Neuropsychiatric symptoms following metal-on-metal implant failure with cobalt and chromium toxicity

Green, Ben; Griffiths, Emily; Almond, Solomon

doi:10.1186/s12888-016-1174-1

Cited by 63 publications

(52 citation statements)

References 30 publications

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“…[4] Nominal cobalt exposure from wear or corrosion of modular CoCr implants or CoCr articular surfaces can cause a subtler presentation of neurologic, psychiatric, and constitutional maladies, easily confused with aging, and similar to the vocational manganese toxicity. [4,12,14,15] F-18 FDG PET brain imaging has become instrumental in early detection and monitoring of neurodegenerative disease. [16][17][18][19][20][21] In 1991, Callender utilized visual interpretation of SPECT and PET imaging to identify regions of brain injury from exposure to organic solvents.…”

Section: Introductionmentioning

confidence: 99%

F-18 FDG PET brain imaging in symptomatic arthroprosthetic cobaltism

Bridges¹,

Cho

Beck

et al. 2019

Eur J Nucl Med Mol Imaging

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Purpose Imaging studies of cobalt toxicity from cobalt-chromium alloy arthroprosthetics have focused on the local intra-articular and peri-articular presentation from failing joint replacements. Most studies investigating neurological findings have been small case series focused on the clinical findings of memory loss, diminished executive function, tremor, hearing and vision loss, depression, and emotional lability. This study utilizes software-based quantitative analysis of brain metabolism to assess the degree of hypometabolism and areas of susceptibility, determine if a pattern of involvement exists, and measure reversibility of findings after prosthetic revision to cobalt-free appliances. Methods Over 48 months, 247 consecutive patients presenting to an orthopedic clinic with an arthroprosthetic joint containing any cobalt-chromium part were screened with whole blood and urine cobalt levels. A clinically validated inventory of 10 symptoms was obtained. Symptomatic patients with a blood cobalt level above 0.4 mcg/L or urine cobalt greater than 1 mcg/ L underwent F-18 FDG PET brain imaging. Analysis was performed with FDA-approved quantitative brain analysis software with the pons as the reference region. Control group was the normal brain atlas within the software. Results Of the 247 consecutively screened patients, 123 had blood and urine cobalt levels above the threshold. The 69 scanned patients had statistically significant regional hypometabolism and higher symptoms inventory. Fifty-seven patients were retained in the study. Distribution of hypometabolism was in descending order: temporal, frontal, Broca's areas, anterior cingulate, parietal, posterior cingulate, visual, sensorimotor, thalamic, and lastly caudate. Metal-on-metal (MoM) and metal-on-plastic (MoP) joint replacements produced similar patterns of hypometabolism. Of 15 patients with necessary revision surgery, 8 demonstrated improved metabolism when later re-scanned. Conclusion All scanned patients had regions of significant hypometabolism. Neurological toxicity from elevated systemic cobalt levels following arthroprosthetic joint replacement has a pattern of regional susceptibility similar to heavy metals and solvents, differing from classical dementias and may occur at blood and urine cobalt levels as low as 0.4 mcg/L and 1 mcg/L, respectively. Presently accepted thresholds for cobalt exposure and monitoring may need revision. Quantitative F-18 FDG PET brain imaging may aid in the decision process for treatment options and timing of possible medical versus surgical intervention.

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Section: Introductionmentioning

confidence: 99%

F-18 FDG PET brain imaging in symptomatic arthroprosthetic cobaltism

Bridges¹,

Cho

Beck

et al. 2019

Eur J Nucl Med Mol Imaging

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show abstract

“…In addition, cobalt can cause systemic toxicity, which can result in serious consequences like blindness, hearing loss, memory loss and cardiomyopathy; cardiomyopathy has caused death in 2 patients. [9][10][11][12][13][14][15] Therefore, accurate measurement of cobalt ion levels in this rare but serious situation is key.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, acute systemic toxic effects of chromium ions can result in renal, hematological, hepatobiliary and respiratory disorders, and chronic elevated chromium ion levels are known to be allergenic and carcinogenic. 6,15 Similarly, elevated levels of cobalt ions can present with polycythemia, hypothyroidism, cardiomyopathy and neurologic manifestations such as parasthesia, numbness, memory loss, vision loss and hearing loss. [9][10][11][12][13][14][15] Although there was good correlation for the results of both chromium and cobalt ion testing between the 2 laboratories in the current study, the absolute value for both analytes differed substantially at higher concentrations.…”

Section: Discussionmentioning

confidence: 99%

Concordance between laboratories in metal ion testing in patients with metal-on-metal hip implants

Saini

Railton

Boyd³

et al. 2019

cjs

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RESEARCH • RECHERCHE Concordance between laboratories in metal ion testing in patients with metal-on-metal hip implantsBackground: Testing of whole blood or serum metal ion levels has become an important part of assessing and monitoring the performance of metal-on-metal bearings, both in hip resurfacing arthroplasty and in total hip replacement. The aim of this study was to determine the concordance between 2 laboratories testing cobalt and chromium ion levels in patients with metal-on-metal bearings.Methods: Serum and whole blood samples from patients who had undergone metalon-metal resurfacing or large-diameter total hip arthroplasty were tested for cobalt and chromium ions in laboratory A (a recognized laboratory) and laboratory B (tasked with testing clinical specimens). Laboratory A performed cobalt and chromium testing on whole blood, and laboratory B performed cobalt testing on whole blood and chromium testing on serum. Results:Samples from 104 patients were tested. Laboratory B reported lower whole blood cobalt levels than laboratory A. Furthermore, laboratory A reported that all patients had elevated whole blood cobalt ion levels compared to the normal reference values for the laboratory, whereas laboratory B reported that 46 patients (44.2%) had whole blood cobalt ion levels within the normal reference range for the laboratory. Conclusion:This comparative study highlights the importance of using a single laboratory for metal ion testing, as values generated from different laboratories may not be directly comparable. With recent literature suggesting that whole blood cobalt levels as low as 1 ppb may be a predictor of adverse reactions to metal debris, accurate clinical measurement needs to be increasingly exact.

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“…Chromium is a transition element whose teratogenicity and carcinogenicity has been demonstrated (Green, Griffiths, & Almond, ). Breastfeeding rats were administered with chromium (50 ppm) and RSV (10 mg·kg·day, b.w, p.o.…”

Section: Chemical‐induced Toxicitymentioning

confidence: 99%

Protective effects of Vitis vinifera (grapes) and one of its biologically active constituents, resveratrol, against natural and chemical toxicities: A comprehensive review

Tabeshpour

Mehri

Behbahani

et al. 2018

Phytotherapy Research

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Vitis vinifera (grape) is one of the "most-produced fruit" in the world. Grape seeds are a valuable source of phenolic compounds including resveratrol (RSV). Grape and one of its biologically active constituents, RSV, exert their protective effects against different natural or chemical toxins which could alter physiological homeostasis through a variety of mechanisms. Some of these mechanisms of actions include increase in superoxide dismutase, hemeoxygenase-1, and glutathione peroxidase activities and reduced glutathione content and decrease in malondialdehyde (MDA) levels and activation of the nuclear erythroid2-related factor2/ARE pathway. There are also various reports of the potential use of such compounds in preventing different ailments including cardiovascular diseases, cancer, degenerative diseases, and inflammatory disorders. Therefore, in this review, we have investigated the possible protective effects of grape and one of its biologically active constituents, RSV, on different organs' toxicity induced by natural toxins (such as mycotoxins, lipopolysaccharide, and triptolide) and chemical toxins (such as antitumors, metals, and carbon tetrachloride). There are insufficient clinical trials on this subject, so our review only includes in vivo and in vitro studies. To establish the grape beneficial effects in human intoxication, more clinical trials need to be accomplished.

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Neuropsychiatric symptoms following metal-on-metal implant failure with cobalt and chromium toxicity

Cited by 63 publications

References 30 publications

F-18 FDG PET brain imaging in symptomatic arthroprosthetic cobaltism

F-18 FDG PET brain imaging in symptomatic arthroprosthetic cobaltism

Concordance between laboratories in metal ion testing in patients with metal-on-metal hip implants

Protective effects of Vitis vinifera (grapes) and one of its biologically active constituents, resveratrol, against natural and chemical toxicities: A comprehensive review

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