PMID- 31895169
OWN - NLM
STAT- MEDLINE
DCOM- 20200910
LR  - 20210201
IS  - 1535-1386 (Electronic)
IS  - 0021-9355 (Linking)
VI  - 102
IP  - 5
DP  - 2020 Mar 4
TI  - Safety of Use of Tantalum in Total Hip Arthroplasty.
PG  - 368-374
LID - 10.2106/JBJS.19.00366 [doi]
AB  - BACKGROUND: Tantalum implants have been used in >500,000 orthopaedic patients. 
      Although the risks of metallosis and aseptic lymphocyte-dominated 
      vasculitis-associated lesions (ALVAL) after total hip arthroplasty (THA) are 
      being debated, we are not aware of any studies investigating the liberation of 
      tantalum ions and their potential effects on the immune system. We evaluated 
      whether tantalum concentrations are elevated after THA with acetabular tantalum 
      implants and assessed potential alterations in T-cell subpopulations. METHODS: 
      After a mean follow-up of 4 years (range, 0.5 to 8.9 years) of 144 patients who 
      had undergone THA, blood samples were analyzed regarding blood tantalum 
      concentrations, total white blood-cell counts, and lymphocyte subsets in 3 groups 
      of patients: those treated with non-tantalum primary THA ("primary non-tantalum," 
      n = 30), those treated with primary THA with a tantalum cup ("primary tantalum," 
      n = 30), and those who underwent revision surgery with a tantalum shell 
      ("revision tantalum," n = 84). Blood donors served as controls for immunological 
      parameters (n = 59). Correlations between tantalum concentrations and human 
      leukocyte antigen (HLA)-DR T cells were calculated, radiographic signs of implant 
      loosening were assessed, and the Harris hip score (HHS) was used to evaluate hip 
      function. RESULTS: The median tantalum concentration was similar to the detection 
      limit both in the primary non-tantalum group (0.05 microg/L, 95% confidence interval 
      [CI] = 0.05 to 0.05 microg/L) and in the primary tantalum group (0.051 microg/L, 95% CI = 
      0.050 to 0.055 microg/L), and it was 0.091 microg/L (95% CI = 0.083 to 0.112 microg/L) in the 
      revision tantalum group (p < 0.0001 in the group-wise comparison with both 
      primary non-tantalum and primary tantalum). We found a weak negative correlation 
      of higher tantalum concentration with the concentration of HLA-DR/CD8 T cells (r 
      = -0.22, 95% CI = -0.35 to -0.05, p = 0.01) but no correlation of tantalum 
      concentration with the concentration of HLA-DR/CD4 T cells (r = -0.11, 95% CI = 
      -0.27 to 0.06, p = 0.24). The values for all lymphocyte subgroups were within 
      normal ranges. No implants were deemed loose. The median HHS was good to 
      excellent. CONCLUSIONS: Exposure to stable tantalum cups is associated with low 
      blood concentrations of tantalum. Signs of T-cell activation typical of ALVAL 
      seem to be lacking. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions 
      for Authors for a complete description of levels of evidence.
FAU - Bruggemann, Anders
AU  - Bruggemann A
AUID- ORCID: 0000-0002-3600-253
AD  - Section of Orthopedics, Department of Surgical Sciences (A.B., H.M., and N.P.H.), 
      and Department of Immunology, Pathology, and Genetics (M.B.), Uppsala University, 
      Uppsala, Sweden.
FAU - Mallmin, Hans
AU  - Mallmin H
AUID- ORCID: 0000-0002-0074-7484
FAU - Bengtsson, Mats
AU  - Bengtsson M
AUID- ORCID: 0000-0003-2612-0724
FAU - Hailer, Nils P
AU  - Hailer NP
AUID- ORCID: 0000-0002-3233-2638
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Bone Joint Surg Am
JT  - The Journal of bone and joint surgery. American volume
JID - 0014030
RN  - 6424HBN274 (Tantalum)
SB  - IM
MH  - Acetabulum
MH  - Aged
MH  - Arthroplasty, Replacement, Hip/adverse effects/*instrumentation
MH  - Female
MH  - Follow-Up Studies
MH  - *Hip Prosthesis
MH  - Humans
MH  - Lymphocyte Count
MH  - Male
MH  - Middle Aged
MH  - Postoperative Complications/*blood/epidemiology
MH  - *Prosthesis Design
MH  - Reoperation
MH  - Retrospective Studies
MH  - Tantalum/*blood
EDAT- 2020/01/03 06:00
MHDA- 2020/09/12 06:00
CRDT- 2020/01/03 06:00
PHST- 2020/01/03 06:00 [pubmed]
PHST- 2020/09/12 06:00 [medline]
PHST- 2020/01/03 06:00 [entrez]
AID - 00004623-202003040-00003 [pii]
AID - 10.2106/JBJS.19.00366 [doi]
PST - ppublish
SO  - J Bone Joint Surg Am. 2020 Mar 4;102(5):368-374. doi: 10.2106/JBJS.19.00366.