Prospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Aug 18, 2024; 15(8): 773-782
Published online Aug 18, 2024. doi: 10.5312/wjo.v15.i8.773
Blood metal concentrations and cardiac structure and function in total joint arthroplasty patients
Peter C Brennan, Stephanie M Peterson, Thomas J O'Byrne, Mariana L Laporta, Cody C Wyles, Paul J Jannetto, Garvan C Kane, Maria Vassilaki, Hilal Maradit Kremers
Peter C Brennan, Cody C Wyles, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, United States
Stephanie M Peterson, Thomas J O'Byrne, Maria Vassilaki, Hilal Maradit Kremers, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, United States
Mariana L Laporta, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN 55905, United States
Paul J Jannetto, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, United States
Garvan C Kane, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
Author contributions: Maradit Kremers H has full access to all data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis, study supervision, obtained funding; Brennan PC, Vassilaki M, and Maradit Kremers H took responsibility for study concept and design, and drafting of the manuscript; O'Byrne TJ and Peterson SM took responsibility for statistical analysis; Brennan PC and Maradit Kremers H took responsibility for administrative, technical, or material support; all authors took responsibility for acquisition, analysis, interpretation of data, critical revision of the manuscript for important intellectual content, and have read and approved the final manuscript.
Supported by The National Institutes of Health, No. R01HL147155 and No. R01AG060920.
Conflict-of-interest statement: Dr. Jannetto reported receiving consultant fees from Roche Diagnostics and Thermo Fisher Scientific and serving on the AACC Board of Directors. Dr. Kane reported royalties for an echocardiography textbook. The Echo Manual. Wolters Kluwer. Dr. Maradit Kremers reported receiving grants from the National Institutes of Health during the conduct of the study. Dr. Vassilaki reported receiving grants from the National Institutes of Health during the conduct of the study, receiving grants from F. Hoffmann-La Roche Ltd, St. Anne’s University Hospital Brno/International Clinical Research Center (Czech Republic/EU), and Biogen and consultant fees from F. Hoffmann-La Roche Ltd outside the submitted work, and being a stockholder in Abbott Laboratories, Johnson and Johnson, Medtronic, Amgen, AbbVie and Merck. She serves on the editorial board for Journal of Alzheimer’s Disease. The other authors report no potential competing interests.
Institutional review board statement: All patients consented to the use of their medical data for research purposes. The Institutional Review Board approved the study and a listing was maintained on clinicaltrials.gov through the duration of the study. All patients had a previous surgical history of at least one prior THA, TKA, or hip resurfacing procedure. The surgical history was ascertained through self-report and the institutional Total Joint Registry.
Clinical trial registration statement: The clinical trial is registered with ClinicalTrials.gov, using identifier NCT04166539.
Informed consent statement: All study participants provided written consent prior to study enrollment.
Data sharing statement: I take full responsibility for the data, the analyses and interpretation, and the conduct of the research; I have full access to all of the data; I have the right to publish any and all data separate and apart from any sponsor.
CONSORT 2010 statement: This manuscript was checked and revised according to the CONSORT 2010.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hilal Maradit Kremers, MD, Professor, Department of Quantitative Health Sciences, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. maradit@mayo.edu
Received: February 9, 2024
Revised: July 19, 2024
Accepted: July 29, 2024
Published online: August 18, 2024
Processing time: 185 Days and 16.4 Hours
Abstract
BACKGROUND

There is concern regarding potential long-term cardiotoxicity with systemic distribution of metals in total joint arthroplasty (TJA) patients.

AIM

To determine the association of commonly used implant metals with echocardiographic measures in TJA patients.

METHODS

The study comprised 110 TJA patients who had a recent history of high chromium, cobalt or titanium concentrations. Patients underwent two-dimensional, three-dimensional, Doppler and speckle-strain transthoracic echocardiography and a blood draw to measure metal concentrations. Age and sex-adjusted linear and logistic regression models were used to examine the association of metal concentrations (exposure) with echocardiographic measures (outcome).

RESULTS

Higher cobalt concentrations were associated with increased left ventricular end-diastolic volume (estimate 5.09; 95%CI: 0.02-10.17) as well as left atrial and right ventricular dilation, particularly in men but no changes in cardiac function. Higher titanium concentrations were associated with a reduction in left ventricle global longitudinal strain (estimate 0.38; 95%CI: 0.70 to 0.06) and cardiac index (estimate 0.08; 95%CI, -0.15 to -0.01).

CONCLUSION

Elevated cobalt and titanium concentrations may be associated with structural and functional cardiac changes in some patients. Longitudinal studies are warranted to better understand the systemic effects of metals in TJA patients.

Keywords: Total joint arthroplasty; Metal-on-metal; Cardiotoxicity; Heart failure; Echocardiography; Cobalt

Core Tip: This study evaluated echocardiographic measures in 110 prospectively recruited total joint arthroplasty patients who had a recent history of elevated metal concentrations. Elevated cobalt and titanium concentrations were positively associated with some structural and functional cardiac changes.