Vetrivel Chezian Sengodan, PJ Sai Sarrvesh
Department of Orthopaedics, Institute of Orthopaedics and Traumatology, Government Coimbatore Medical College and Hospital, Coimbatore; Department of Orthopaedics, Tamil Nadu Dr. MGR Medical University, Chennai, Tamil Nadu, India.
Introduction: Surgical corrections of fracture using fixation devices made from various alloys (stainless steel, cobalt-chromium alloys, and titanium) carry a risk of these alloys leaching into circulation, potentially causing undesired health effects. Hence, monitoring the levels of metal ions in the serum of postoperative patients with metal implants is mandated. Materials and Methods: Blood samples from seventy patients with orthopedic metal implants was collected after a minimum postoperative period of 1 year. The samples were subjected to triple acid digestion and serum levels of chromium and nickel were analyzed using inductively coupled plasma-mass spectrometry. Results: The concentration of chromium (0.13 ± 0.06 μg/L) and nickel (0.39 ± 0.28 μg/L) in serum was within the reference range (chromium: 0.05–0.15 μg/L; nickel: 0.05–1.0 μg/L). Although a relatively high variability in the concentration of nickel was observed compared to chromium. In a subgroup analysis, the concentrations of both metal ions were not influenced by either gender, age groups, site of intramedullary nail, or postoperative duration. Conclusion: The concentration of chromium and nickel in serum of patients with orthopedic metal implants was within the normal reference levels at over 1-year post implant. The concentration of these metal ions was not influenced by gender, age groups, site of intramedullary nail, or postoperative duration.
Keywords: 316L stainless steel, chromium, implants, inductively coupled plasma-mass spectrometry, intramedullary nail, nickel.