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Blood and plasma titanium levels associated with well-functioning hip implants

Swiatkowska, I; Martin, NG; Henckel, J; Apthorp, H; Hamshere, J; Hart, AJ; (2020) Blood and plasma titanium levels associated with well-functioning hip implants. Journal of Trace Elements in Medicine and Biology , 57 pp. 9-17. 10.1016/j.jtemb.2019.09.005. Green open access

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Abstract

Background Hip implants are usually manufactured from cobalt-chromium and titanium alloys. As the implants wear and corrode, metal debris is released into the surrounding tissue and blood, providing a potential biomarker for their function. Whilst there are laboratory reference levels for blood cobalt and chromium in patients with well and poorly functioning hip implants, there are no such guidelines for titanium. This is despite the increasing use of titanium implants worldwide. Patients and methods We recruited a consecutive series of 95 patients (mean age 71 years, mean time after surgery 8.5 years) with one hip implant type, inserted by the same surgeon. We assessed clinical and radiological outcome, and measured blood and plasma titanium using high resolution inductively-coupled plasma mass spectrometry. Results The upper normal reference limit for blood and plasma titanium was 2.20 and 2.56 μg L−1, respectively, and did not differ significantly between males and females. Conclusion We are the first to propose a laboratory reference level for blood and plasma titanium in patients with well-functioning titanium hip implants. This is an essential starting point for further studies to explore the clinical usefulness of blood titanium as a biomarker of orthopaedic implant performance, and comes at a time of considerable controversy regarding the use of certain titanium alloys in hip arthroplasty.

Type: Article
Title: Blood and plasma titanium levels associated with well-functioning hip implants
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.jtemb.2019.09.005
Publisher version: https://doi.org/10.1016/j.jtemb.2019.09.005
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, Toxicity, TMZF, Reference range, HR ICP-MS, Total hip arthroplasty
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/10082083
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