Clinical Information

Chromium (Cr) is a naturally occurring element widely distributed in the environment. Chromium exists in several valence states with the 3 main forms being Cr, Cr(3+), and Cr(6+). Cr(3+) 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.

The general population is most likely to be exposed to trace levels of chromium in the food that is eaten. Low levels of Cr(3+) occur naturally in a variety of 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.

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. Blood Cr concentrations are likely to be increased above the reference range in patients with metallic joint prosthesis. Prosthetic devices produced by DePuy Company, Dow Corning, Howmedica, LCS, PCA, Osteonics, Richards Company, Tricon, and Whiteside typically are made of chromium, cobalt, and molybdenum. This list of products is incomplete, and these products change occasionally; see prosthesis product information for each device for composition details.