Chromium speciation in the blood of metal-on-metal hip implant patients

The objective of this study was to determine the valence state of chromium (Cr) in the blood of individuals with Cr-containing metal hip implants. Serum and red blood cell (RBC) Cr concentrations from 52 patients with Cr-containing total hip arthroplasties were measured preoperatively and at 3, 12, and 24 months postoperatively. Geometric mean and median pre-surgery serum Cr concentrations were consistently below 0.2 µg/L, while geometric mean and median pre-op RBC Cr concentrations were typically about four- to six-fold higher than the serum values. A significant 5- to 13-fold increase was found in the mean and median serum Cr concentrations three months post-surgery, with an 8- to 18-fold rise at 12 and 24 months, respectively. Steady-state serum concentrations were reached between 3 and 12 months. In contrast, there were no marked differences in mean and median RBC Cr concentrations pre- and post-surgery. Slope regression analysis for our data was similar to those reported for Cr(III) in spiked blood samples. The analysis showed that Cr released from hip implants preferentially distributed into serum and not RBC, indicating that the form of Cr present in blood of hip implant patients was in the form of non-toxic Cr(III). Our findings indicate that blood Cr concentrations Cr(III) associated with metal implants do not pose an adverse health risk to patients, which is in agreement with findings published by most investigators.     

Total cobalt determination in human blood and synovial fluid using inductively coupled plasma-mass spectrometry: method validation and evaluation of performance variables affecting metal hip implant patient samples

Inductively coupled plasma with mass spectrometric detection (ICP-MS) has been used for clinical analysis of cobalt (Co) due to its sensitivity and specificity; however, media-specific validation studies are lacking. This study provides data on performance variables affecting differences between selected analytical platforms (Perkin Elmer and Agilent), tissue sample preparation, storage, and interferences affecting measurements in whole blood, serum, and synovial fluid. The limits of detection (LOD) range from 0.2–0.5 µg/L in serum and synovial fluid, and 0.6–1.7 µg Co/L in whole blood. The Agilent platform with collision reaction cell is more sensitive, while the Perkin Elmer platform with dynamic reaction cell demonstrates more polyatomic interferences near the LOD for serum and whole blood. Split sample analysis showed good accuracy, precision, and reproducibility between serum Co measurements using acid digestion or detergent dilution preparations for persons with metal hip implants or following supplement intake. The results demonstrated reliability of the ICP-MS methodology across the two analytical platforms and between two commercial laboratories for Co concentrations above 5 µg Co/L, but digestion procedures and polyatomic interferences may affect measurements in some media at lower concentrations. These studies validate the described ICP-MS methodology for clinical purposes with precautions at low cobalt concentrations (<5 µg Co/L).