< Return to all Tests

Test Category: Specialist Biochemistry

Investigation Name:Chromium – Joint fluid

Alias or Abbreviation:Cr, Fluid Cr

Accreditation:Currently not on scope

Intro:

In some individuals with metal-on-metal (MoM) replacement hip joints, and similar prostheses, it has become evident that release of metal debris from the devices may occur, leading to elevated blood metal ion concentrations and local soft tissue reactions. These can result in destruction of nearby muscle and bone and in a small number of cases, complete failure of the joint. ,br/> The MHRA recommends monitoring of blood cobalt and chromium in all patients with MoM hip joints, with the frequency of monitoring depending on the risk.
Cobalt and chromium may also be measured in the synovial fluid surrounding the prosthetic joint to assess the wear on the joint.,br/> This is not indicated for most patients with a MoM replacement hip joint but may occasionally be useful, in combination with imaging, in difficult cases to assess the amount of wear on the joint or, if a patient has bilateral hip prostheses and it is not clear which hip joint is the most affected.

Pathology Laboratory:Trace Elements Laboratory

Requestable Seperately?Yes

Units:nmol/L

Minimum Sample Volume:1.5 mL joint fluid (may be used for measurement of both cobalt and chromium)

Expected Turnaround Time:14 days.
Urgent analysis where clinically indicated may be arranged directly with the laboratory.

Test Code:JFCR

Sample Type:

Joint fluid collected into a universal container or other plain tube

Complex Reference Range:There are no reference ranges for joint fluid cobalt and chromium.
In most cases, where there is significant wear on the MOM joint, Co and Cr concentrations will be very high (e.g., >1000 nmol/L).
It is common to see exceedingly high joint fluid Co and Cr results in excess of 100,000 nmol/L. However, such concentrations do not relate to blood concentrations of the metals or to systemic toxicity.

Referred to Another Laboratory?No

Storage Requirements:Store at 4 °C prior to dispatch

Posting Address / Requirements:Ambient temperature. 1st class post,
Sandwell Health Campus,
Pathology laboratory,
Specialist chemistry,
Lyndon, B71 4HJ

NPEX / PDF Reporting Available:Yes

EQA Scheme:No specific scheme available for this matrix, however we participate in UK NEQAS for Trace Elements for blood cobalt and chromium, and in the UK NEQAS for Trace Elements, Solid Matrix Scheme for sample digestion processes.

Further information:We are a designated Supra-Regional Assay Service (SAS) Laboratory for Trace Elements.

Lead Contact Details:Dr Nicola Barlow, Consultant Clinical Scientist, >br/> SAS Director Trace Elements Laboratory, Email: nicola.barlow1@nhs.net

Email Address For Chasing Results:rwh-tr.bcpsspecialistchemistryenquiries@nhs.net

Methodology:Inductively coupled plasma mass spectrometry

Site Sample Tested:Sandwell Health Campus

Cost:Please email: bcpspathology.info@nhs.net for further details

Contact Number:Tel: 0121 507 5162