Total joint arthroplasty + brain metal concentrations: findings from the Mayo Clinic

TJA is a common surgical intervention: approximately 8 million Americans currently live with artificial hip and/or knee joints, and an estimated 1.2 million TJA procedures are performed annually – underscoring the relevance of understanding potential long-term systemic effects of implantable materials.

Using post‑mortem frozen occipital cortex samples, Profs. Daniel Berry, David Lewallen, and team compared 88 subjects with prior TJA to 89 matched controls without implants. Ultra‑trace concentrations of eight metals (aluminum, chromium, cobalt, manganese, molybdenum, nickel, titanium, and vanadium) were measured using triple‑quadruple-inductively coupled plasma mass spectrometry.

Overall, Alzheimer’s Disease Neuropathologic Change (ADNC) scores did not differ between groups. However, individuals with TJA showed higher concentrations of cobalt and titanium in brain tissue. Across TJA and non‑TJA subjects, higher concentrations of cobalt, titanium, manganese, and molybdenum were statistically associated with the presence of diffuse and neuritic amyloid plaques. No significant associations were observed between any of the measured metals and tau neurofibrillary tangles.

The study found that relationships between metals – reflecting aspects of cerebral metal homeostasis – differed in the presence of neuritic plaques and/or joint implants. Also, within the TJA group, cobalt concentrations were higher in individuals with 3+ joint replacements than in those with one or two.

The authors emphasize that these findings are associative only. The contribution of these metal concentrations to the aging process or neurodegenerative disease remains uncertain, and the study does not demonstrate that TJA or implant metals cause Alzheimer’s disease or dementia. Given the high prevalence and established therapeutic benefit of TJA in arthritis‑related disability, the authors highlight the need for further research to better understand the long‑term systemic effects of lifelong exposure to implant‑related materials.

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This post reflects CeramTec’s summary of a peer‑reviewed scientific publication and does not constitute clinical guidance or product‑related recommendations. This content was created with the support of AI.