Metal ions document, looking for help

[Tin Soldier]

I'm looking for some help on this topic.  We've discussed this through and through and I always seem to have technical questions about the body's chemistry and how an alloy breaks down, how the metals get in an ionic form, and so on and so forth.  The HR community has lots of questions about this and it seems like there is solid technical info for parts of this issue, but no fully synthesized paper on the issue from the beginning to the end.

Beginning - alloy ingot gets pulled off the shelf by the tech in Tenessee, part gets heated and hammered into the basic form, then gets cut, polished and packaged

Surgery - package is opened up on the operating table and placed in a human, synovial membrane gets sewed up,...

Recovery - mechanical wear, synovial fluid reacts with metal, various transport mechanisms, within the body, and routes of exposure to metals, forms of the metal in the blood, identify true risk of metals in the blood and tissue, some metal is excreted,...

Essentially, I'm looking for a general paper/document on metals fate and transport in the human body from time of placement to complete metallosis.  I think the HR community could benefit from something like this.  If it were peer-reviewed by some of the top surgeons, with lots of references, then I think it may really help folks understand what's going on with metallosis.  Possibly in more plain language form so that the non-medically trained, could still understand the document.

Call me crazy, but since I can't find such a document, maybe I should write it myself?  I could use everyone's input on the studies that I should reference.  I've co-authored a few papers having to do wth environmental geology/toxicology related to heavy metals so I have a little training, but not being medically-trained, I'm concerned that I might not get the "approval" from the HR community.  One of the main reasons for this effort is that I think we aren't getting a good understanding of the forms of metals being generated by the hip.  A good example of how important the form of the metal is, is arsenic in mine tailings, it's often tightly bound to sulfur, same thing with mercury.  Ingestion of that form of arsenic is not as bad as you might think.  Gastric fluids can't break the bond between arsenic and sulfur, thus the bioavailibity is quite low and the metal compound gets excreted in.  Obviously synovial fluid and blood are different than gastric fluids, but that is the level of detail I'm looking for.

When you ask will I have time to write this document?  Good question.  May take a year.  Anyway all the support I can get will be much appreciated.

I plan to start with Pritchett's paper on metallosis and then dig through the proceedings of the latest American Orth Conf back in Feb?  I think.   If anyone has any great advice or documents to look at, that would be great.

[Tin Soldier]

Oops, I should have posted this in the metals ion folder. 

[Tin Soldier]

and once again, I'll also begin with Pat's article here on Surface Hippy, and the reference materials there.  I knew there was lots of info out there.

[maxi]

good luck with it mate .. would definitely make for some interesting reading ..

i will ask my surgeon his opinion next visit if that helps you ...  may have to take notes ..

[hernanu]

I think that's a good idea, would at least expand our knowledge a bit.

[ScubaDuck]

Tin-

I would be willing to help anyway I can.  Just let me know if I can research or review anything.  I don't have a science background but I do have a degree in math.

Dan

[Tin Soldier]

Sounds good.  I'm good to put together a list of documents and then go from there.  Any documents you come across that are specific to the metals issue, I would like to have a link to.  I will probabaly also get this topic moved over to the metals ion forum, soon. 

[hipnhop]

Tin, you guys must have engineering degrees. I still working on my GED so I'll try to answer your complicated questions when I graduate. Right now I'm just hoping for a PH.D. (Perfect Hippy Diagnosis).

To do is to be - Satre
To be is to do - Nitchze
Do be do be doo  - Sinatra

[JMS]

I think the suggestion of trying to pull the information together  and get it published in a  refereed journal is a great one, Tin Soldier. Pritchett is obviously a good place to start.  The FDA paper on MOM also is quite clear.
I work at a University so have easy access to Pub Med and the like. I'll do a lit search and send you the findings.
JMS

[JMS]

A very quick search - mostly Google Scholar - suggests the following might be of interest. The more specific the search terms the older the papers tend to be unfortunately.  Let me know if you have any difficulty tracking these down or downloading them.  Some of the titles have got rather screwed up in the  transfer process.

Investigations of the corrosive deposition of components of metal implants and of the behaviour of biological trace elements in metallosis tissue by means of …
F Lux… - Journal of Radioanalytical and Nuclear Chemistry, 1974 - Springer

EARLY CLINICAL FAILURE OF THE BIRMINGHAM METAL-ON-METAL HIP RESURFACING IS ASSOCIATED WITH METALOSIS AND SOFT TISSUE NECROSIS
BJ Ollivere, C Darrah, T Barker, J Nolan… - Orthopaedic …, 2010 - JBJS (Br)

An introduction of various spectroscopic methods to identify in vivo metal wear in total knee arthroplasty
MW Kovacik, IA Gradisar, JC Tokash… - … Research Part A, 2008 - Wiley Online Library

PDF] Metallosis
[PDF] from jbjs.org.ukPG Bullough - Journal of Bone and Joint Surgery-British Volume, 1994 - JBJS (Br)
©1994 British Editorial Society of Bone and Joint Surgery 0301-620X/94/5900 $2.00 J Bone
Joint Surg
 1994; 76-B:687-8.

METALOSIS IN METAL-ON-METAL PPF TOTAL HIP ARTHROPLASTIES (THR)
R Legenstein, W Huber, A Ungersboeck… - Orthopaedic …, 2009 - JBJS (Br)

Zweymueller with metal-on-metal articulation: clinical, radiological and histological analysis of short-term results
[PDF] from mediccor.czP Korovessis, G Petsinis… - Archives of orthopaedic and trauma …, 2003 - Springer
..

Corrosion of Cr-Ni-Mo steel implants electrically stimulated
J Szewczenko… - Journal of materials processing technology, 2006 - Elsevier


Cobalt toxicity and iron metabolism in Neurospora crassa
[PDF] from nih.govG Padmanaban… - Biochemical Journal, 1966 - ncbi.nlm.nih.gov


[CITATION] Metallosis after contemporary metal-on-metal total hip arthroplasty. Five to nine-year follow-up
P Korovessis, G Petsinis, M Repanti… - The Journal of Bone and …, 2006 - JBJS
Cited by 113 - Related articles - BL Direct - All 58 versions

Synovial metallosis resulting from intraarticular intramedullary nailing of a distal femoral nonunion
EE Johnson, CE Marroquin… - Journal of orthopaedic …, 1993 - journals.lww.com


Extensive metallosis and necrosis in failed prostheses with cemented titanium-alloy stems and ceramic heads
[PDF] from jbjs.org.ukL Milosev, V Antolic, A Minovic, A Cor… - Journal of Bone and …, 2000 - JBJS (Br)
L. Milo˘sev, PhD, Research Associate A. Minovi˘c, PhD, Student J. Stefan Institute, Jamova
39, 1001 Ljubljana, Slovenia. V. Antoli˘c, MD, Lecturer in Orthopaedic Surgery S. Herman,
MD, Professor of Orthopaedic Surgery V. Pavlov˘ci˘c, MD, Associate Professor of ...

The toxicity of metals used in orthopaedic prostheses. An experimental study using cultured human synovial fibroblasts
[PDF] from jbjs.org.ukT Rae - Journal of Bone and Joint Surgery-British Volume, 1981 - JBJS (Br)
... It is important to establish how toxic these metals are and to assess the risk oflocalised ... human
synovial fibroblasts with various preparations of metals for periods up to 18 days ... changes were
evident after exposure to cobalt chloride at a concentration of 50 nanomoles per mililitre ..

The effects of particulate cobalt, chromium and cobalt-chromium alloy on human osteoblast-like cells in vitro
[PDF] from jbjs.org.ukMJ Allen, BJ Myer, PJ Millett… - Journal of Bone and Joint …, 1997 - JBJS (Br)
... We exposed two human osteoblast-like cell lines (SaOS-2 and MG-63) to particulate cobalt,
chromium and cobalt-chromium alloy at concentrations of 0, 0.01, 0.1 and 1.0 mg/ml. Cobalt was
toxic to both cell lines and inhibited the production of type-I collagen, osteocalcin and ..
Toxicity of Industrial Metals.
E Browning - Toxicity of Industrial Metals., 1961 - cabdirect.org
... on experimental animal physiology and toxicity before the accounts of human poisoning. ... toxicology;
nor is phosphorus, as the preface says, a highly toxic industrial agent ... bismuth, boron and boranes;
cadmium, cerium, caesium, chromium and chromâtes, cobalt, columbium and ...
Cited by 409 - Related articles - All 7 versions
Orthopaedic implant related metal toxicity in terms of human lymphocyte reactivity to metal‐protein complexes produced from cobalt‐base and titanium‐base implant …
NJ Hallab, K Mikecz, C Vermes, A Skipor… - Molecular and Cellular …, 2001 - Springer
Metal toxicity from sources such as orthopaedic implants was investigated in terms of immune
system hyper-reactivity to metal implant alloy degradation products. Lymphocyte response to
serum protein complexed with metal from implant alloy degra- dation was investigated in ...

[Tin Soldier]

Excellent.  Thanks JMS.  I was just PMing Pat saying there is a lot of info out there.  The first step might be to catalogue the papers into a few different categories.  I know that one can essentially search that stuff on the net or from varisous libraries, but maybe there would be some benefit to having differnet catergores of the whole process so that one could find document relating to metallurgy only, or synovial fluid stuides, or long term effects of heavy metals,...

I'll put these in the reference list.  Thanks

[JMS]

One excellent reference I have come across is
Metal ions in biology and medicine, Volume 10
 By Philippe Collery, Yvan Maymard, Theophile Teophanides, Lylia Khassanova

It is the proceedings of an International Symposium on the topic, and has a section of four articles specifically on metal ions in relation to hip surgeries.  It's a book, so not so easy to get hold of electronically, but significant chunks of it are available on Google Books, including the section of particular interest.

Another  article I found useful for understanding the basic process by which the ions affect the system is
Oxidative mechanisms in the toxicity of metal ions. Stohs & Bagchi, 1995. Free Radical Biology & Medicine, Vol.18.2.  pp321-336.  This is available as a pdf download.

[Tin Soldier]

Thanks, you've got some great references.  I'm slow to gettign a biblio put together, but I was thinking of maybe creating a spreadsheet with the references and then they could categorized and people could search for variours paper/studies.

[JMS]

Sounds like a good way to proceed.  Let me know if I can help.

[JMS]

Another useful reference is tte following review study:

Keegan GM, Learmonth ID, Case CP. Orthopaedic metals and their potential toxicity in the arthroplasty patient: review of current knowledge and future strategies. J Bone
Joint Surg
 2007;89-B:567-73.

Abstract: The long-term effects of metal-on-metal arthroplasty are currently under scrutiny because of the potential biological effects of metal wear debris. This review summarises data describing the release, dissemination, uptake, biological activity, and potential toxicity of metal wear debris released from alloys currently used in modern orthopaedics. The introduction of risk assessment for the evaluation of metal alloys and their use in arthroplasty patients is discussed and this should include potential harmful effects on immunity, reproduction, the kidney, developmental toxicity, the nervous system and carcinogenesis.

[Tin Soldier]

That's a juicy one.  I'll take a look.  It appears from the abstract that it may well provide much of what I was looking for. 

Thanks

[JMS]

Yes - but it would really benefit from someone re-writing it in everyday English

[hernanu]

Yes - but it would really benefit from someone re-writing it in everyday English

I've done medical research, I think what you're asking for is impossible. We just don't have the technology, JMS.

[JMS]

Sorry , don't follow that, Hernanu.  You mean we couldn't follow the science even if it was expressed in everyday language? Or what?

[hernanu]

Nope, we can follow it, I just don't think researchers can express themselves that way...