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Blood nickel concentrations in patients with stainless-steel hip prostheses
Nickel concentrations were analyzed by electrothermal atomic absorption spectrophotometry in serum and whole blood specimens from patients 9 to 15 years after unilateral (N = 11) or bilateral (N = 2) hip arthroplasty. The hip prostheses were of the "Charnley" or "TR-28" (metal-to-plastic) types, fabricated of stainless-steel (14 to 16 percent Ni) with polyethylene acetabular cups. In 12 of the 13 patients, nickel concentrations (+/- SD) averaged 0.30 +/- 0.25 microgram per L (range 0.05 to 0.85) in serum and 0.36 +/- 0.20 microgram per L (range 0.11 to 0.67) in whole blood; these values did not differ significantly from the corresponding nickel concentrations in specimens from 30 healthy controls (0.28 +/- 0.24 microgram per L, range less than 0.05 to 1.08, in serum; 0.34 +/- 0.28 microgram per L, range less than 0.05 to 1.05, in whole blood). The remaining patient, a 78-year-old man with bilateral hip arthroplasty, had nickel concentrations of 3.1 micrograms per L in serum and 2.3 micrograms per L in whole blood; renal insufficiency apparently contributed to hypernickelemia in this patient. The arthroplasty patients were asymptomatic with respect to their joint replacements; X-rays at the last follow-up examinations did not reveal bone resorption around the implants. This study shows that patients with stainless-steel hip prostheses of the metal-to-plastic types do not develop hypernickelemia in the apparent absence of corrosion, local complications, or systemic conditions, such as renal insufficiency.
Nickel concentrations were analyzed by electrothermal atomic absorption spectrophotometry in serum and whole blood specimens from patients 9 to 15 years after unilateral (N = 11) or bilateral (N = 2) hip arthroplasty. The hip prostheses were of the "Charnley" or "TR-28" (metal-to-plastic) types, fabricated of stainless-steel (14 to 16 percent Ni) with polyethylene acetabular cups. In 12 of the 13 patients, nickel concentrations (+/- SD) averaged 0.30 +/- 0.25 microgram per L (range 0.05 to 0.85) in serum and 0.36 +/- 0.20 microgram per L (range 0.11 to 0.67) in whole blood; these values did not differ significantly from the corresponding nickel concentrations in specimens from 30 healthy controls (0.28 +/- 0.24 microgram per L, range less than 0.05 to 1.08, in serum; 0.34 +/- 0.28 microgram per L, range less than 0.05 to 1.05, in whole blood). The remaining patient, a 78-year-old man with bilateral hip arthroplasty, had nickel concentrations of 3.1 micrograms per L in serum and 2.3 micrograms per L in whole blood; renal insufficiency apparently contributed to hypernickelemia in this patient. The arthroplasty patients were asymptomatic with respect to their joint replacements; X-rays at the last follow-up examinations did not reveal bone resorption around the implants. This study shows that patients with stainless-steel hip prostheses of the metal-to-plastic types do not develop hypernickelemia in the apparent absence of corrosion, local complications, or systemic conditions, such as renal insufficiency.