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Test Code CRCOF Chromium and Cobalt, Synovial Fluid


Ordering Guidance


This test should only be used in individuals with chromium or cobalt implants.



Specimen Required


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

Supplies: Metal Free B-D Tube (EDTA), 6 mL (T183)

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

Specimen Volume: 1 mL

Collection Instructions: See Metals Analysis Specimen Collection and Transport 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.


Useful For

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.

Profile Information

Test ID Reporting Name Available Separately Always Performed
CRSY Chromium, Synovial Fl Yes Yes
COSY Cobalt, Synovial Fl Yes Yes

Method Name

Inductively Coupled Plasma Mass Spectrometry (ICP-MS)

Reporting Name

Chromium and Cobalt, Synovial Fl

Specimen Type

Synovial Fluid

Specimen Minimum Volume

0.4 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Synovial Fluid Refrigerated (preferred) 90 days
  Ambient  90 days
  Frozen  90 days

Reference Values

CHROMIUM:

0-17 years: Not established

≥18 years: <16.9 ng/mL

 

COBALT:

0-17 years: Not established

≥18 years: <19.8 ng/mL

Interpretation

Chromium:

Based on an internal study, synovial fluid chromium concentrations of 16.9 ng/mL or above were more likely due to a metal reaction (eg, adverse local tissue reaction [ALTR]/adverse reaction to metal debris [ARMD]) versus a nonmetal reaction in patients undergoing metal-on-metal revision (sensitivity of 92.3% and specificity of 92.6%).

 

Cobalt:

Based on an internal study, synovial fluid cobalt concentrations of 19.8 ng/mL or above were more likely due to a metal reaction (eg, ALTR/ ARMD) versus a nonmetal reaction in patients undergoing metal-on-metal revision (sensitivity of 92.3% and specificity of 96.3%).

Clinical Reference

1. Houdek MT, Taunton MJ, Wyles CC, Jannetto PJ, Lewallen DG, Berry DJ. Synovial fluid metal ion levels are superior to blood metal ion levels in predicting an adverse local tissue reaction in failed total hip arthroplasty. J Arthroplasty. 2021;36(9):3312-3317.e1. doi:10.1016/j.arth.2021.04.034

2. Eltit F, Assiri A, Garbuz D, et al. Adverse reactions to metal on polyethylene implants: Highly destructive lesions related to elevated concentration of cobalt and chromium in synovial fluid. J Biomed Mater Res A. 2017;105(7):1876-1886. doi:10.1002/jbm.a.36057

3. Lass R, Grubl A, Kolb A, et al. Comparison of synovial fluid, urine, and serum ion levels in metal-on-metal total hip arthroplasty at minimum follow-up of 18 years. J Orthop Res. 2014;32(9):1234-1240. doi:10.1002/jor.22652

4. De Pasquale D, Stea S, Squarzoni S, et al. Metal-on-metal hip prostheses: Correlation between debris in the synovial fluid and levels of cobalt and chromium ions in the bloodstream. Int Orthop. 2014;38(3):469-475. doi:10.1007/s00264-013-2137-5

Day(s) Performed

Friday

Report Available

2 to 8 days

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information

83018

82495

LOINC Code Information

Test ID Test Order Name Order LOINC Value
CRCOF Chromium and Cobalt, Synovial Fl 95525-2

 

Result ID Test Result Name Result LOINC Value
606352 Cobalt, Synovial Fl 23842-8
606353 Chromium, Synovial Fl 95526-0