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Journal of Bone and Joint Surgery - British Volume, Vol 88-B, Issue 4, 449-454.
doi: 10.1302/0301-620X.88B4.17216  
Copyright © 2006 by British Editorial Society of Bone and Joint Surgery
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The association between metal ions from hip resurfacing and reduced T-cell counts

A. J. Hart, MA, FRCS(Orth), Specialist Registrar1; T. Hester, BSc, Medical Student1; K. Sinclair, PhD, Senior Research Analyst2; J. J. Powell, PhD, FRSC, Professor2; A. E. Goodship, BVSc, PhD, MRCVS, Professor1; L. Pele, PhD, Career Development Fellowship2; N. L. Fersht3; and J. Skinner, FRCS(Orth), Consultant Orthopaedic Surgeon1

1 Institute of Orthopaedics and Musculoskeletal Science, Royal National Orthopaedic Hospital, University College, London Campus, Middlesex, HA7 4LP, UK.
2 MRC Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge CB1 9NL, UK.
3 Cell Cycle Laboratory, Cancer Research UK London Institute, 44 Lincoln’s Inn Fields, London WC2A 3PX, UK.

Correspondence should be sent to Mr A. J. Hart; e-mail: alisterjhart{at}yahoo.com.

We have studied the relationship between metal ion levels and lymphocyte counts in patients with metal-on-metal hip resurfacings. Peripheral blood samples were analysed for lymphocyte subtypes and whole blood cobalt and chromium ion levels in 68 patients (34 with metal-on-metal hip resurfacings and 34 with standard metal-on-polyethylene total hip replacements). All hip components were radiologically well-fixed and the patients were asymptomatic. Cobalt and chromium levels were significantly elevated in the patients with metal-on-metal hip resurfacings, compared with the patients with standard metal-on-polyethylene designs (p < 0.0001). There was a statistically significant decrease in the level of CD8+ cells (T-cytotoxic/suppressor) (p = 0.005) in the metal-on-metal hip resurfacing group. A threshold level of blood cobalt and chromium ions was associated with reduced CD8+ T-cell counts. We have no evidence that our patients suffered as a result of this reduced level of CD8+ T-cells.




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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General