Hip-implant related chorio-retinal cobalt toxicity

Ng, Soo Khai; Ebneter, Andreas; Gilhotra, Jagjit S

doi:10.4103/0301-4738.105053

Cited by 39 publications

(17 citation statements)

References 5 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%

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%

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

et al. 2017

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“…Of the 18 cases of cobalt toxicity that have been described, 13 had evidence of neurotoxic manifestations. [30][31][32][33][34][35][36]81,85,92 Of these cases, none developed symptoms of neurological dysfunction with cobalt levels below 20 μg/L, and only three had reported peak cobalt concentrations of < 100 μg/L. 35,36,92 The most common neurological symptoms were paraesthesia, tinnitus, and visual loss.…”

Section: Neurologicalmentioning

confidence: 99%

Systemic cobalt toxicity from total hip arthroplasties

Cheung

Banerjee

Cherian

et al. 2016

The Bone & Joint Journal

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“… 21–23 For example, cobalt and chromium particles disrupt cells locally and have been implicated in systemic disorders such as hypothyroidism, cardiomyopathy, or neuroocular disease. 19 , 20 , 24 , 25 Although titanium alloys are thought to be biologically inert, 26 they may be a source of titanium dioxide (TiO 2 ) particles that influence human cells. The potential effects of TiO 2 particles need to be further investigated, particularly in the microenvironment of mesenchymal skeletal repair cells within synovial joints, where the largest titanium implants are typically applied.…”

Section: Introductionmentioning

confidence: 99%

Local Cellular Responses to Titanium Dioxide from Orthopedic Implants

Yao

Lewallen

Trousdale

et al. 2017

BioResearch Open Access

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We evaluated recently published articles relevant to the biological effects of titanium dioxide (TiO2) particles on local endogenous cells required for normal bone homeostasis, repair, and implant osseointegration. Structural characteristics, size, stability, and agglomeration of TiO2 particles alter the viability and behavior of multiple bone-related cell types. Resulting shifts in bone homeostasis may increase bone resorption and lead to clinical incidents of osteolysis, implant loosening, and joint pain. TiO2 particles that enter cells (through endocytosis or Trojan horse mechanism) may further disrupt implant retention. We propose that cellular responses to titanium-based nanoparticles contribute to pathological mechanisms underlying the aseptic loosening of titanium-based metal implants.

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Hip-implant related chorio-retinal cobalt toxicity

Cited by 39 publications

References 5 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

Systemic cobalt toxicity from total hip arthroplasties

Local Cellular Responses to Titanium Dioxide from Orthopedic Implants

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