Clinical Information

Chromium (Cr) is a naturally-occurring element widely distributed in the environment. It exists in several valence states with the 3 main forms being Cr(0), Cr(III), and Cr(VI). Cr(III) is an essential trace element that enhances the action of insulin. Deficiency leads to impaired growth, reduced life span, corneal lesions, and alterations in carbohydrates, lipid, and protein metabolism.

Chromium is widely used in manufacturing processes to make various metal alloys, such as stainless steel. It is also used in many consumer products, including wood treated with copper dichromate, leather tanned with chromic sulfate, and metal-on-metal hip replacements.

Per US Food and Drug Administration recommendations, orthopedic surgeons should consider measuring and following serial chromium concentrations in EDTA anticoagulated whole blood in symptomatic patients with metal-on-metal hip implants as part of their overall clinical evaluation. However, a recent publication(1) has shown synovial fluid measurements were superior to whole blood and serum chromium concentrations in predicting local tissue destruction in failed hip arthroplasty constructs.

Prosthetic devices produced by Depuy Company, Dow Corning, Howmedica, LCS, PCA, Osteonics, Richards Company, Tricon, and Whiteside are typically made of chromium, cobalt, and molybdenum. This list of products is incomplete, and the products' compositions change occasionally; see each prostheses' product information for composition details.

The general population is most likely to be exposed to trace levels of chromium, as Cr(III) is naturally occurring in foods, such as fruits, vegetables, nuts, beverages, and meats. The highest potential occupational exposure occurs in the metallurgy and tanning industries, where workers may be exposed to high air concentrations. In cases of suspected toxicity, blood, serum, or urine concentrations of chromium can be checked.