Loss of sight and sound. Could it be the hip?

Rizzetti, Maria Cristina; Liberini, Paolo; Zarattini, Guido; Catalani, Simona; Pazzaglia, U. E.; Apostoli, Pietro; Padovani, Alessandro

doi:10.1016/s0140-6736(09)60490-6

Cited by 139 publications

(101 citation statements)

References 4 publications

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“…Chelating treatment with edetic acid decreased metal ion concentrations, but neurologic symptoms improved only after resection arthroplasty [37]. Other case reports describe hypothyroidism, peripheral neuropathy, cardiomyopathy [35], impairment of hearing and sight, numbness in the feet, and dermatitis on the head and neck, with Normal range (blood) = Cr \ 1 lg/L, Co \ 4 lg/L; measurements were performed on whole blood using quadrupole ICP-MS (XSeries 2 ICP-MS, Thermo Scientific, Dreieich, Germany); cord blood levels were * 10.5% for chromium and **52.4% for cobalt of the maternal values at delivery; Cr = chromium; Co = cobalt.…”

Section: Discussionmentioning

confidence: 98%

Case Report: High Chromium and Cobalt Levels in a Pregnant Patient with Bilateral Metal-on-Metal Hip Arthroplasties

Fritzsche

Borisch

Schaefer

2012

Clinical Orthopaedics &Amp; Related Research

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Background Metal-on-metal bearings frequently are used in young patients leading to the concern that disseminated metals such as chromium (Cr) and cobalt (Co) as the main constituents could affect pregnancies. Case Description We describe a 41-year-old patient with bilateral metal-on-metal hip arthroplasties, a recurrent pseudotumor, and extremely high blood levels (Cr 39 lg/L, Co 138 lg/L) at 12 gestational weeks. At different gestational weeks, maternal blood, aspirate of the pseudotumor, and amniotic fluid were analyzed for Cr and Co. Therapy with chelating agents was not recommended because the mother showed no symptoms of toxicity and the safety of chelating therapy during pregnancy is not established.

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Section: Discussionmentioning

confidence: 98%

Case Report: High Chromium and Cobalt Levels in a Pregnant Patient with Bilateral Metal-on-Metal Hip Arthroplasties

Fritzsche

Borisch

Schaefer

2012

Clinical Orthopaedics &Amp; Related Research

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“…These patients have been treated supportively. Some patients identified by our methods received thyroid replacement and corticosteroids but clinical response is inconsistently documented [6,7]. Machado et al reported a "good clinical response" to beta-blockade, ACE inhibition, and diuresis in their patient with cardiomyopathy [13].…”

Section: Published Recommendations For Managementmentioning

confidence: 84%

“…Interestingly, in a patient with sensory polyneuropathy identified by our search, sural nerve biopsy revealed "moderate axonal degeneration with no inflammatory changes," suggesting that inflammation of nerves may not completely explain neurotoxicity [8]. Another patient identified by our search exhibited hyperintense lesions on brain magnetic resonance imaging (MRI) suggesting demyelination [7,27]. Comprehensive reviews of cobalt's pathologic mechanisms are available elsewhere [27,28,33,34,36].…”

Section: Proposed Mechanisms Of Toxicitymentioning

confidence: 92%

“…Recently, safety concerns-excessive revision rates, local reactions, and high metal ion levels-have resulted in product recalls, a medical device alert, and issuance of clinical guidance by the Food and Drug Administration (FDA) in the USA [1][2][3][4]. During the past 6 years, cases of systemic symptoms associated with cobalt-containing metal alloy hip prosthetics (Co-HP) have been reported [5][6][7][8][9][10][11][12][13]. A definitive causal link between Co-HP and systemic symptoms, as opposed to local reactions, has not been definitively established.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Features, Testing, and Management of Patients with Suspected Prosthetic Hip-Associated Cobalt Toxicity: a Systematic Review of Cases

et al. 2013

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Safety concerns regarding cobalt-containing metal alloy hip prosthetics (Co-HP) have resulted in product recalls, a medical device alert, and issuance of guidance for clinicians. Recently, cases of suspected prosthetic hip-associated cobalt toxicity (PHACT) from Co-HP have been reported. Although little is known about suspected PHACT, these patients may be referred to medical toxicologists for evaluation and management recommendations. We searched MEDLINE, EMBASE, and unpublished abstracts from toxicology scientific meetings for references relevant to PHACT. Authors independently screened publications for inclusion criteria: publication in English, human study population, subject(s) are symptomatic (except for isolated hip pain), and cobalt values in any matrix (blood, serum, urine, CSF, synovial fluid) available for review. Data from 10 cases are reviewed. Patients with suspected PHACT had findings consistent with cobalt toxicity, including thyroid, cardiac, and neurologic dysfunction.Signs and symptoms appeared between 3 and 72 months after arthroplasty (median 19 months). Neurologic symptoms were most common. Ancillary testing varied considerably. All patients had elevated cobalt levels in one or more matrices. Enhanced elimination was attempted in 27 % of patients. At this time, the information currently available regarding patients with suspected PHACT is inadequate to guide clinical decision making. No consensus has been reached regarding the management of Co-HP patients with systemic symptoms. Indications for chelation have not been established and require further study. Improved case definitions, improved surveillance, and controlled studies are needed to elucidate the scope of this problem and guide future investigations.

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“…Multiple reports [10, 18 -24] have described patients with metal hip prostheses who presented with serious systemic symptoms ( Table 1 ). These include neurological symptoms such as auditory impairment/deafness [10, 18, 20 -24] , visual impairment/blindness [10,22,23] , peripheral neuropathy/dysesthesia of the extremities [10, 18, 20 -22, 24] , and poor concentration/ cognitive decline [20,23,24] . Other symptoms include cardiomyopathy [19 -21, 23] and hypothyroidism [18, 20 -22] .…”

Section: Systemic Effectsmentioning

confidence: 99%

Metal release from hip prostheses: cobalt and chromium toxicity and the role of the clinical laboratory

Campbell

Estey

2012

Clinical Chemistry and Laboratory Medicine (CCLM)

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Individuals with advanced hip disease suffer from pain, impaired hip function, and decreased quality of life. Roughly one million metal-on-metal (MoM) hip prostheses have been implanted worldwide in order to ameliorate these issues. While most MoM hip replacements are successful, some patients suffer from serious adverse effects secondary to the release of metal debris due to implant wear and corrosion. MoM hip prostheses are comprised predominantly of cobalt and chromium, and the serum concentration of these metal ions has been shown to correlate with both implant wear and the accumulation of metal debris in the periprosthetic tissue. Consequently, measurement of cobalt and chromium concentrations may be useful in the assessment of implant function and the potential for adverse effects in the follow-up of patients with MoM hip prostheses. The purpose of this Mini Review is to describe the adverse biological consequences of metal release from hip prostheses, provide an overview of the clinical utility of cobalt and chromium measurement and the current recommendations for testing, and alert laboratorians and physicians to the many challenges associated with measuring these metal ions.

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Loss of sight and sound. Could it be the hip?

Cited by 139 publications

References 4 publications

Case Report: High Chromium and Cobalt Levels in a Pregnant Patient with Bilateral Metal-on-Metal Hip Arthroplasties

Case Report: High Chromium and Cobalt Levels in a Pregnant Patient with Bilateral Metal-on-Metal Hip Arthroplasties

Clinical Features, Testing, and Management of Patients with Suspected Prosthetic Hip-Associated Cobalt Toxicity: a Systematic Review of Cases

Metal release from hip prostheses: cobalt and chromium toxicity and the role of the clinical laboratory

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