Blood Titanium Research

Titanium metal is used extensively to manufacture spine, hip and knee implants and is regarded as one of the safest and most biocompatible implant materials in use. The recent and rapid adoption of 3D printing technology however has seen titanium being used in orthopaedic implants in a new way (from a starting powder). Additionally, our research of the performance of magnetically controlled growing rods (MCGRs) for children with early onset scoliosis (EOS), has demonstrated a risk of titanium wear/corrosion debris being generated. 

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Evidence of titanium debris (examples on the right) found on retrieved MCGRs


Reference Blood Titanium Levels

We are the first to propose a laboratory reference level for blood and plasma titanium in patients with well-functioning titanium hip implants. The upper normal reference limit for blood titanium was 2.20 ppb, and did not differ significantly between males and females. This is an essential starting point for further studies to explore the clinical usefulness of blood titanium as a biomarker of orthopaedic implant performance. 

The full peer-reviewed publication of this work is available to read here.

Blood Titanium as a Biomarker for Implant Function

We are running research studies to understand if measuring the levels of titanium ions in blood samples from patients with titanium based implants, can be used as an indicator of how the implant is performing in the patient. Our review paper on the subject is available to read here.

Biomarkers for Function Book.pngWe have done the same before for the monitoring of patients with metal-on-metal hip implants. Our research was directly used by the UK Medicines and Healthcare products Regulatory Agency (MHRA) and other regulators worldwide to define a threshold level for blood cobalt and chromium levels of 7 parts per billion (ppb). 

One of our PhD graduates, Ilona Swiatkowska, edited the book "Biomarkers of Hip Implant Function" which aims to bring together all established and promising new biomarkers and critically evaluate their clinical usefulness. The writing of this involved 6 RNOH based co-authors.




Research Prize at the British Scoliosis Society Meeting

One of our three podium talks at the annual meeting (Edinburgh, November 2022) of the British Scoliosis Society (BSS), was awarded the BSS Prize of Best Scientific Oral Presentation out of the 40 talks presented.  

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The full peer-reviewed publication of this work is available to read for open-access here.


This talk explained our research demonstrating that patients implanted with MCGRs, and 3D printed titanium hip implants, have greater levels of titanium ions in their blood, when compared to baseline levels previously published by our group.

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Planar frontal radiographs of the different titanium implant types involved in this study: (A) A dual growing rod spine rod construct; (B) Humeral tumour replacement; (C) Hip tumour megaprostheses; (D) 3D-printed custom acetabular cup


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Plotting the spread of data for the large titanium implants and those with sliding mechanisms, shows how they are elevated above previously established baseline levels.