A Systematic Comparison of the Actual, Potential, and Theoretical Health Effects of Cobalt and Chromium Exposures from Industry and Surgical Implants

Keegan, Gemma; Learmonth, Ian D.; Case, C. P.

doi:10.1080/10408440701845534

Cited by 191 publications

(129 citation statements)

References 191 publications

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“…Local inflammatory and other immunologic reactions in periprosthetic tissues also have been reported [22]. Inflammatory and necrotic changes in addition to a presumed delayed hypersensitivity response to CoCr particles might lead to the formation of pseudotumors [30,50].…”

Section: Discussionmentioning

confidence: 99%

“…For industrial exposure to Co and Cr, health effects include: (1) impairment of cardiac, renal, and the male reproductive systems; (2) greater incidence of inflammatory and other immune reactions; and (3) development of lung cancer after long-term exposure to Cr (VI) [22]. Local inflammatory and other immunologic reactions in periprosthetic tissues also have been reported [22].…”

Section: Discussionmentioning

confidence: 99%

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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: 99%

Section: Discussionmentioning

confidence: 99%

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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“…Occupational epidemiology has strongly implicated exposure by welders and others as contributing to the pathogenesis of lung cancer [122,123,214]. There is also considerable data that document that Cr(VI) can cause lung tumors in mice [251] as well as a TH1-driven response indicative of type IV hypersensitivity [38].…”

Section: Chromiummentioning

confidence: 99%

“…Case and colleagues [122] conducted extensive studies in patients, and these have led to the following general observations [122,132]: (1) Cr(VI) and cobalt (Co) were shed into the bloodstream of patients with prior metal-on-metal hip arthroplasties, but not in non-metal or knee arthroplasties (in which there is no direct metal-metal contact). (2) The concentration of Cr(VI) in the blood of these patients peaked at 6-12 years at 10 times "normal" levels and was measurable up to 10 years later.…”

Section: Chromiummentioning

confidence: 99%

Melanoma Epidemiology and Prevention

Berwick

Buller

Cust

et al. 2015

Cancer Treatment and Research

122

121

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The epidemiology of melanoma is complex, and individual risk depends on sun exposure, host factors, and genetic factors, and in their interactions as well. Sun exposure can be classified as intermittent, chronic, or cumulative (overall) exposure, and each appears to have a different effect on type of melanoma. Other environmental factors, such as chemical exposures-either through occupation, atmosphere, or food-may increase risk for melanoma, and this area warrants further study. Host factors that are well known to be important are the numbers and types of nevi and the skin phenotype. Genetic factors are classified as

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“…12 These ultra-small particles cause less granulomatous inflammation but are produced in greater numbers. 13 This can lead to a greater release of osteolytic enzymes compared with large polyethylene particles, which results in granulomatous giant cell formation with less release of osteolytic mediators.…”

mentioning

confidence: 99%

Metal-on-Metal Total Hip Arthroplasty: Known and Unknown Side Effects

Raay¹

2012

Orthopedics

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447n guest editorial T he indications for hip replacement, especially in young patients with end-stage degenerative arthritis of the hip, have increased during the past 20 years. Because of the accelerated risk of polyethylene wear and subsequent prosthetic loosening due to osteolysis, new interest has focused on the metal-on-metal articulation couple. Failures of first-generation metal-on-metal total hip arthroplasties (THAs) are attributed to suboptimal surgical technique, excessive or negative clearance, poor fixation, and neck-socket impingement.1 Improvements in metallurgic and tribological properties (ie, sphericity and radial clearance) of metal-on-metal bearing couples has led to a renaissance of metal-on-metal resurfacing arthroplasties and THAs. Secondgeneration metal-on-metal wear rates are noted to be 20 to 100 times lower than metal-on-polyethylene wear rates. 2Good clinical and radiological results have been reported after metal-on-metal resurfacing arthroplasties in patients younger than 55 years, with survival rates of 99% and 98% at 10-and 13-year follow-up, respectively.3 Also, good results have been described after a minimum 6-year follow-up (mean, 5.7 years) of cementless second-generation metal-on-metal THAs in prospective, randomized, controlled clinical trials, with a survival rate of 100%. [4][5][6] Few prospective, randomized, controlled studies compare conventional metal-on-polyethylene THAs with second-generation metal-on-metal THAs. Zijlstra et al 7 reported a 10-year survival rate of 95.5% for a metal-on-metal group and a 10-year survival rate of 96.8% for a metal-on-polyethylene group, with no difference in clinical or radiological outcomes. Small bearing couples of 28-mm femoral heads were used.Interpretation of the results of different prosthetic devices, as well as metal-on-metal resurfacing arthroplasties, is problematic because of differences in design, alloy, radial clearance, risk of head-neck impingement, edge wear, and other metallurgic properties. Besides better metallurgical and tribological properties, orthopedic companies also claim clinical advantages of largehead metal-on-metal THAs over conventional small-head metalon-polyethylene THAs, including a larger range of motion and a decreased risk of dislocation. However, in a randomized clinical trial, no clinically relevant difference in range of motion was observed between conventional 28-mm metal-on-polyethylene THAs compared with large-head metal-on-metal THAs. Recently, concern has emerged about the development of pseudotumors in large-head metal-on-metal THAs and resurfacing arthroplasties. These pseudotumors, also known as aseptic, lymphocyte-dominated, vasculitis-associated lesions or adverse reactions to metal debris, are caused by a local metal allergy or sensitivity and a type IV, local, delayed-type hypersensitivity caused by T lymphocytes. Even with low wear rates, this type of allergy can develop. Whether aseptic, lymphocyte-dominated, vasculitis-associated lesions are specific to metal-on-metal implants is ...

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A Systematic Comparison of the Actual, Potential, and Theoretical Health Effects of Cobalt and Chromium Exposures from Industry and Surgical Implants

Cited by 191 publications

References 191 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

Melanoma Epidemiology and Prevention

Metal-on-Metal Total Hip Arthroplasty: Known and Unknown Side Effects

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