From the Cumming School of Medicine, University of Calgary, Calgary, Alta. (Powell, Saini, Boyd, Railton); and Calgary Laboratory Services, Calgary, Alta. (Sadrzadeh).
Can J Surg. 2019 Feb 1;62(1):9-13. doi: 10.1503/cjs.015717.
Testing of whole blood or serum metal ion levels has become an important part of assessing and monitoring the performance of metal-on-metal bearings, both in hip resurfacing arthroplasty and in total hip replacement. The aim of this study was to determine the concordance between 2 laboratories testing cobalt and chromium ion levels in patients with metal-on-metal bearings.
Serum and whole blood samples from patients who had undergone metal-on-metal resurfacing or large-diameter total hip arthroplasty were tested for cobalt and chromium ions in laboratory A (a recognized laboratory) and laboratory B (tasked with testing clinical specimens). Laboratory A performed cobalt and chromium testing on whole blood, and laboratory B performed cobalt testing on whole blood and chromium testing on serum.
Samples from 104 patients were tested. Laboratory B reported lower whole blood cobalt levels than laboratory A. Furthermore, laboratory A reported that all patients had elevated whole blood cobalt ion levels compared to the normal reference values for the laboratory, whereas laboratory B reported that 46 patients (44.2%) had whole blood cobalt ion levels within the normal reference range for the laboratory.
This comparative study highlights the importance of using a single laboratory for metal ion testing, as values generated from different laboratories may not be directly comparable. With recent literature suggesting that whole blood cobalt levels as low as 1 ppb may be a predictor of adverse reactions to metal debris, accurate clinical measurement needs to be increasingly exact.
检测全血或血清中的金属离子水平已成为评估和监测金属对金属关节中金属对金属轴承性能的重要手段，包括髋关节表面置换术和全髋关节置换术。本研究旨在确定 2 家实验室检测金属对金属轴承患者钴和铬离子水平的一致性。
对接受金属对金属表面置换或大直径全髋关节置换术的患者的血清和全血样本进行实验室 A（认可的实验室）和实验室 B（负责检测临床标本）的钴和铬离子检测。实验室 A 对全血进行钴和铬检测，实验室 B 对全血进行钴检测，对血清进行铬检测。
对 104 例患者的样本进行了检测。实验室 B 报告的全血钴水平低于实验室 A。此外，实验室 A 报告说，与实验室的正常参考值相比，所有患者的全血钴离子水平均升高，而实验室 B 报告说，46 例患者（44.2%）的全血钴离子水平在实验室的正常参考范围内。
这项对比研究强调了使用单一实验室进行金属离子检测的重要性，因为来自不同实验室的检测值可能无法直接比较。最近的文献表明，全血钴水平低至 1 ppb 可能是金属碎片不良反应的预测指标，因此需要更精确的临床测量。
