Identification and Management of Cobalt Toxicity: A Case Report of Rapidly Progressing Toxicity after Hip Arthroplasty Revision

Mohan, Neena; Kasprowicz, Eric

doi:10.29046/tmf.017.1.019

Cited by 2 publications

(3 citation statements)

References 7 publications

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“…A variety of symptoms have been described, related to hearing and balance 23,223,238,241,251,257,[266][267][268][269][270] , vision 23,238,252,266,[269][270][271][272] , cognitive function 223,238,241,273 , and sensory and motor performance 23,238,252,268,270 . Moreover, these symptoms often coincide with polyneuropathy.…”

Section: Peripheral and Central Nervous Systemsmentioning

confidence: 99%

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Cobalt toxicity in humans—A review of the potential sources and systemic health effects

et al. 2017

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Cobalt (Co) and its compounds are widely distributed in nature and are part of numerous anthropogenic activities. Although cobalt has a biologically necessary role as metal constituent of vitamin B, excessive exposure has been shown to induce various adverse health effects. This review provides an extended overview of the possible Co sources and related intake routes, the detection and quantification methods for Co intake and the interpretation thereof, and the reported health effects. The Co sources were allocated to four exposure settings: occupational, environmental, dietary and medical exposure. Oral intake of Co supplements and internal exposure through metal-on-metal (MoM) hip implants deliver the highest systemic Co concentrations. The systemic health effects are characterized by a complex clinical syndrome, mainly including neurological (e.g. hearing and visual impairment), cardiovascular and endocrine deficits. Recently, a biokinetic model has been proposed to characterize the dose-response relationship and effects of chronic exposure. According to the model, health effects are unlikely to occur at blood Co concentrations under 300μg/l (100μg/l respecting a safety factor of 3) in healthy individuals, hematological and endocrine dysfunctions are the primary health endpoints, and chronic exposure to acceptable doses is not expected to pose considerable health hazards. However, toxic reactions at lower doses have been described in several cases of malfunctioning MoM hip implants, which may be explained by certain underlying pathologies that increase the individual susceptibility for Co-induced systemic toxicity. This may be associated with a decrease in Co bound to serum proteins and an increase in free ionic Co. As the latter is believed to be the primary toxic form, monitoring of the free fraction of Co might be advisable for future risk assessment. Furthermore, future research should focus on longitudinal studies in the clinical setting of MoM hip implant patients to further elucidate the dose-response discrepancies.

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Section: Peripheral and Central Nervous Systemsmentioning

confidence: 99%

“…These effects mostly disappeared after cessation of the exposure 275,279 . Additionally, chronic thyroiditis, disturbance of the thyroid hormone metabolism (mostly hypothyroidism) and a reduced thyroid volume have been described in Co-exposed individuals 23,65,223,238,252,253,255,268,270 .…”

Section: Endocrine Systemmentioning

confidence: 99%

Cobalt toxicity in humans—A review of the potential sources and systemic health effects

et al. 2017

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“…The release of metallic alloying debris after arthroplasty is a reason for concern. High serum cobalt levels, for example, can result in hearing and vision loss [ 31 , 32 , 33 ], and can even lead to death due to poisoning [ 34 ].…”

Section: Drawbacks In Metallic Implant Devicesmentioning

confidence: 99%

Poly (Ether-Ether-Ketone) for Biomedical Applications: From Enhancing Bioactivity to Reinforced-Bioactive Composites—An Overview

2023

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The global orthopedic market is forecasted to reach US$79.5 billion by the end of this decade. Factors driving the increase in this market are population aging, sports injury, road traffic accidents, and overweight, which justify a growing demand for orthopedic implants. Therefore, it is of utmost importance to develop bone implants with superior mechanical and biological properties to face the demand and improve patients’ quality of life. Today, metallic implants still hold a dominant position in the global orthopedic implant market, mainly due to their superior mechanical resistance. However, their performance might be jeopardized due to the possible release of metallic debris, leading to cytotoxic effects and inflammatory responses in the body. Poly (ether-ether-ketone) (PEEK) is a biocompatible, high-performance polymer and one of the most prominent candidates to be used in manufacturing bone implants due to its similarity to the mechanical properties of bone. Unfortunately, the bioinert nature of PEEK culminates in its diminished osseointegration. Notwithstanding, PEEK’s bioactivity can be improved through surface modification techniques and by the development of bioactive composites. This paper overviews the advantages of using PEEK for manufacturing implants and addresses the most common strategies to improve the bioactivity of PEEK in order to promote enhanced biomechanical performance.

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Identification and Management of Cobalt Toxicity: A Case Report of Rapidly Progressing Toxicity after Hip Arthroplasty Revision

Cited by 2 publications

References 7 publications

Cobalt toxicity in humans—A review of the potential sources and systemic health effects

Cobalt toxicity in humans—A review of the potential sources and systemic health effects

Poly (Ether-Ether-Ketone) for Biomedical Applications: From Enhancing Bioactivity to Reinforced-Bioactive Composites—An Overview

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