METAL LEVELS IN “CELL SAVER” BLOOD RECOVERED DURING REVISION HIP ARTHROPLASTY.

Abstract

Aims: The aims of our study were:

1. to measure the total metal content in cell saver blood recovered during revision hip arthroplasty,

2. to evaluate the efficacy of centrifuging and washing the recovered blood in reducing the metal content,

3. to investigate whether transfusion of the salvaged blood resulted in a significant increase in the metal ion levels in the patients’ blood in the immediate post-operative period.

Materials and methods: We analysed the levels of metallic debris and metal ions in cell saver blood in nine patients undergoing revision hip replacement. Using inductively coupled plasma mass spectrometry (ICP-MS), the levels were measured for titanium, aluminium, vanadium, chromium, cobalt, nickel and molybdenum. The metal ion levels were analysed using a dilution technique and the total metal content levels (particulate debris and ions) were analysed with a digestion technique.

Results: Significantly higher levels of metal ions and metal debris were found in the pre-processed blood compared with the processed blood (after centrifuging and washing). The ion levels in the processed blood were not high enough to cause a significant increase in the patients’ immediate post-operative blood ion levels when compared with pre-operative levels.

Discussion: There are markedly elevated levels of metal ions and particulate metal debris in the blood salvaged during revision total hip arthroplasty. The processing of the recovered blood in a commercial “cell saver” significantly reduces the total metal load that is re-infused. Re-infusion of salvaged blood does not result in elevated metal ion levels in the immediate post-operative period.