Arthroprosthetic Cobaltism and Cardiomyopathy

Machado, Colin; Appelbe, Alan; Wood, Robert

doi:10.1016/j.hlc.2012.03.013

Cited by 69 publications

(51 citation statements)

References 4 publications

(4 reference statements)

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“…33 More recently, case reports and small series have reported cardiomyopathy related to failure of MoM implants. 7,[35][36][37][38][39] However, there were < 30 cases in total and these patients had extreme levels of circulating metal ions. Prentice et al 40 performed a cross-sectional observational study of systemic complications and found a 5% lower ejection fraction in 35 patients with MoM resurfacing implants compared with patients with conventional arthroplasties.…”

Section: Discussionmentioning

confidence: 99%

The risk of cardiac failure following metal-on-metal hip arthroplasty

Sabah

Moon

Jenkins‐Jones

et al. 2018

The Bone & Joint Journal

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AimsThe aim of this study was to determine whether patients with metal-on-metal (MoM) arthroplasties of the hip have an increased risk of cardiac failure compared with those with alternative types of arthroplasties (non-MoM). Patients and Methods ConclusionThe risk of cardiac failure following total hip arthroplasty was not increased in those in whom MoM implants were used, compared with those in whom other types of prostheses were used, in the first seven years after surgery.

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Section: Discussionmentioning

confidence: 99%

The risk of cardiac failure following metal-on-metal hip arthroplasty

Sabah

Moon

Jenkins‐Jones

et al. 2018

The Bone & Joint Journal

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“…All of these patients underwent conversion to a THR, which was followed by an improvement in symptoms and a gradual fall in metal ion levels. Elevated cobalt ions have been shown to cause clinical toxicity in a few studies [49][50][51][52][53][54][55][56][57] (Table VIII), but none of the patients in our study developed any symptoms suggestive of systemic metal ion toxicity.…”

Section: Discussionmentioning

confidence: 49%

The Canadian Arthroplasty Society’s experience with hip resurfacing arthroplasty

Society¹

2013

The Bone & Joint Journal

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The purpose of this study was twofold: first, to determine whether the five-year results of hip resurfacing arthroplasty (HRA) in Canada justified the continued use of HRA; and second, to identify whether greater refinement of patient selection was warranted. This was a retrospective cohort study that involved a review of 2773 HRAs performed between January 2001 and December 2008 at 11 Canadian centres. Cox’s proportional hazards models were used to analyse the predictors of failure of HRA. Kaplan–Meier survival analysis was performed to predict the cumulative survival rate at five years. The factors analysed included age, gender, body mass index, pre-operative hip pathology, surgeon’s experience, surgical approach, implant sizes and implant types. The most common modes of failure were also analysed. The 2773 HRAs were undertaken in 2450 patients: 2127 in men and 646 in women. The mean age at operation was 50.5 years (sd 8.72; 18 to 82) and mean follow-up was 3.4 years (sd 2.1; 2.0 to 10.1). At the last follow-up a total of 101 HRAs (3.6%) required revision. Using revision for all causes of failure as the endpoint, Kaplan–Meier survival analysis showed a cumulative survival of 96.4% (95% confidence interval (CI) 96.1 to 96.9) at five years. With regard to gender, the five-year overall survival was 97.4% in men (95% CI 97.1 to 97.7) and 93.6% in women (95% CI 92.6 to 94.6). Female gender, smaller femoral components, specific implant types and a diagnosis of childhood hip problems were associated with higher rates of failure. The most common cause of failure was fracture of the femoral neck, followed by loosening of the femoral component. The failure rates of HRA at five years justify the ongoing use of this technique in men. Female gender is an independent predictor of failure, and a higher failure rate at five years in women leads the authors to recommend this technique only in exceptional circumstances for women. Cite this article: Bone Joint J 2013;95-B:1044–50.

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“…One patient identified in our review developed dyspnea 6 years after receiving a Co-HP. The patient, diagnosed with PHACT and cardiomyopathy, improved symptomatically with concomitant ejection fraction increase from 21 to 45 % after hardware removal [13]. Similarly, Tower reported subjective improvement in exercise tolerance, dyspnea, and diastolic dysfunction 11 months after hardware removal [9].…”

Section: Natural Course Of Suspected Phactmentioning

confidence: 89%

“…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]. Little evidence exists to inform decisions about enhanced elimination of cobalt in cases of suspected PHACT.…”

Section: Published Recommendations For Managementmentioning

confidence: 93%

“…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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Arthroprosthetic Cobaltism and Cardiomyopathy

Cited by 69 publications

References 4 publications

The risk of cardiac failure following metal-on-metal hip arthroplasty

The risk of cardiac failure following metal-on-metal hip arthroplasty

The Canadian Arthroplasty Society’s experience with hip resurfacing arthroplasty

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

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