Prospective Study
Copyright ©The Author(s) 2024.
World J Orthop. Aug 18, 2024; 15(8): 773-782
Published online Aug 18, 2024. doi: 10.5312/wjo.v15.i8.773
Table 1 Characteristics of the study population, n (%)
Characteristic
Total
Age (years)
Mean (SD)68.8 (9.2)
Median (IQR)69.0 (63.0, 75.0)
Min, Max44.0, 93.0
Women 45 (40.9)
Race
Pacific Islander2 (1.8)
White108 (98.2)
Smoking history
Current smoker4 (3.6)
Previous smoker36 (32.7)
Never smoker58 (52.7)
History of heart failure1 (0.9)
Body mass index (kg/m2)
Mean (SD)30.3 (6.0)
Median (IQR)30.0 (62.2, 34.3)
Min, Max18.8, 47.0
Body surface area (m2)
Mean (SD)2.1 (0.3)
Median (IQR)2.1 (1.9, 2.2)
Min, Max1.4, 2.7
Systolic blood pressure, mmHg
Mean (SD)134.0 (18.9)
Median (IQR)132.0 (122.0, 144.0)
Min, Max90.0, 187.0
Diastolic blood pressure, mmHg
Mean (SD)77.6 (8.8)
Median (IQR)78.0 (72.0, 83.0)
Min, Max60.0, 108.0
TJA history
Joint
Hip (total hip arthroplasty)79 (71.8)
Knee (total knee arthroplasty)11 (10.0)
Both20 (18.2)
Revision surgery59 (53.6)
Years between first TJA surgery and study visit
Mean (SD)13.4 (5.7)
Median (IQR)12 (10.0, 16.0)
Min, Max2.0, 31.0
Table 2 Metal concentrations by sex, n (%)
Metal concentrations (ng/mL)
Total
Men
Women
Detectable chromium, 43 (39.5)28 (43.8)15 (33.3)
Mean (SD)3.8 (4.7)3.0 (3.5)5.2 (6.3)
Median (IQR)1.9 (1.2, 3.8)1.9 (1.3, 2.9)2.8 (1.2, 5.8)
Min, max1.1, 21.41.1,18.51.2,21.4
Detectable cobalt51 (46.4)36 (55.4)15 (33.3)
Mean (SD)4.9 (4.3)5.2 (4.7)4.1 (3.2)
Median (IQR)3.7 (1.9, 6.3)4.1 (2.1, 6.9)3.2 (1.9, 5.2)
Min, max1.1, 24.61.1, 24.61.1, 12
Detectable titanium89 (80.9)49 (75.4)40 (88.9)
Mean (SD)4.8 (5.1)4.6 (6.1)5.1 (3.5)
Median (IQR)3.0 (2.0, 5.0)3 (1,5)4 (3,7)
Min, Max1.0, 35.01,351,15
Table 3 Association of metal concentrations with echocardiographic parameters

Measure available
Mean (SD); Median (interquartile range)
Regression estimates (95%CI)1
Measure (unit)


Chromium
Cobalt
Titanium
LV size and systolic function
2D Biplane LV end-diastolic volume (mL)100134.04 (34.14); 129.5 (109, 153)1.20 (-5.23 to 7.64)5.09 (0.02-10.17)a-3.67 (-8.55 to 1.22)
3D LV end-diastolic volume (mL)95130.38 (32.14); 126 (110, 147)0.95 (-4.59 to 6.50)4.09 (-0.57 to 8.74)a-1.69 (-6.35 to 2.96)
2D Biplane LV end-systolic volume (mL)9950.76 (18.22); 48 (38, 60)0.44 (-3.05 to 3.92)3.13 (0.40-5.87)-1.53 (-4.20 to 1.14)
3D LV end-systolic volume (mL)9449.24 (14.2); 48 (38, 57)0.44 (-1.86 to 2.75)1.46 (-0.50 to 3.42)-1.16 (-3.09 to 0.76)
3D LV ejection fraction 9462.12 (4.34); 62 (60, 65)-0.10 (-0.88 to 0.68)-0.51 (-1.17 to 0.15)0.07 (-0.59 to 0.73)
LV global longitudinal strain 108-19.74 (2.12); -20 (-21, -19)-0.15 (-0.55 to 0.26)-0.27 (-0.60 to 0.07)-0.38 (-0.70 to 0.06)b
LV stroke volume (mL)10894.5 (17.22)/91 (82.5, 105)-0.28 (-3.43 to 2.87)1.59 (-0.99 to 4.16)-2.69 (-5.24 to 0.15)b
LV cardiac output (l/minute)1096.12 (1.3); 5.84 (5.22, 6.8)-0.01 (-0.35 to 0.16)0.01 (-0.20 to 0.22)-0.20 (-0.40 to 0.004)a
LV cardiac index (l/minute/m2)1082.92 (0.4)/2.82 (2.68,3.16)0.01 (-0.08 to 0.09)0.01 (-0.06 to 0.07)-0.08 (-0.15 to -0.01)b
LV diastolic function    
LV diastolic function (normal/abnormal)110Normal 42 (38.2)ReferenceReferenceReference
Abnormal 68 (61.8)1.21 (0.78-1.87)1.14 (0.80-1.62)0.67 (0.47-0.97)b
Medial E/e' ratio10610.76 (3.7)/10 (8.3,12.5)-0.38 (-1.02 to 0.27)-0.05 (-0.60 to 0.49)0.18 (-0.34 to 0.70)
LA biplane vol index (mL/m2)10731.32 (9.02); 30 (25, 37)1.26 (-1.36 to 3.86)2.72 (0.60-4.84)b-0.24 ( -2.3 to 1.82)
LA reservoir strain10529.9 (6.9); 29.5 (26.2, 33.9)0.002 (-1.38 to 1.39)0.083 (-1.06 to 1.22)1.602 (0.55-2.66)c
Right heart parameters    
RV systolic pressure (mmHg)8028.34 (5.34); 28 (23.5, 32)-0.41 (-1.54 to 0.73)-0.22 (-1.19 to 0.75)-0.28 (-1.15 to 0.58)
RV size (normal/enlarged)110Normal 99 (90)ReferenceReferenceReference
Abnormal 11 (10)1.66 (0.91-3.05)1.80 (1.08-2.99)b1.22 (0.74-2.01)
RV basal diameter (mm)5340.48 (6.3); 41 (36, 46)0.37 (-1.18 to 1.92)1.17 (-0.18 to 2.51)a-0.17 (-1.42 to 1.08)
Tricuspid annular plane systolic excursion (mm)9123.58 (3.7); 23 (21, 26)-0.34 (-1.21 to 0.53)0.11 (-0.61 to 0.83)0.17 (-0.50 to 0.84)
RV Basal Lateral Systolic Strain 34-25.06 (4.88); -26 (-29, -24)1.19 (-0.64 to 3.01)0.40 (-1.50 to 2.29)-0.59 (-2.12 to 0.94)
Other parameters
Mid ascending thoracic aortic diameter (mm)8235.9 (4.08); 36 (33, 38)0.16 (-0.65 to 0.98)0.43 (-0.27 to 1.13)-0.71 (-1.38 to -0.05)b
N terminal pro b-type natriuretic peptide (pg/mL)109153.4 (269.3); 85 (42, 138)-20.47 (-72.32 to 31.38)10.01 (-32.78 to 52.80)13.41 (-27.74 to 54.55)
Troponin (ng/mL)10813.4 (11.3); 11 (7, 15)-0.97 (-2.94 to 0.99)-0.85 (-2.47 to 0.77)0.22 (-1.34 to 1.78)