Background It has recently been found that some metal-on-metal (m-o-m) friction arthroplasties may produce a variety of clinical alterations because of the presence of metal ions, especially chromium (Cr) and cobalt (Co), in blood and urine. These complications may cause general or local damage known as ALVALs (aseptic lymphocyte-dominant vasculitis-associated lesions). Patient monitoring involves several analytical and imaging tests that increase the patient’s follow up costs.

Purpose To draw attention to the possibility of detecting metal ions in patients’ hair by ICP-MS (Inductively Coupled Plasma Mass Spectrometry) as a cheaper method of screening versus double analysis of blood and urine.

Materials and methods Cr and Co levels in serum and urine, and Cr, Co, and Mo levels in hair were analysed in 45 patients who had metal-on-metal hip resurfacing arthroplasties (DePuy ASR). Metal quantification was performed with a high-resolution and double-focus ICP-MS. Samples were taken 3 times (months 0–6–12). Hair samples were taken by trained non-specialised personnel.

Results The mean ion metal levels were: Cr 163.27 (SD 300.62), Co 61.98 (SD 126.48) in hair; Cr 8.29 (SD 17.97), Co 8.38 (SD 21.97) ppb in serum; and Cr 16.20 (SD 190.86), Co 75.40 (SD 190.86) ppb in urine. The total analyses in hair involve a cost of 2,997 € whilst the double analysis in blood and urine increases the cost to 5,994 €. The cost per element and sample was 7.4€.

Conclusions We have demonstrated that metal ions in hair are a biomarker that allows the detection of ion levels in higher amounts (ppm), versus serum or urine (ppb). In addition, it is an interesting screening method in patients with ASR devices (since several agency alerts have warned against the use of these prostheses) because it is an easier, safer technique. Hair collection does not require highly trained personnel and is therefore cost effective.

No conflict of interest.