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Blood titanium level as a biomarker of orthopaedic implant wear

Swiatkowska, I; Martin, N; Hart, AJ; (2019) Blood titanium level as a biomarker of orthopaedic implant wear. Journal of Trace Elements in Medicine and Biology , 53 pp. 120-128. 10.1016/j.jtemb.2019.02.013. Green open access

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Abstract

Background: Joint replacement implants are usually manufactured from cobalt-chromium or titanium alloys. After the device is implanted, wear and corrosion generate metal particles and ions, which are released into local tissue and blood. The metal debris can cause a range of adverse local and systemic effects in patients. Research problem: In the case of cobalt and chromium, a blood level exceeding 7 μg L −1 indicates potential for local toxicity, and a failing implant. It has been repeatedly suggested in the literature that measurement of titanium could also be used to assess implant function. Despite an increasing interest in this biomarker, and growing use of titanium in orthopaedics, it is unclear what blood concentrations should raise concerns. This is partly due to the technical challenges involved in the measurement of titanium in biological samples. Aim: This Review summarises blood/serum titanium levels associated with well-functioning and malfunctioning prostheses, so that the prospects of using titanium measurements to gain insights into implant performance can be evaluated. Conclusion: Due to inter-laboratory analytical differences, reliable conclusions regarding “normal” and “abnormal” titanium levels in patients with orthopaedic implants are difficult to draw. Diagnosis of symptomatic patients should be based on radiographic evidence combined with blood/serum metal levels.

Type: Article
Title: Blood titanium level as a biomarker of orthopaedic implant wear
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.jtemb.2019.02.013
Publisher version: http://doi.org/10.1016/j.jtemb.2019.02.013
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Blood titanium, Titanium alloy, Joint replacement, Joint implant, Implant wear, ICP-MS
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Ortho and MSK Science
URI: https://discovery.ucl.ac.uk/id/eprint/10070885
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