (ng/mL): Ti 0.144, Cr 0.0922, Co 0.17, and Ni 0.202. Comparison of metal ion levels between control mothers and control babies revealed no statistical difference. Mean serum levels of metal ions in implant mothers were (ng/mL): Ti 0.656, Cr 1.87, Co 0.972, and Ni 0.136. Mean serum concentrations in implant babies were (ng/mL): Ti 0.366, Cr 0.288, Co 0.486, and Ni 0.304. Mothers with implants have higher serum Cr and Co levels than control mothers (P b .05). Babies from mothers with implants have higher serum Co (P b .05) and Cr (P = .053) levels than control babies. Conclusion: The Cr and Co serum levels obtained from both mothers with implants and the offspring of mothers with implants are elevated in comparison to the control maternal and offspring levels. Therefore, we have concluded that Co and Cr cross the placental barrier. The FDA has not cleared the following medical device (Conserve Plus, Wright Medical Technology) for the use described in this presentation.