Systemic Effects of Metals Released from Arthroplasty Implants – a Brief Summary

Anastasia Rakow; Janosch Schoon

doi:10.1055/a-1187-1751

Zeitschrift für Orthopädie und Unfallchirurgie, Table of Contents

Z Orthop Unfall 2020; 158(05): 501-507
DOI: 10.1055/a-1187-1751

Review/Übersicht

Systemische Effekte einer Metallbelastung durch Endoprothesen – ein Überblick

Article in several languages: English | deutsch

Anastasia Rakow

¹Center for Musculoskeletal Surgery, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany

²Berlin Institute of Health Center for Regenerative Therapies, Berlin, Germany

,

Janosch Schoon

³Klinik und Poliklinik für Orthopädie und Orthopädische Chirurgie, Universitätsmedizin Greifswald, Germany

⁴Julius Wolff Institute, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany

› Author Affiliations

Abstract

Zusammenfassung

Systemische Effekte von aus Endoprothesen freigesetzten Metallen rücken zunehmend in den Fokus des Interesses von Patienten, Ärzten, Wissenschaftlern und Legislative. Besondere Herausforderungen stellen das Fehlen valider Schwellenwerte für (Organ-)Toxizität und die zunehmend langen Standzeiten moderner Hüft- und Knietotalendoprothesen dar. Tatsächlich ist die Evidenz für systemische Komplikationen einer Metallbelastung durch solche Implantate jedoch sehr schwach. Eine systemische Exposition gegenüber Cobalt wurde wiederholt vor allem mit kardio- und neurotoxischen Effekten, aber auch mit thyreoidalen Funktionsstörungen in Verbindung gebracht. Das toxische Potenzial von freigesetztem Chrom gilt als weitaus weniger ausgeprägt, ist allerdings im Kontext der Endoprothetik schwer zu evaluieren, da hier quasi regelhaft eine simultane Exposition gegenüber Chrom und Cobalt erfolgt. Die Toxizität nanopartikulären Titandioxids ist Gegenstand internationaler regulatorischer Debatten, sein vielfältiges Vorkommen in unserem Alltag, etwa als Weißmacher in Zahnpasta, Kosmetika oder Lebensmitteln, erschwert die Einschätzung einer möglichen zusätzlichen Belastung durch Endoprothesen. Bislang gibt es keine eineindeutige Evidenz für systemische Komplikationen durch die Freisetzung von Titandioxid aus Endoprothesen. Die Freisetzung von weiteren Metallen wie Tantal, Niob, Nickel, Vanadium und Zirkonium aus Endoprothesen wurde in einzelnen Fällen beschrieben, systemische Effekte entsprechender Langzeitexpositionen sind noch nicht bekannt. Generell ist die Charakterisierung freigesetzter Metalle hinsichtlich ihrer chemischen und physikalischen Spezifikationen für die Bewertung eines möglichen systemischen Risikos entscheidend. Systematische Studien, die die Akkumulation von in der Endoprothetik relevanten Metallen in verschiedenen Organen bzw. Organsystemen und deren biologische Konsequenzen untersuchen, sind dringend erforderlich.

Schlüsselwörter

Metallionen - Korrosion - Endoprothesen - Metalltoxizität - systemische Effekte

Full Text

References

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