During the past fifty years metal hip implants have been used in orthopaedics. While these implants are considered biologically inert, several studies indicated that prosthetic implants could release metal ions following wear. The aim of this study was to evaluate serum and urine concentrations of metal ions in patients treated with hybrid surface replacement of the hip.

Co, Cr, Mn, Mo, and Ni in the serum and urine of 14 patients and 19 controls were quantified by Sector Field Inductively Coupled Plasma Mass Spectrometry (SF-ICP-MS). A Spectrometer ELEMENT (Finnigan MAT, Bremen, Germany) was used at the following resolution: 98Mo, 100Mo, (m/D;m = 300); 52Cr, 53Cr, 55Mn, 59Co, 60Ni, (m/D;m = 3000). The internal standard method (In) was applied to correct the random fluctuations of the signal. Indium was added to the sample solutions so as to reach a final concentration of 1 ng mL-1. Limits of Detection were calculated on the basis of the 3=555; criterion for 10 replicate measurements of solutions containing dilute pooled blood serum and dilute pooled urine, and recovery was obtained by quantifying the analytes of interest in spiked serum and urine. Recoveries of the elements ranged between 94.6% (serum Cr) and 118% (urine Ni).

Data support the assumption that the concentrations of Co and Cr (the major components of the alloy) are substantially higher in serum and urine of patients than in those of controls while for the other elements no specific trend could be observed.

Actually there isn’t any explanation on the possible biological consequences related to the increase of the metal ions levels although many hypothesis have been made. Further studies are thus mandatory to clarify this pattern.

Elastofibroma dorsi is a rare benign unencapsulated tumour characterized by a elastic fibres proliferation in a collagen stroma with adipose tissue. Lesion is often asymptomatic, monolateral and localized at the tip of the scapular. It is slow-growing. It mainly occurs in adult females. At now some controversies concerning diagnosis and modality of treatment are reported in the literature. Authors report clinicopathological features of elastofibroma dorsi analysing 8 cases from 2001 to 2005, and revise the literature. Seven females and 1 adult male were observed, often dedicated to manual labour. Six symptomatic patients underwent marginal excision of tumour, and the remaining asymptomatic 2 patients were only followed. No local recurrences were observed in operated patients.

On the basis of these data Authors evidenced limits of different instrumental methodologies of diagnosis (ultasonography, computer tomography and magnetic resonance imaging) and suggested a algorithm for diagnosis and treatment remarking that marginal excision constitutes effective treatment of symptomatic patients.