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Ion Production and Excretion in a Patient with a Metal-on-Metal Bearing Hip ProsthesisA Case Report
Rudi G. Bitsch, MD1; Michelle Zamorano2; Travis Loidolt, BA2; Christian Heisel, MD1; Joshua J. Jacobs, MD3; Thomas P. Schmalzried, MD2
1 Stiftung Orthopädische Universitätsklinik, Schlierbacher Landstrasse 200A, 69118 Heidelberg, Germany
2 Joint Replacement Institute at Orthopaedic Hospital, 2400 South Flower Street, Los Angeles, CA 90007. E-mail address for T.P. Schmalzried: schmalzried@earthlink.net
3 Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612
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Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants of less than $10,000 from the Stiftung Orthopädische Universitätsklinik, Heidelberg, Germany, and the Piedmont Fund of the Los Angeles Orthopaedic Hospital Foundation and in excess of $10,000 from the National Institutes of Health (Grant 39310 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases) and Wright Medical. In addition, one or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from commercial entities (DePuy, Zimmer, Wright Medical, Medtronic, Archus Orthopedics, and Spinal Motion). Also, commercial entities (Zimmer, Wright Medical, Medtronic, Archus Orthopedics, and Spinal Motion) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.
Investigation performed at the Joint Replacement Institute, Orthopaedic Hospital, Los Angeles, California

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2007 Dec 01;89(12):2758-2763. doi: 10.2106/JBJS.F.00551
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Metal-on-metal bearings have been associated with the generation of metal particles and ions1,2 and, in comparison with that seen in other bearing surfaces, a measurable increase in the concentration of cobalt and chromium ions in blood and urine3-7. The risks of higher ion levels include delayed-type hypersensitivity, organ toxicity, and carcinogenesis8-10. Studies of cobalt and chromium ion levels have demonstrated variability from patient to patient4,7. Levels tend to be highest in the short-term and, with a well-functioning prosthesis, decrease with time4.
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