Serum metal ion levels after rotating-hinge knee arthroplasty: comparison between a standard device and a megaprosthesis



The effects of systemic metal ion exposure in patients with implants made of common prosthetic alloys continue to be a matter of concern. The aim of the study was to determine the measurement values of cobalt (Co), chromium (Cr) and molybdenum (Mo) in serum following rotating-hinge knee arthroplasty.


Blood was taken from 25 patients [mean follow-up 35 (range nine to 67) months] treated with megaprostheses (n=17) or standard rotating-hinge devices (n=8) and analysed using electrothermal graphite furnace atomic absorption spectrometry (ET-ASS).


Determining the concentrations of metal ions following rotating-hinge knee arthroplasty revealed increments for Co and Cr but not Mo. Metal ion release was significantly higher in patients with megaprostheses compared to a standard rotating-hinge knee device (Co p=0,024; Cr p=0.025).


The authors believe there might be an additional metal ion release from the surface of the prosthesis and not only from the articulating surfaces because, in cases of rotating-hinge knee prosthesis, there is a metal-on-polyethylene articulation and not a direct metal-on-metal junction. Nevertheless, long-term studies are required to determine adverse effects of Co, Cr and Mo following total hip replacement and total knee arthroplasty.

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Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Correspondence to Werner Maurer-Ertl.

Additional information

The study was approved by the Ethics Committee, and informed consent was obtained from all patients.

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Friesenbichler, J., Maurer-Ertl, W., Sadoghi, P. et al. Serum metal ion levels after rotating-hinge knee arthroplasty: comparison between a standard device and a megaprosthesis. International Orthopaedics (SICOT) 36, 539–544 (2012).

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  • Total Knee Arthroplasty
  • Graphite Furnace Atomic Absorption Spectrometry
  • Total Disc Arthroplasty
  • Total Femoral Replacement
  • Determine Serum Concentration