Journal article
Cobalt-Chromium-Molybdenum Femoral Knee Implant Damage Correlates with Elevated Periprosthetic Metal Concentrations
The Journal of arthroplasty, v 40(7), pp 315-323
05 Mar 2025
PMID: 40054540
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Total knee arthroplasty (TKA) device systems frequently include cast cobalt chrome alloy (CoCrMo) femoral components. However, compared to total hip arthroplasty (THA), gaps persist in our understanding of the correlations between femoral component damage, local metal release, and potential biological effects. Additionally, it remains unclear how TKA metal release affects clinical success or patient satisfaction. In this study, we investigated the associations between implant damage and metal release in the periprosthetic tissues following TKA. We asked: (1) does damage severity correlate with increased metal concentrations within the periprosthetic tissue; and (2) does the magnitude of metal released from CoCrMo femoral components merit clinical concern?
There were 51 CoCrMo femoral components and synovial samples that were prospectively collected by an institutional review board-exempt retrieval program. Devices received damage scores ranging from minimal (1) to severe (4). Tissue metal concentrations for cobalt (Co), chromium (Cr), molybdenum (Mo), and titanium (Ti) were quantified using inductively coupled plasma mass spectroscopy.
Visual damage correlated with increases in cobalt, chromium, and molybdenum concentrations in the periprosthetic tissue (P = 0.0008, 0.029, 0.007, respectively). Within the tissue adjacent to severely damaged implants, we measured median Co, Cr, and Mo concentrations of 7.81, 5.26, and 0.713 μg/mL, respectively. For minimally damaged implants, we report median Co, Cr, and Mo concentrations of 0.111, 1.80, and 0.179 μg/mL. In several of the 51 (14%) tissue samples, we measured cobalt and chromium concentrations greater than 10 μg/mL. Additionally, within periprosthetic tissues of devices with titanium tibial trays, titanium concentrations increased (P = 0.0052) arising, in part, from tibial-femoral component contact during arthroplasty.
We showed (1) elevated periprosthetic tissue metal concentrations in TKA patients and (2) established a positive correlation between damage severity and subsequent metal release. Measured tissue metal concentrations approached the magnitudes reported following metal-on-metal THA.
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1 citations in Scopus
Details
- Title
- Cobalt-Chromium-Molybdenum Femoral Knee Implant Damage Correlates with Elevated Periprosthetic Metal Concentrations
- Creators
- Peter W Kurtz - Clemson UniversityShabnam Aslani - Drexel UniversityMichael A Kurtz - Drexel UniversityLilliana M Taylor - Medical University of South CarolinaEmma R Barnes - Drexel UniversityDaniel W MacDonald - Drexel UniversityNicolas S Piuzzi - Cleveland ClinicWilliam M Mihalko - Campbell ClinicSteven M Kurtz - Drexel UniversityJeremy L Gilbert - Medical University of South Carolina
- Publication Details
- The Journal of arthroplasty, v 40(7), pp 315-323
- Publisher
- Elsevier
- Number of pages
- 9
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- School of Biomedical Engineering, Science, and Health Systems
- Web of Science ID
- WOS:001512550800047
- Scopus ID
- 2-s2.0-105001472803
- Other Identifier
- 991022038959604721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Orthopedics