Knee arthroplasty failure is associated with significant systemic multimetal exposure

Area of Science:

• Orthopedic Surgery
• Biomaterials Science
• Toxicology

Background:

• Total knee arthroplasty (TKA) involves implants made of various metals.
• Concerns exist regarding systemic exposure to these metals following TKA.
• Revision TKA is performed when primary implants fail, potentially increasing metal release.

Purpose of the Study:

• To determine if patients awaiting revision TKA have systemic exposure to arthroplasty metals.
• To compare systemic metal levels between patients with failed constrained and unconstrained TKA implants.
• To explore correlations between different metal levels in patients with failed TKA.

Main Methods:

• Whole blood samples were analyzed from 51 patients scheduled for revision TKA and 53 controls.
• Inductively coupled plasma mass spectrometry quantified TKA-relevant metals (Co, Cr, Mo, Ti, Nb, Zr).
• Statistical analyses included Mann-Whitney, Kruskal-Wallis, Spearman correlation, and linear regression.

Main Results:

• Revision TKA patients had significantly higher systemic levels of Co, Cr, Mo, Ti, Nb, and Zr compared to controls.
• Failed constrained TKA implants were linked to higher Co, Cr, Ti, Nb, and Zr levels than unconstrained implants.
• In patients with failed constrained TKA, Co and Ti, and Zr and Ti levels correlated significantly.

Conclusions:

• Patients with failed TKA experience systemic exposure to arthroplasty metals.
• A link between Co/Ti and Zr/Ti release is suggested in revision of constrained TKA implants.
• Further research is needed on the biological effects and clinical thresholds of TKA-related metals.