{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T16:53:28Z","timestamp":1787936008124,"version":"build-2784847793"},"reference-count":46,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2020,2,5]],"date-time":"2020-02-05T00:00:00Z","timestamp":1580860800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2020,4]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To investigate the course of<jats:italic>in vivo<\/jats:italic>blood metal ion levels in patients undergoing primary total knee arthroplasty (TKA) and to investigate potential risk factors associated with metal ion release in these patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Twenty\u2010five patients with indication for TKA were included in this prospective study. Whole blood metal ion analysis was performed pre\u2010operatively and at 1\u2009week, 6\u2009weeks, 3\u2009months, 6\u2009months, and 12\u2009months postoperatively. Clinical scores were obtained using the American Knee Society Score (AKSS) and the Oxford Knee Score (OKS) at each follow\u2010up and patients\u02bc activity levels were assessed by measuring the mean annual walking cycles at 12\u2009months follow\u2010up. Anteroposterior and lateral radiographs of the operated knee were evaluated postoperatively and at 12\u2010month follow\u2010up with regard to implant position and radiological signs of implant loosening. Correlation analysis using multivariate linear regression was performed to investigate the influence of different variables (age, gender, functional scores, number of walking cycles, and body mass index [BMI]) on blood cobalt ion concentrations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Mean metal ion levels of cobalt, chromium, molybdenum, and titanium were 0.28 \u03bcg\/L (SD, 0.14), 0.43 \u03bcg\/L (SD, 0.49), 0.62 \u03bcg\/L (SD, 0.45), and 1.96 \u03bcg\/L (SD, 0.98), respectively at 12\u2010month follow\u2010up. Mean cobalt ion levels significantly increased 1\u2010year after surgery compared to preoperative measurements. There was no statistically significant increase of mean metal ion levels of chromium, titanium, and molybdenum at 1\u2010year follow\u2010up. Overall, metal ion levels were low and no patient demonstrated cobalt ion levels above 1 \u03bcg\/L. Postoperative radiographs demonstrated well\u2010aligned TKAs in all patients and no signs of osteolysis or implant loosening were detected at 1\u2010year follow\u2010up. Both the AKSS and OKS significantly improved during the course of the study up to the final follow\u2010up. Multivariate regression analysis did not show a statistically significant correlation between the tested variables and blood cobalt ion concentrations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>A statistically significant increase of mean cobalt ion concentration at 1\u2010year follow\u2010up was found in this cohort of patients with well\u2010functioning TKA, although overall blood metal ion levels were relatively low. Despite low systemic metal ion concentrations seen in this cohort, the local effects of increased metal ion concentrations in the periprosthetic environment on the long\u2010term outcome of TKA should be further investigated.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.12591","type":"journal-article","created":{"date-parts":[[2020,2,5]],"date-time":"2020-02-05T18:38:58Z","timestamp":1580927938000},"page":"396-403","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["Blood Metal Ion Release After Primary Total Knee Arthroplasty: A Prospective Study"],"prefix":"10.1111","volume":"12","author":[{"given":"Tobias","family":"Reiner","sequence":"first","affiliation":[{"name":"Center for Orthopedics, Trauma Surgery and Spinal Cord Injury Heidelberg University Hospital Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reza","family":"Sorbi","sequence":"additional","affiliation":[{"name":"Center for Orthopedics, Trauma Surgery and Spinal Cord Injury Heidelberg University Hospital Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maike","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"Center for Orthopedics, Trauma Surgery and Spinal Cord Injury Heidelberg University Hospital Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timo","family":"Nees","sequence":"additional","affiliation":[{"name":"Center for Orthopedics, Trauma Surgery and Spinal Cord Injury Heidelberg University Hospital Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan Philippe","family":"Kretzer","sequence":"additional","affiliation":[{"name":"Laboratory of Biomechanics and Implant Research, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury Heidelberg University Hospital Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Rickert","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Orthopaedic Surgery University Hospital Giessen and Marburg (UKGM) Giessen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1714-2171","authenticated-orcid":false,"given":"Babak","family":"Moradi","sequence":"additional","affiliation":[{"name":"Center for Orthopedics, Trauma Surgery and Spinal Cord Injury Heidelberg University Hospital Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,2,5]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-012-2401-9"},{"key":"e_1_2_5_3_1","unstructured":"National Joint Registry 16th Annual Report 2019 \u2010 National Joint Registry for England Wales Northern Ireland and the Isle of Man. 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