Cobalt–chromium toxic retinopathy case study

Apel, Warren; Stark, Denis; Stark, Anthony P; O’Hagan, Stephen; Ling, Joseph

doi:10.1007/s10633-012-9356-8

Cited by 55 publications

(38 citation statements)

References 36 publications

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“…Weber et al described a woman with a history of hip prosthesis and decreased vision OU with an ISCEV-standard full-field ERG showing significant cone dysfunction (6). Similarly, Apel et al reported a case of arthroprosthetic cobaltism with persistent abnormalities in all phases of ERG including a negative b-waveform, suggesting inner retinal pathology (4). In contrast, the ISCEV standard full-field ERG conducted on our patient’s non-amblyopic eye showed normal flicker timing and amplitude, with both photopic and scotopic wave-forms within normal limits (Fig.…”

Section: Discussionmentioning

confidence: 93%

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Cobalt–Chromium Metallosis With Normal Electroretinogram

Grillo

Nguyen

Tsang

et al. 2016

Journal of Neuro-Ophthalmology

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Background Ocular cobalt toxicity is a rare phenomenon reported with increased frequency due to the rise of cobalt-chromium metal hip implants. We report the case of a 66 year-old previously healthy man who developed decreased vision due to cobalt-chromium toxicity from a metal-on-metal hip arthroplasty. Our objective was to determine whether the origin of his visual loss was due to toxicity of the optic nerve, of the retina, or of both. Methods Ocular examination, 10–2 SITA-Standard Humphrey Visual Field (VF), standard full-field electroretinogram (ERG) as indicated by the International Society for Clinical Electrophysiology of Vision (ISCEV), multifocal electroretinogram (mfERG), multifocal visual evoked potentials (mfVEP), and optical coherence tomography (OCT) were conducted. Results Ocular examination revealed decreased visual acuity, poor color vision, normal funduscopy, and cecocentral scotomas on visual field. As his right eye was amblyopic since childhood, test results from only the left eye are shown. Electrophysiology studies revealed an ISCEV standard full-field ERG with photopic and scotopic responses within normal limits, mfERG with amplitudes and latencies within normal limits, and mfVEP with latencies within normal limits, but with decreased central amplitudes. Peripapillary and macular OCT showed retinal nerve fiber layer (RNFL) and retinal ganglion cell-inner plexiform layer (RGC-IPL) thickness within normal limits. Conclusion As decreased color vision and cecocentral scotoma on 10–2 VF are most consistent with toxic optic neuropathy, and decreased central amplitudes on mfVEP are suggestive of neural dysfunction, we hypothesize that our patient presented with an early stage of optic nerve toxicity that was not yet apparent as a structural abnormality on OCT.

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Section: Discussionmentioning

confidence: 93%

“…In contrast, three cases found retinal toxicity, two with abnormal ERG and one with photoreceptor thinning on OCT (Table 2; 3–6). Two of these three reported normal VEP testing, isolating toxicity to the retina (3–4). …”

Section: Discussionmentioning

confidence: 99%

Cobalt–Chromium Metallosis With Normal Electroretinogram

Grillo

Nguyen

Tsang

et al. 2016

Journal of Neuro-Ophthalmology

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“…In addition, cobalt can cause systemic toxicity, which can result in serious consequences like blindness, hearing loss, memory loss and cardiomyopathy; cardiomyopathy has caused death in 2 patients. [9][10][11][12][13][14][15] Therefore, accurate measurement of cobalt ion levels in this rare but serious situation is key.…”

Section: Discussionmentioning

confidence: 99%

Concordance between laboratories in metal ion testing in patients with metal-on-metal hip implants

Saini

Railton

Boyd³

et al. 2019

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RESEARCH • RECHERCHE Concordance between laboratories in metal ion testing in patients with metal-on-metal hip implantsBackground: Testing of whole blood or serum metal ion levels has become an important part of assessing and monitoring the performance of metal-on-metal bearings, both in hip resurfacing arthroplasty and in total hip replacement. The aim of this study was to determine the concordance between 2 laboratories testing cobalt and chromium ion levels in patients with metal-on-metal bearings.Methods: Serum and whole blood samples from patients who had undergone metalon-metal resurfacing or large-diameter total hip arthroplasty were tested for cobalt and chromium ions in laboratory A (a recognized laboratory) and laboratory B (tasked with testing clinical specimens). Laboratory A performed cobalt and chromium testing on whole blood, and laboratory B performed cobalt testing on whole blood and chromium testing on serum. Results:Samples from 104 patients were tested. Laboratory B reported lower whole blood cobalt levels than laboratory A. Furthermore, laboratory A reported that all patients had elevated whole blood cobalt ion levels compared to the normal reference values for the laboratory, whereas laboratory B reported that 46 patients (44.2%) had whole blood cobalt ion levels within the normal reference range for the laboratory. Conclusion:This comparative study highlights the importance of using a single laboratory for metal ion testing, as values generated from different laboratories may not be directly comparable. With recent literature suggesting that whole blood cobalt levels as low as 1 ppb may be a predictor of adverse reactions to metal debris, accurate clinical measurement needs to be increasingly exact.

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“…In addition, the effect of chronic exposure of chromium and cobalt due to a metallic hip prosthesis has been investigated. Studies reported about the toxic effects to the nervous and respiratory system (Catalani, Rizzetti, Padovani, & Apostoli, 2012), the risk of ulcers, organ damages, and cancer (Costa & Klein, 2006;Dayan & Paine, 2001), as well as inner retinal dysfunction (Apel, Stark, Stark, O'Hagan, & Ling, 2013).…”

Section: Assessment Of Alternative Productsmentioning

confidence: 99%

Development of magnesium implants by application of conjoint‐based quality function deployment

Siefen

Höck

2019

J Biomedical Materials Res

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Biodegradable magnesium‐based implants are the subject of a great deal of research for different orthopedic and vascular applications. The targeted design and properties depend on the specific medical function and location in the body. Development of the biomaterial requires a comprehensive understanding of the biological interaction between the implant and the host tissue, as well as of the behavior in the physiological environment in vivo. Research into and the development of innovative magnesium implants entails interdisciplinary research efforts and communication between materials science, bioscience, and medical experts. The present study provides a transparent planning and communication tool for market‐oriented implant development processes. The objective was to identify medical needs at an early stage of the development process and to quantify the importance of the engineering characteristics of different research fields that cater to specific implant requirements. The method is demonstrated by the performance of a survey‐based conjoint analysis, which was integrated into a quality function deployment approach. Twenty‐seven medical professionals and 29 biomaterial scientists assessed the importance of identified medical requirements, whereby the control of mechanical integrity and degradation along with nontoxicity and nonimmunogenicity showed the highest number of preferences. The evaluation of implant options by 31 experts indicated that the engineering characteristic with the highest importance was the condition and sterilization of the surface. These values can be used to set priorities in strategic decisions. Research trials can be aligned to medical preferences, ensuring high product quality and an effective development process. This is the first paper to report on the application of conjoint‐based quality function deployment in biomaterial research.

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Cobalt–chromium toxic retinopathy case study

Abstract: These results suggest that cobalt-chromium toxicity can cause inner retinal dysfunction.

Cited by 55 publications

References 36 publications

Cobalt–Chromium Metallosis With Normal Electroretinogram

Cobalt–Chromium Metallosis With Normal Electroretinogram

Concordance between laboratories in metal ion testing in patients with metal-on-metal hip implants

Development of magnesium implants by application of conjoint‐based quality function deployment

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