Chromium and Cobalt


Test in Focus

Chromium and cobalt are elements often used in alloy to make some types of metal hip implants. In this "Test in Focus" episode of the "Answers From the Lab" podcast, Paul Jannetto, Ph.D., describes Mayo Clinic Laboratories' new testing for these elements, which can indicate that a hip implant is malfunctioning.

"Tiny particles can wear off these metal-on-metal devices and ultimately get into the bloodstream," Dr. Jannetto says. "Over time, the metal particles can cause damage to the bone and tissue surrounding these implants — leading to a condition sometimes called adverse reaction to metal debris."

The FDA recommends that orthopedic surgeons measure chromium and cobalt in metal-on-metal hip implant in patients with symptoms of this adverse reaction. Specifically, the FDA recommends EDTA anticoagulated whole blood testing, which Mayo Clinic Laboratories offers. 

However, a Mayo Clinic study has found that synovial fluid offers better sensitivity and specificity compared with whole blood or serum. The Metals Laboratory evaluated chromium and cobalt concentrates in EDTA whole blood, serum and synovial fluid collected from patients undergoing hip revision surgery at Mayo Clinic.

"In patients with adverse local tissue reaction, the synovial fluid cobalt and chromium concentrations were 120 and 414 times higher than whole blood chromium and cobalt concentrations, respectively," Dr. Jannetto says. "Based on our study, synovial fluid offers superior sensitivity and specificity to identify adverse reaction to metal debris in patients with metal-on-metal hip implants."

"If synovial fluid isn't available, EDTA whole blood is the next best specimen type for analysis of chromium and cobalt," Dr. Jannetto says.

Listen to learn more about how synovial fluid testing can provide more-sensitive detection of chromium and cobalt in individuals suspected of having malfunctioning hip implants.

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Testing

Useful information

COSY | Cobalt, Synovial Fluid

  • Monitoring metallic prosthetic implant wear and local tissue destruction in failed hip arthroplasty constructs.
  • This test is not useful for assessment of nutritional status or potential cobalt toxicity.

CRCOF | Chromium and Cobalt, Synovial Fluid

  • Monitoring metallic prosthetic implant wear and local tissue destruction in failed hip arthroplasty constructs.
  • This test is not useful for assessment of vitamin B12 activity.

CRSY | Chromium, Synovial Fluid

  • Monitoring metallic prosthetic implant wear and local tissue destruction in failed hip arthroplasty constructs.
  • This test is not useful for assessment of potential chromium toxicity.

Specimen requirements

COSY | Cobalt, Synovial Fluid

Patient Preparation: High concentrations of gadolinium and iodine are known to interfere with most metal tests. If either gadolinium- or iodine-containing contrast media has been administered, a specimen should not be collected for at least 96 hours.

Container/Tube: Royal blue top (metal-free EDTA)

Specimen Volume: 1 mL

Collection Instructions: See Trace Metals Analysis Specimen Collection and Transport in Special Instructions for complete instructions.

Additional Information: Cobalt is present in the black rubber plunger seals found in most disposable syringes. As a result, synovial fluid should not be collected in these devices as contamination may occur.

CRCOF | Chromium and Cobalt, Synovial Fluid

Patient Preparation: High concentrations of gadolinium and iodine are known to interfere with most metal tests. If either gadolinium- or iodine-containing contrast media has been administered, a specimen should not be collected for at least 96 hours.

Container/Tube: Royal blue top (metal-free EDTA)

Specimen Volume: 1 mL

Collection Instructions: See Trace Metals Analysis Specimen Collection and Transport in Special Instructions for complete instructions.

Additional Information: Cobalt and chromium are present in the black rubber plunger seals found in most disposable syringes. As a result, synovial fluid should not be collected in these devices as contamination may occur.

CRSY | Chromium, Synovial Fluid

Patient Preparation: High concentrations of gadolinium and iodine are known to interfere with most metal tests. If either gadolinium- or iodine-containing contrast media has been administered, a specimen should not be collected for at least 96 hours.

Container/Tube: Royal blue top (metal-free EDTA)

Specimen Volume: 1 mL

Collection Instructions: See Trace Metals Analysis Specimen Collection and Transport in Special Instructions for complete instructions.

Additional Information: Chromium is present in the black rubber plunger seals found in most disposable syringes. As a result, synovial fluid should not be collected in these devices as contamination may occur.

Performance information

Analytic time: 2 to 8 days

Days performed: Wednesday

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Barbara J. Toman (@barbaratoman)

Barbara J. Toman

Barbara J. Toman is a Senior Communications Specialist at Mayo Clinic Laboratories. She is also the science writer for Mayo’s Neurosciences Update newsletter, which helps referring physicians to stay informed about Mayo’s treatment and research. Barbara has worked at Mayo Clinic since 2007. She enjoys international travel and cooking.