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Nearly all orthopaedic surgeons have implanted a cobalt-chromium hip and most general practitioners have at least one patient with cobalt-chromium implant on their books. The recent worldwide controversy surrounding metal-on-metal hips means that advice on how to manage patients with these implants is of great interest to these professionals. Specifically, they want to know if there are any diagnostic tests that could be performed to gain clues about implant performance and risk of local or systemic toxicity.
Biomarkers of Hip Implant Function: Diagnostic Modalities to Prevent Chronic Periprosthetic Joint Infection and Implant Failure aims to bring together all established and potential new biomarkers, and critically evaluate their clinical usefulness based on the most recent evidence available. Researchers will benefit from an updated, comprehensive view of the topic to identify underexplored areas. Orthopaedic surgeons and general practitioners will use the book to monitor implant performance and facilitate management of their patients. Additionally, the work will benefit engineers and joint implant manufacturers to guide improvements in implant design. The book will also be of interest to regulators and policymakers to update their guidelines on follow-up of hip implant recipients.
- Covers all candidate biomarkers of hip implant wear and toxicity in a single source
- Summarizes recent research into blood titanium levels associated with well-functioning and malfunctioning hip implants to aid implant revision decisions
- Each chapter contains essential clinical cases and tables
Researchers with crossover for clinicians. Orthopaedic surgeons and general practitioners. Engineers and joint implant manufacturers; regulators and policy influencers, such as the FDA and the UK's Medicines and Healthcare products Regulatory Agency
Part I: Foundational information
1. Hip arthroplasty
1.1. The hip joint
1.2. Hip replacement surgery
1.3. Hip implant materials
2. Degradation of metal hip implants
2.4. Factors affecting implant degradation
3. Toxicity of metallic implant debris
3.1. Cobalt toxicity
3.2. Chromium toxicity
3.3. Titanium toxicity
3.4. Aluminum, vanadium and nickel toxicity
3.5. Chemical speciation of metal implant debris
Part II: Biomarkers of implant function and adverse reactions to metal debris
4. Metal levels as biomarkers of hip implant wear
4.1. Blood cobalt and chromium levels
4.2. Blood titanium levels
4.3. Urine testing
4.4. Analytical considerations
5. Biomarkers of adverse reactions to metal debris
5.1. Biomarkers of peri-implant osteolysis and aseptic loosening
5.2. Identification of novel biomarkers of periprosthetic bone loss
5.3. HIF-1 pathway activation
5.4. Markers of oxidative stress and DNA damage
6. Diagnosing chronic periprosthetic joint infection
6.1. Serum tests
6.2. Synovial fluid tests
6.3. Tissue tests
7. Imaging in the diagnosis of adverse tissue reactions
7.1. Plain radiographs
7.2. MARS magnetic resonance imaging
7.3. Computed tomography
8. Blood cobalt level as a predictor of systemic toxicity risk
8.1. Case reports
8.2. Treatment of systemic cobalt toxicity
8.3. Individual susceptibility to cobalt
Part III: Translational effect of biomarker research on clinical practice
9. Official guidelines and expert recommendations
9.1. Monitoring of patients with metal-on-metal hips
9.2. Investigation for systemic toxicity
9.3. Monitoring of patients with titanium-based hips
9.4. Investigation for chronic periprosthetic infection
10. Future directions in patient management
- No. of pages:
- © Academic Press 2021
- 1st May 2021
- Academic Press
- Paperback ISBN:
Ilona Swiatkowska is a final year doctoral candidate with 4 years of research experience. Her work has centered around the local and systemic adverse effects of cobalt, chromium and titanium in the setting of hip arthroplasty. The PhD project is supervised by Professor Alister Hart of the Royal National Orthopaedic Hospital, UK, whose research into blood cobalt and chromium levels in hip replacement patients has directly influenced the current MHRA guidelines concerning follow-up of patients with metal-on-metal hips. Ilona has published a comprehensive review on titanium as a biomarker of implant wear and defined an updated laboratory reference range for blood titanium associated with well-functioning titanium-based hip implants (manuscript currently under review at the Journal of Trace Metals in Medicine and Biology).
University of College London, UK
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