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.

Table 2 Observed cardiac side effects in patients undergoing total joint arthroplasty with various implant types

Study	Implant type	Findings	Cardiac events observed
Brennan et al[1], 2024	General TJA	Elevated metal ion levels linked to adverse cardiac changes	Cardiomyopathy, heart failure, arrhythmias
Bellouard et al[2], 2024	Metal-on-polyethylene, metal-on-metal	Metal ions accumulate in cardiac tissues	Cardiomyopathy, arrhythmias, heart failure
Brüggemann and Hailer[4], 2024	General TJA	Elevated cobalt and chromium levels, immunological changes	Myocarditis, cardiomyopathy, arrhythmias
Spranz et al[3], 2024	Tantalum-based	Elevated blood tantalum levels	Potential cardiotoxicity, arrhythmias (further studies needed)
Stołtny et al[17], 2023	Metaphyseal hip arthroplasty with modular metal heads	High serum chromium and cobalt levels	Cardiomyopathy, myocardial fibrosis
Langton et al[19], 2022	Various (metal-on-metal, ceramic-on-polyethylene, ceramic-on-ceramic)	MoM implants have higher cardiotoxicity	Metal hypersensitivity, cardiomyopathy, heart failure
Linna et al[22], 2020	Occupational cobalt exposure (parallel to cobalt implants)	Increased cardiac events in chronic exposure	Arrhythmias, cardiomyopathy, heart failure
Berber et al[10], 2017	Metal-on-metal	Cobalt and chromium cardiotoxicity	Myocardial fibrosis, cardiomyopathy, heart failure

This table presents the incidence of cardiac events in patients undergoing total joint arthroplasty on the basis of the type of implant used. The studies listed explore the association between various implant materials and the occurrence of cardiac complications. Key findings include the influence of metal ion release on cardiac function, with metal-on-metal implants being associated with higher rates of cardiotoxicity, such as cardiomyopathy and heart failure. The table also highlights the role of immunological and inflammatory responses linked to elevated metal ion levels and their contribution to adverse cardiac outcomes, including myocarditis (inflammation of the heart muscle), which can contribute to or exacerbate conditions such as cardiomyopathy and arrhythmias. TJA: Total joint arthroplasty.

Table 3 Summary of blood metal concentrations and associated cardiac effects in recent studies on total joint arthroplasty patients

Study	Implant material	Blood metal concentrations	Cardiac findings	Other relevant findings
Brennan et al[1], 2024	Various metals	Elevated cobalt and chromium levels	Altered cardiac structure and function	N/A
Bellouard et al[2], 2024	Metal-on-polyethylene	Elevated metal levels in cardiac tissues	Long-term potential cardiac health impact	Metal accumulation in various organs
Brüggemann and Hailer[4], 2024	Cobalt, chromium, titanium	Significant metal ion levels	Immunological changes possibly linked to cardiotoxicity	N/A
Spranz et al[3], 2024	Tantalum	Elevated tantalum concentrations in blood	Adverse cardiac effects	N/A
Rył et al[5], 2024	Zinc, copper, iron	Increased bioelement concentrations	Possible systemic effects extending to cardiac health	Focus on erectile dysfunction in aging men
Taleb et al[7], 2024	Metal-based implants	Systemic metal exposure	Potential impact on multiple organs, including the heart	Focus on brain integrity

This table presents an overview of key findings on blood metal concentrations, cardiac effects, and observations from studies involving patients who have undergone total joint arthroplasty. The data highlight the association between various types of implant materials (such as metal-on-polyethylene, tantalum, cobalt, chromium, and titanium) and their potential influence on cardiac health, including changes in cardiac structure and function, in addition to immunological alterations. The information provides a concise overview of key outcomes rather than an exhaustive analysis of each study.