Brand named Aurum®, a novel implant coating process is being introduced to the orthopedic community at AAOS as a first step toward Total Joint Orthopedics, Inc.’s commitment to eliminate cobalt chrome in orthopedics. if it meets all of its pre-launch promise, this modern application could well challenge cobalt chrome’s strength, hardness, and longevity and, in the process, establish a new standard for total knee arthroplasty implant materials.

It’s been decades since a truly new arthroplasty implant material was introduced at AAOS.

The company launching this new implant material is Utah-based Total Joint Orthopedics, Inc. (TJO). “Our team has been working diligently for several years to find a material that can rival cobalt chrome in strength and hardness, and we are thrilled to introduce the first cobalt chrome alternative to our portfolio,” said Erin Hofmann, CEO of Total Joint Orthopedics.

Aurum® is made using a patented ion beam enhanced deposition (IBED) process which ballistically bonds a titanium nitride (TiN) coating to a titanium femur substrate for significantly improved wear-resistance, abrasion-resistance, and surface hardness when compared to cobalt chrome.

The benefits of the material include:

The company is introducing the Aurum® to the orthopedic community in the form of a new femur implant, brand named The Klassic®.

Aurum® Presentation at AAOS: Date, Time and Location

Thursday, March 24 | 1:30pm | Academy’s Innovation Theater | Chicago’s McCormick Center

This is a must-attend meeting for all large joint surgeons.

Presenting Aurum® technology (as embodied in the Klassic® femur implant) is Christopher E. Pelt, M.D., Tenured Associate Professor in the Department of Orthopaedics at the University of Utah, Medical Director of the Orthopaedic and Trauma Unit at the University Hospital, and Chief Value Officer for the inpatient orthopaedic service line in the Department of Orthopaedics.

“It’s time to remove cobalt chrome from the human body,” Dr. Pelt told OTW.

Cobalt Chrome’s Checkered History

A majority of knee implants are made with cobalt chrome in large part because of cobalt chrome’s 15-20-year longevity in the human body. Indeed, according to an August 2021 research letter in the Journal of the American Medical Association (JAMA), twenty million North Americans have cobalt-chrome arthro-prosthetic components.

But cobalt chrome has a checkered history. In the JAMA research letter from six months ago, the authors summarized the issues with cobalt chrome large joint implants.  Here’s a link to that research letter.

According to authors Stephen S. Tower, M.D.; Christina S. Cho, B.A., B.S.; Robert L. Bridges, M.D., M.S.; and Bradford D. Gessner, M.D., M.P.H. (University of Alaska, University of Washington School of Medicine Anchorage Alaska, Tower Orthopedic and Joint Replacement Clinic, Aegis Imaging Consultants and EpiVac Consulting Services, respectively): “Cobalt is a mitochondrial toxin—encephalopathy and cardiomyopathy (cobaltism) may occur from iatrogenic, industrial, dietary, or arthro-prosthetic cobalt exposure.”

For the study, the authors first established a baseline level of cobalt levels in unexposed populations which: “In unexposed populations, the 95th percentile of cobalt levels in urine and blood are 1 part per billion (ppb) and 0.4 ppb, respectively.”

And, they noted, “Wear and corrosion of cobalt-chrome joint implantations can result in periprosthetic tissue inflammation or necrosis, also known clinically as adverse reactions to metallic debris. Periprosthetic cobalt-chrome metallosis is disseminated systemically and may result in arthro-prosthetic cobaltism. Systemic cobalt dissemination can result in brain hypometabolism and atrophy; patients with levels of cobalt in blood as low as 1.1 ppb and in urine as low as 4.1 ppb are reported as having cobalt encephalopathy.”

The authors screened 241 patients at a single center (one of limiting factors of this study) for the presence of cobalt in urine and blood.

Most patients who presented at their clinic with cobalt-chrome hip, knee, or shoulder implantations were, they wrote, “cobalturic (i.e., cobalt levels in urine of 1 ppb or above) and had cobalt levels in urine or blood in excess of levels associated with encephalopathy.”

And, they noted, patients were unaware of the type, brand, or materials in their implants and, therefore, the risks entailed in having a cobalt chrome implant—particularly if they had a metal-on-metal articulating surface. Over the years, two models of joint replacements have been recalled in the U.S. for cobalt-chrome metallosis complications. Noted the authors: “Millions of residents of North America implanted with nonrecalled extreme-risk or high-risk implantations are likely not monitored and are likely experiencing cobalturia.”

How timely is this AAOS presentation of an alternative implant material to Cobalt Chrome?

Again, the Aurum® presentation by Dr. Pelt will be on Thursday, March 24, 1:30pm at the Academy’s Innovation Theater. See you there. Robin Young, Publisher, Orthopedics This Week.

interesting to see if there will be any improvement and positive effect using this technology. May backfire, too….

We have been through this before! Modified titanium bearing surfaces were introduced by Zimmer in the 1980’s. They were a disaster because the titanium would wear, leaving the joints stained with black metallic residue and with loosening analogous to the loosening seen from polyethylene wear particles. Those who ignore history are doomed to repeat it all over again!

This new material has potential of skin damage caused by exposure of the knee for more than 3 hours continuous exposure to the sun with high level of temperature , unlike cobalt chrome? Is that a truth?

Some of the oil paint pigments used by artists are cobalt compounts known to be toxic.

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