Table 1

Approximate average concentrations of metal in human body fluids with and without total joint replacements. Note: where ranges were reported they are included here within parentheses, eg (1– 4). All concentrations are reported in ppb (ng/mL)

Concentrations of metal in body fluids (ng/mL or ppb)

	Co	Cr	Mo	Ni	Ti	Al		References
Serum
Normal	<0.2–0.6¹⁰⁹ (0.2–8.3)¹⁰⁹	0.2¹¹⁰ (0.1–0.7)¹¹⁰	0.42¹¹⁰ (0.3–1.8)¹¹⁰	^{^*}	1.2–2.7¹⁰⁹^;¹¹¹ (1.1–7.9)	1.2–2.2¹¹¹ (1.1–6.4)	<0.8¹¹¹ <0.8	^{109, 111}
TKA-M/P	0.2 (<0.02–1.15)¹¹²	0.1 (<0.02–0.6)¹¹²	^{^*}	0.4 (0.05–1.5)¹¹²	3.2 (<2.1–6.3)¹¹¹	6.5 (2.1–9.4)¹¹¹	<0.8 <0.8¹¹¹	^{111, 112}
TKA-F	^{^*}	^{^*}	^{^*}	^{^*}	135.6 (24.1–716.9)¹¹¹	3.7 (0.8–6.2)¹¹¹	0.9 (<0.8–2.6)¹¹¹	¹¹¹
THA-M/P	0.9 (<0.3–3.9)¹¹³	1.28 (0.1–2.4)¹¹³	^{^*}	^{^*}	1.4–4.1⁶, 2.6¹¹³(<1.1–11.17)¹⁰⁹ ^;¹¹³	1.2–1.7¹⁰⁹ (0.2–2.46)¹⁰⁹	^{^*}	^{40;109;113;114}
THA-M-M	2.4 (0.6–7.9)¹¹³	3.5 (0.8–9.1)¹¹³	^{^*}	^{^*}	1.9¹¹³ (1.1–6.0)¹¹³	^{^*}	^{^*}	¹¹³
TDA	1.9–4.8⁵⁴^;⁵⁵	1.9–2.4⁵⁴^;⁵⁵	^{^*}	^{^*}	^{^*}	^{^*}	^{^*}	⁵⁴^;⁵⁵
Synovial fluid
Normal	^{^*}	^{^*}	^{^*}	^{^*}	<0.1 (<0.1–7.6)¹¹⁵	7.3 (1.9–19)¹¹⁵	^{^*}	^115;116
THA	5¹¹⁶, 0.2 (<0.02–1.15)¹¹²	3¹¹⁶, 0.1 (<0.02–0.6)¹¹²	21 ± 8¹¹⁶	4¹¹⁶, 0.4 (0.05–1.5)¹¹²	13–556¹¹⁶	109–654¹¹⁶	5–62¹¹⁶	^112;116
THA-F	588 ± 427¹¹⁶	385 ± 232¹¹⁶	58 ± 53¹¹⁶	32 ± 16¹¹⁶	86 ± 35¹¹⁶	256 ± 271¹¹⁶	25 ± 19¹¹⁶	¹¹⁶
Whole blood
Normal	0.1–1.2¹¹⁶	2–6¹¹⁶	0.5–1.8¹¹⁶	2.9–7.0¹¹⁶	17 ± 60¹¹⁶	12 ± 4¹¹⁶	5.8 ± 4¹¹⁶	¹¹⁶
THA					67 ± 62¹¹⁶	218 ± 233¹¹⁶	23 ± 31¹¹⁶	¹¹⁶
THA-F	20 ± 25¹¹⁶	110 ± 150¹¹⁶	12 ± 9¹¹⁶	29 ± 29¹¹⁶	602 ± 927¹¹⁶	237 ± 307¹¹⁶	55 ± 63¹¹⁶	¹¹⁶

Human tissue (µg/g) (roughly equivalent to: 10⁻¹ to 10⁻² mM)

Liver
Normal	100	890	14	120	<14	^{^*}	^{^*}	^117;118
TJA	560	680	22	15200	1130	^{^*}	^{^*}	^117;118
Psuedocapsule
Normal	<65	120	<9	50	150	^{^*}	^{^*}	^{116;117;119;120}
TJA	39400	460	121	5490	3820	^{^*}	^{^*}	^{116;117;119;120}
Lymphatic
Normal	^{^*}	^{^*}	^{^*}	10	690	^{^*}	^{^*}	¹¹⁷
Tissue
TJA	^{^*}	^{^*}	^{^*}	390	690	^{^*}	^{^*}	¹¹⁷

Abbreviations: Normal, subjects without any metallic prosthesis (not including dental); M/P, metal on polyarticulation; M/M, metal-on-metal articulation; F, subjects with a poorly functioning arthroplasty (loose or migratory osteolysis prior to surgical revision); THA, total hip arthroplasty; TKA, total knee arthroplasty; TJA, subjects with well functioning total joint arthroplasty (either knee or hip); TDA Spine, total disc arthroplasty (metal on metal).
↵* Data not available.