Kurtz Peter W, Aslani Shabnam, Kurtz Michael A, Taylor Lilliana M, Barnes Emma R, MacDonald Daniel W, Piuzzi Nicolas S, Mihalko William M, Kurtz Steven M, Gilbert Jeremy L
Department of Bioengineering, Clemson University, Clemson, South Carolina; The Clemson University-Medical University of South Carolina Bioengineering Program, Charleston, South Carolina.
Department of Biomedical Engineering, Drexel University, Implant Research Core, Philadelphia, Pennsylvania.
J Arthroplasty. 2025 Jul;40(7S1):S315-S323. doi: 10.1016/j.arth.2025.02.075. Epub 2025 Mar 5.
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 Co, Cr, and Mo concentrations in the periprosthetic tissue (P = 0.0008, 0.029, and 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, respectively. In several of the 51 (14%) tissue samples, we measured Co and Cr concentrations > 10 μg/mL. Additionally, within periprosthetic tissues of devices with Ti tibial trays, Ti concentrations increased (P = 0.0052) arising, in part, from tibial-femoral component contact during arthroplasty.
We (1) showed 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.
全膝关节置换术（TKA）器械系统通常包括铸造钴铬钼合金（CoCrMo）股骨部件。然而，与全髋关节置换术（THA）相比，我们对股骨部件损伤、局部金属释放和潜在生物学效应之间的相关性仍存在差距。此外，TKA金属释放如何影响临床成功率或患者满意度仍不清楚。在本研究中，我们调查了TKA后假体周围组织中植入物损伤与金属释放之间的关联。我们提出了以下问题：（1）损伤严重程度是否与假体周围组织中金属浓度升高相关？以及（2）CoCrMo股骨部件释放的金属量是否值得临床关注？
通过一项机构审查委员会豁免的回收计划前瞻性收集了51个CoCrMo股骨部件和滑膜样本。器械的损伤评分范围从最小（1）到严重（4）。使用电感耦合等离子体质谱法定量钴（Co）、铬（Cr）、钼（Mo）和钛（Ti）的组织金属浓度。
肉眼可见的损伤与假体周围组织中Co、Cr和Mo浓度的增加相关（分别为P = 0.0008、0.029和0.007）。在严重受损植入物附近的组织中，我们测得Co、Cr和Mo的中位浓度分别为7.81、5.26和0.713μg/mL。对于轻度受损的植入物，我们报告Co、Cr和Mo的中位浓度分别为0.111、1.80和0.179μg/mL。在51个（14%）组织样本中的几个样本中，我们测得Co和Cr浓度>10μg/mL。此外，在带有Ti胫骨托的器械的假体周围组织中，Ti浓度升高（P = 0.0052），部分原因是关节置换术中胫股部件的接触。
我们（1）显示TKA患者假体周围组织金属浓度升高，并且（2）确定了损伤严重程度与随后的金属释放之间存在正相关。测得的组织金属浓度接近金属对金属THA后报告的水平。
