Cardiotoxicity concerns in total joint arthroplasty

Table 1 Blood metal ion concentrations in patients receiving total joint arthroplasty and corresponding cardiac structural and functional changes

Study	Metal ions measured	Concentration (µg/L)	Timing of measurement	Cardiac structural changes	Cardiac functional changes	Notes
Brennan et al[1], 2024	Cobalt, Chromium, Titanium	Cobalt: 1.9-6.3, Chromium: 1.2-3.8, Titanium: 2.0-5.0	12 months post-TJA	Increased left ventricular mass	Decreased ejection fraction	Significant correlation with metal ion levels
Bellouard et al[2], 2024	Cobalt, Chromium, Titanium	Cobalt: 2.1-4.8, Chromium: 1.0-3.2, Titanium: 0.5-1.3	6 months post-TJA	No significant changes	No significant changes	Levels not sufficient for cardiac changes
Brüggemann and Hailer[4], 2024	Cobalt, Chromium, Titanium	Cobalt: 0.1-13, Chromium: 0.4-5.0, Titanium: 0.2-13	18-year follow-up	Increased myocardial thickness	Decreased fractional shortening	Chronic exposure effects observed
El-Shoura et al[14], 2024	Cobalt	Not specified	Experimental study	Cardiomyopathy, endothelial dysfunction	Reduced myocardial contractility	Rat models show strong correlation with human data
Rył et al[5], 2024	Zinc, Copper, Iron, Chromium, Magnesium, Manganese	Zn: 1000-2000, Cu: 700-1000, Fe: 300-500, Cr: 0.5-2.5, Mg: 500-900, Mn: 0.5-1.5	Baseline (pre-surgery)	No significant changes	No significant changes	Bioelements showed no correlation with cardiac changes
Spranz et al[3], 2024	Tantalum	0.1-14	12 months post-TJA	Mild hypertrophy	Slight reduction in cardiac output	Elevated tantalum levels linked with mild structural changes
Linna et al[22], 2020	Cobalt	Not specified	Occupational exposure study (6-year follow-up)	Hypertrophy, fibrosis	Reduced heart rate variability	Longitudinal data on chronic exposure
Wyles et al[20], 2017	Cobalt	0.1-0.17	Variable (post-TJA)	Myocardial cobalt deposition	Impaired myocardial function	Cobalt deposition in heart tissue associated with functional decline

This table presents blood metal ion concentrations in patients receiving total joint arthroplasty and the corresponding cardiac structural and functional changes. The table includes data from multiple studies, highlighting the metal ions measured (cobalt, chromium, titanium, tantalum, and various bioelements), their concentrations in micrograms per liter (µg/L), and observed cardiac changes. These data underscore the importance of timing in the detection of metal-related cardiotoxicity, particularly with chronic exposure. Cardiac structural changes, such as increased left ventricular mass, myocardial thickness, and hypertrophy, and functional changes, including decreased ejection fraction and fractional shortening, are detailed. The table also includes notes on specific findings, such as the presence of myocardial cobalt deposition and the lack of significant changes in certain studies. This synthesis underscores the requirement for monitoring blood metal ion concentrations to detect and prevent potential cardiotoxic effects in patients undergoing arthroplasty. TJA: Total joint arthroplasty.