Myocardial Cobalt Levels Are Elevated in the Setting of Total Hip Arthroplasty

Wyles, Cody C.; Wright, Thomas C.; Bois, Melanie C.; Amin, Shahrier; Fayyaz, Ahmed U.; Jenkins, Sarah M.; Wyles, Saranya P.; Day, Patrick L.; Murray, David; Trousdale, Robert T.; Anavekar, Nandan S.; Edwards, William D.; Maleszewski, Joseph J.

doi:10.2106/jbjs.17.00159

Cited by 22 publications

(15 citation statements)

References 28 publications

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“…In addition, these cobalt levels were 69% higher in patients who had undergone THA revision than in those who underwent primary THA. [ 28 ] This further supports the results from our large cohort where patients with later revision of their artificial joint suffer more cardiac events and the mechanism for this finding can thus have several explanations. In addition, the findings presented in the current study are consistent with the previously reported incidence of admissions to hospital care due to cardiovascular reasons in THA patients and matched control individuals.…”

Section: Discussionsupporting

confidence: 88%

Aseptic loosening after total hip arthroplasty and the risk of cardiovascular disease: A nested case-control study

et al. 2018

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BackgroundPatients with surgically treated osteoarthritis of the hip have an increased risk of cardiovascular morbidity and mortality many years after the operation compared with controls. Our hypothesis is that this increased risk after total hip arthroplasty (THA) is mediated by development of periprosthetic osteolysis leading to aseptic loosening of the implant.MethodsWe conducted a nation-wide, nested, case-control study consisting of patients receiving a cemented THA due to osteoarthritis between the years 1992 and 2005. Our study population included a total of 14,430 subjects identified in the Swedish hip arthroplasty register and linked to the Swedish National Patient Register. The case group consisted of patients (n = 2,886) who underwent reoperation of the treated hip due to osteolysis or aseptic loosening at any time within five years after the index surgery. Each case was matched with four controls (n = 11,544) who had not undergone reoperation. The main outcomes were cardiovascular events i.e. myocardial infarction, heart failure and cerebral infarction according to ICD-codes and time to the first cardiovascular event during the exposure period. Outcomes were subgrouped into cardiac and cerebral events. We used regression models to calculate the incidence rates and adjusted our results for confounders.FindingsOverall, 5.1% of patients had cardiac events, with slightly more overall cardiovascular events occurring in the control group (8.1% vs. 6.7%, odds ratio 0.8, 95% confidence interval (CI) 0.7 to 1.0). After adjusting for confounders, the case group had an increased relative risk of 1.3 (95% confidence interval (CI) 1.1 to 1.3) for total number of cardiovascular events. Similar effect sizes were observed for time to first event.InterpretationPatients with osteoarthritis who received THA and subsequently underwent a revision operation due to loosening had a higher relative risk of developing cardiovascular events than controls. Thus there is an association which could be explained by a common inflammatory disease pathway that requires further experimental research.

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Section: Discussionsupporting

confidence: 88%

Aseptic loosening after total hip arthroplasty and the risk of cardiovascular disease: A nested case-control study

et al. 2018

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“…Median cardiac Co and Cr level was 0.35 (range, 0.31-0.91) and 0.14 (range, 0.06-0.30) µg/g dry tissue, respectively, and did not differ significantly based on femoral stem material (CoCr vs Ti) or between fixation methods (cemented vs uncemented). The median cardiac Co load was mildly elevated (normal: 0.06 µg/g [27]).…”

Section: Icp-msmentioning

confidence: 99%

Synchrotron analysis of human organ tissue exposed to implant material

Swiatkowska

Mosselmans

Geraki

et al. 2018

Journal of Trace Elements in Medicine and Biology

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“…An autopsy study from the Mayo Clinic found significantly higher median myocardial concentrations of cobalt in individuals who were post-THA compared with controls 9 . The majority, however, were below those seen in case reports of death from cobalt cardiotoxicity associated with metal-onmetal prostheses.…”

Section: Cardiotoxicitymentioning

confidence: 97%

“…J Arthroplasty. 2017 Sep;32 (9):2744-7. Epub 2017 Apr 13. This retrospective study presented 10-year follow-up results of a randomized trial including 71 patients who had undergone 2-incision or mini-posterior THA.…”

Section: Evidence-based Orthopaedicsmentioning

confidence: 99%