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. 2020 May 8:21:e00167.
doi: 10.1016/j.plabm.2020.e00167. eCollection 2020 Aug.

Whole blood titanium metal ion measurement reproducibility of two laboratories

Janie Barry  1 , David Eichler  1 , Robert Robitaille  1 , Pascal-André Vendittoli  1
Affiliations

Whole blood titanium metal ion measurement reproducibility of two laboratories

Janie Barry et al. Pract Lab Med. .

Erratum in

Abstract

Background: Metal ion blood concentrations evaluation can be useful in monitoring wear and corrosion of orthopedic implants. Elevated metal ion level may help detecting defective hip arthroplasty implants and serve as an indicator for revision surgery. Our objective was to evaluate the reproducibility of titanium metal ion level measurements by two different laboratories.

Methods: Seventy-one whole blood samples were collected from 64 patients with unilateral ceramic-on-ceramic hip arthroplasty. For each patient, two whole blood samples were collected and analyzed in two different laboratories.

Results: For each case, laboratory 1 had significantly higher values than laboratory 2. There was a clinically significant absolute difference between the two laboratories, above the predetermined threshold, for 90% of samples. A mean variation ratio of 410% between the two laboratories was found.

Conclusion: Not all laboratories use the same techniques and calibrations to perform these measurements. Therefore, their results should be interpreted with caution and clinical decision should rely on metal ion trends provided by the same laboratory.

Keywords: Arthroplasty; Ceramic; Hip; ICPMS; Ion screening; Metal; Titanium.

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Figures

Fig. 1
Fig. 1
Box plot of the concentration of titanium metal ions in the two laboratories and the difference between laboratories (laboratory 1 minus 2). Horizontal bars define the quartiles, with the second and third quartiles contained in the boxes. Circles represent outliers, defined as values that are 1,5 to 3 times higher than the values of the third quartile. Data identified with stars are extreme outliers, defined as values that are at least three times higher than the values of the third quartile.
Fig. 2
Fig. 2
Diagram showing the percentage of cases for different concentration ratios between laboratories (laboratory 1 divided by laboratory 2).
Fig. 3
Fig. 3
Bland-Altman plot between titanium concentrations obtained in two different laboratories based on mean concentration in laboratory 2. The solid line indicates the mean difference (or bias); the dotted lines indicate the 95% CI of the mean difference between laboratories.
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