University of Oulu

Lainiala, O., Karsikas, M., Reito, A. et al. Whole blood chromium concentration is very rarely elevated independently of whole blood cobalt. Sci Rep 11, 12352 (2021).

Whole blood chromium concentration is very rarely elevated independently of whole blood cobalt

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Author: Lainiala, Olli1,; Karsikas, Mari1,2; Reito, Aleksi1,3;
Organizations: 1Coxa Hospital for Joint Replacement and Faculty of Medicine and Health Technologies, Tampere University, Niveltie 4, 33520 Tampere, Finland
2Center for Life Course Health Research, University of Oulu, P.O.Box 8000, 90014 Oulu, Finland
3Department of Orthopaedics and Traumatology, Tampere University Hospital, Kuntokatu 2, 33520 Tampere, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.8 MB)
Persistent link:
Language: English
Published: Springer Nature, 2021
Publish Date: 2021-09-03


Due to the risk of adverse reactions to metal debris resulting from increased wear of the arthroplasty more than one million metal-on-metal (MoM) hip replacements worldwide are in active follow-up. Follow-up usually includes measurement of both whole blood cobalt (Co) and chromium (Cr) concentrations. Our experience is that Cr is seldom independently elevated. We wanted to ascertain whether blood Cr measurements could be omitted from follow-up protocols without lowering the quality of follow-up. We identified 8438 whole blood Co and Cr measurements performed without or prior to revision surgery. When the cut-off levels 5 µg/L and 7 µg/L were used, Cr was independently elevated in only 0.5% (95% confidence interval, CI, 0.3 to 0.6) and 0.2% (CI 0.1 to 0.3) of the measurements. The models with continuous variables showed that the higher the blood metal concentrations are the lower the percentage of measurements with Cr higher than Co. Our results suggest that whole blood Cr is very rarely independently elevated and therefore the authorities should consider omitting Cr measurements from their screening guidelines of MoM hip replacements. We believe this change in practice would simplify follow-up and lead to cost savings without decreasing the quality of follow-up.

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Series: Scientific reports
ISSN: 2045-2322
ISSN-E: 2045-2322
ISSN-L: 2045-2322
Volume: 11
Article number: 12352
DOI: 10.1038/s41598-021-91512-9
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: Our institution received funding from the research funds of our hospital district, representing public funding.
Copyright information: © The Author(s) 2021. Open Access. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit