大型模块化人工关节已成为肿瘤切除后重建下肢的主要方式。这些植入物通常采用可发生磨损和腐蚀的钴铬合金制成，释放钴和铬离子进入周围组织和血液。然而，对这些患者的血液金属水平的研究很少。对于装有大型模块化人工关节的患者，其全血中的钴和铬离子水平是多少？我们对我们的全关节登记处进行了横断面研究，以确认在我们机构接受过人工关节重建治疗的患者。纳入了在我们审查时仍然存活以及在肿瘤切除后接受人工关节重建的患者。从有下肢肿瘤人工关节置换史的27名患者（男性14名，女性13名）采集了全血样本。手术至采血时间的中位数为8年（范围为6个月至32年）。全血样本采集并存储在无金属污染的螯合剂乙二胺四乙酸管中。样本在一个国际标准化七级洁净室中用聚四氟乙烯涂层仪器进行电感耦合等离子体质谱分析，以减少金属污染的风险。铬和钴的分析测量范围为1至200 ng/mL。当血液水平≥1ppb时，认为钴和铬水平升高。27名患者中，59%（16名）患者的钴水平升高，26%（7名）患者的铬水平升高。在金属离子值升高的患者中，17名患者中有15名使用了Stryker/Howmedica Global模块化置换系统植入物进行重建。装有模块化肿瘤人工关节重建的患者血液金属水平升高。未来的工作需要确定适当的随访程序，并确定在发生系统性并发症时是否以及何时发生升高的金属水平以及如何潜在地处理这些升高的水平。跨多个中心和专业学会的前瞻性和回顾性合作将是解决这个潜在易损患者群体中的这些未知问题所必需的。4级疗效研究。版权所有©2023年由骨科医生协会。

Massive modular endoprostheses have become a primary means of reconstruction after oncologic resection of a lower extremity tumor. These implants are commonly made with cobalt-chromium alloys that can undergo wear and corrosion, releasing cobalt and chromium ions into the surrounding tissue and blood. However, there are few studies about the blood metal levels in these patients.What is the whole blood cobalt and chromium ion level in patients with massive modular endoprostheses?We performed a cross-sectional study of our total joints registry to identify patients with a history of an endoprosthetic reconstruction performed at our institution. Patients who were alive at the time of our review in addition to those undergoing an endoprosthetic reconstruction after an oncologic resection were included. Whole blood samples were obtained from 27 (14 male and 13 female) patients with a history of a lower extremity oncologic endoprosthesis. The median time from surgery to blood collection was 8 years (range 6 months to 32 years). Blood samples were collected and stored in metal-free ethylenediaminetetraacetic acid tubes. Samples were analyzed on an inductively coupled plasma mass spectrometer in an International Organization for Standardization seven-class clean room using polytetrafluoroethylene-coated instruments to reduce the risk of metal contamination. The analytical measuring range was 1 to 200 ng/mL for chromium and cobalt. Cobalt and chromium levels were considered elevated when the blood level was ≥ 1 ppb.Cobalt levels were elevated in 59% (16 of 27) of patients, and chromium levels were elevated in 26% (seven of 27). In patients with elevated metal ion values, 15 of 17 patients had a reconstruction using a Stryker/Howmedica Global Modular Replacement System implant.Blood metal levels were elevated in patients who received reconstructions using modular oncology endoprostheses Future work is needed to establish appropriate follow-up routines and determine whether and when systemic complications occur because of elevated metal levels and how to potentially address these elevated levels when complications occur. Prospective and retrospective collaboration between multiple centers and specialty societies will be necessary to address these unknown questions in this potentially vulnerable patient group.Level IV, therapeutic study.Copyright © 2023 by the Association of Bone and Joint Surgeons.