Monitoring metallic prosthetic implant wear
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Titanium is the ninth most abundant element in the earthâ€™s crust. Multiple oxidation states between 2+ and 4+ allow formation of a variety of compounds. There is no evidence that titanium is an essential element. Due in part to titaniumâ€™s oxide formation propensity, the element is considered to be nontoxic. Soils, drinking water, and air all contain trace amounts of titanium. The food processing industry uses large quantities of titanium as a food additive; processed foods contain higher levels than are found in most produce and organic food-stuffs. The average daily oral intake through food consumption is 0.1 to 1 mg/day, which accounts for more than 99% of exposure. Gastrointestinal absorption of titanium is low (approximately 3%) and the majority of ingested titanium is rapidly excreted in the urine and stool. The total body burden of titanium is usually in the range of 9 to 15 mg, a significant portion of which is contained in the lung. Titanium dust entering the respiratory tract is nonirritating and is almost completely nonfibrogenic in humans.
Titanium-containing alloys are used in some artificial joints, prosthetic devices, and implants. Titanium dioxide allows osseointegration between an artificial medical implant and bone. Despite their wide use, exposure to these materials has not been linked to toxicity. In one study patients monitored up to 36 months following joint replacement with titanium-containing joints showed a statistically significant increase in detectable serum titanium within the study group. While titanium concentrations are not a measure of toxicity, they are useful in determining whether implant breakdown is occurring. Serum titanium concentrations are likely to be increased above the reference range in patients with metallic joint prosthesis. Prosthetic devices produced by Zimmer Company and Johnson and Johnson typically are made of aluminum, vanadium, and titanium. This list of products is incomplete, and these products change occasionally; see prosthesis product information for each device for composition details
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
Prosthesis wear is known to result in increased circulating concentration of metal ions. In the absence of an implant, circulating titanium is <1 ng/mL. Modest increase (1.0-3.0 ng/mL) in serum titanium concentration is evident with a prosthetic device in good condition. Serum concentrations >10 ng/mL in a patient with titanium-based implant suggest prosthesis wear. Increased serum titanium concentration in the absence of corroborating clinical information does not independently predict prosthesis wear or failure.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Titanium is a trace metal commonly used in alloys and readily present in the environment. Thus, contamination of the collection site and of the specimen must be avoided. Failure to use metal-free collection procedures and devices may cause falsely increased results. See Specimen Required for collection and processing information.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
1. Chao EY, Frassica F, Prichard DJ, Moyer TP: Metal ion release in patients with porous coated megaprostheses. 41st Annual Meeting of the Orthopaedic Research Society, Orlando, Florida, 1995 Feb 13-16
2. Jacobs JJ, Skipor AK, Patterson LM, et al: Metal release in patients who have had a primary total hip arthroplasty. A prospective, controlled, longitudinal study. J Bone Joint Surg Am 1998 Oct;80(10):1447-1458
3. Liu TK, Liu SH, Chang -H, Yang RS: Concentration of metal elements in the blood and urine in the patients with cementless total knee arthroplasty. Tohoku J Exp Med1998;185:253-262
4. Krachler M, Domj W, Irgolic KJ: Concentrations of trace elements in osteoarthritic knee-joint effusions. Biol Trace Elem Res 2000;75:253-263