Severe Cobalt Intoxication Due to Prosthesis Wear in Repeated Total Hip Arthroplasty

Oldenburg, Marcus; Wegner, Ralf; Baur, Xaver

doi:10.1016/j.arth.2008.07.017

Cited by 164 publications

(134 citation statements)

References 15 publications

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“…Similarly, Tower reported subjective improvement in exercise tolerance, dyspnea, and diastolic dysfunction 11 months after hardware removal [9]. Oldenberg et al did not specifically comment on cardiac symptom resolution in the sole biopsyproven case of cardiomyopathy identified in our review [6]. Typical symptom duration with suspected PHACT appears to vary.…”

Section: Natural Course Of Suspected Phactmentioning

confidence: 72%

“…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%

“…Symptoms gradually improved and appear to correspond to decreasing blood cobalt levels; however, complete resolution was not achieved by 8 weeks in either patient [10]. Oldenburg et al reported one patient whose symptoms had improved within 6 months of hardware removal [6]. Unfortunately, "in long-term follow-up, the patient's neurologic symptoms [had] persisted."…”

Section: Natural Course Of Suspected Phactmentioning

confidence: 99%

“…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%

See 3 more Smart Citations

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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Section: Natural Course Of Suspected Phactmentioning

confidence: 72%

Section: Published Recommendations For Managementmentioning

confidence: 84%

Section: Natural Course Of Suspected Phactmentioning

confidence: 99%

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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“…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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Addendum zu Cobalt und Cobaltverbindungen [BAT Value Documentation in German language, 2018]

Schmitz‐Spanke

Drexler

Hartwig

2018

The MAK‐Collection for Occupational Health and Safety

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The German Commission for the Investigation of Health Hazards of Chemical Compounds in the Work Area has derived a biological guidance value at the workplace (“Biologischer Leitwert”, BLW) and a biological reference value (“Biologischer Arbeitsstoff‐Referenzwert”, BAR) and has re‐evaluated the exposure equivalents for carcinogenic substances (EKA) for cobalt and cobalt compounds [CAS No. 7440‐48‐4 ] in 2017. Available publications are described in detail. The evaluation of the BLW was based on the association between urinary concentration of cobalt to characterize the internal exposure and cardiotoxicity as critical effect. Moderate restrictive lung dysfunctions and slight interferences with thyroid metabolism (hypothyroidism) were observed at urinary cobalt concentrations of 79 µg/l urine and 84 µg/l urine, respectively. At urinary concentrations of 38 µg cobalt/l urine and 36 µg cobalt/l urine no adverse effects of restrictive lung dysfunction and cardiotoxicity were observed. Therefore, a BLW of 35 µg/l urine was derived. The sampling time is for long‐term exposures at the end of the shift after several shifts. In some biomonitoring studies, the excretion of cobalt in urine of persons occupationally not exposed to cobalt was examined. Due to geogenic differences, a German study was considered for the evaluation, where urine samples of 87 adults were analyzed and a 95th percentile of 1.53 µg cobalt/l urine was recorded. These results are in good accordance with other international studies. Therefore, a BAR of 1.5 µg cobalt/l urine was evaluated. The relationships between the concentration of cobalt in ambient air and that in urine derived from the more recent studies are in good accordance with the present EKA. The Commission therefore retains the EKA already derived in 1986 and extended in 2006 in the lower range between the concentration of cobalt in the air and in urine.

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Severe Cobalt Intoxication Due to Prosthesis Wear in Repeated Total Hip Arthroplasty

Cited by 164 publications

References 15 publications

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

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

Addendum zu Cobalt und Cobaltverbindungen [BAT Value Documentation in German language, 2018]

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