Chromium speciation in the blood of metal-on-metal hip implant patients

The objective of this study was to determine the valence state of chromium (Cr) in the blood of individuals with Cr-containing metal hip implants. Serum and red blood cell (RBC) Cr concentrations from 52 patients with Cr-containing total hip arthroplasties were measured preoperatively and at 3, 12, and 24 months postoperatively. Geometric mean and median pre-surgery serum Cr concentrations were consistently below 0.2 mu g/L, while geometric mean and median pre-op RBC Cr concentrations were typically about four-to six-fold higher than the serum values. A significant 5- to 13-fold increase was found in the mean and median serum Cr concentrations three months post-surgery, with an 8- to 18-fold rise at 12 and 24 months, respectively. Steady-state serum concentrations were reached between 3 and 12 months. In contrast, there were no marked differences in mean and median RBC Cr concentrations pre- and post-surgery. Slope regression analysis for our data was similar to those reported for Cr(III) in spiked blood samples. The analysis showed that Cr released from hip implants preferentially distributed into serum and not RBC, indicating that the form of Cr present in blood of hip implant patients was in the form of non-toxic Cr(III). Our findings indicate that blood Cr concentrations Cr(III) associated with metal implants do not pose an adverse health risk to patients, which is in agreement with findings published by most investigators.