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Increased wear leads to elevated systemic and local metal ion concentrations for patients treated with metal-on-metal bearings. The local metal ion content in the close environment of the joint replacement (e.g. joint aspirate or tissue) is several times higher compared to the systemic metal content (e.g. in blood or serum). As a result of increased metal ion levels, local and systemic effects, such as osteolysis, pseudotumors, sensitization or in rare cases toxicity may occur. Although the definition of a specific threshold to define clinical problems is difficult due to a lack of sensitivity, the systemic metal concentration is frequently measured clinically. Currently a threshold for cobalt and chromium between 4 µg/l and 7 µg/l is under debate. Very high levels (≥ 20 µg/l) or a steady increase over time should be a warning sign; however, metal ion levels should not be interpreted as a single diagnostic tool but rather in the entire context of the clinical, radiological and cross-sectional imaging, metal artefact reduction sequence (MARS) magnetic resonance imaging (MRI), ultrasound and computed tomography (CT) findings.

In this study 67 workmen exposed to ions of heavy metals have been investigated because of their fertility. Concentrations of the noxious substances and their metabolites in blood and urine have been estimated and spermiograms were performed. The investigations demonstrated that a correlation exists between the concentrations of noxious substances in the place of employment, in the blood, and in the ejaculate, besides of zinc. An increased number of pathological spermiograms could be established especially in cases with an exceed of maximum permitted concentrations in the place of employment.