Systemic cobalt toxicity from total hip arthroplasties

Cheung, Angela; Banerjee, Samik; Cherian, Jeffrey J.; Wong, Florence; Butany, Jagdish; Gilbert, Cameron; Overgaard, Christopher B.; Syed, Khalid; Zywiel, Michael G.; Jacobs, Joshua J.; Mont, Michael A.

doi:10.1302/0301-620x.98b1.36374

Cited by 99 publications

(45 citation statements)

References 81 publications

(124 reference statements)

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“…Cobalt is a trace metal element that is essential for the production of cobalamin permitting normal cellular function; however, in excess levels it may cause cellular damage: apoptosis, necrosis, and oxidative damage to DNA [1]. Cobalt toxicity first became evident following use of cobalt-chloride as a haematopoietic agent in anaemic individuals when it was noted to be goitrogenic [2, 3] and neurotoxic [3].…”

Section: Discussionmentioning

confidence: 99%

“…The tribological aspect describes the mechanical behaviour causing wear and tear, whilst corrosion refers to the electrochemical component of the process. Cobalt, once released into the systemic circulation, exists as a bivalent or trivalent nanoparticle and has a cytotoxicity profile similar to other nanoparticles (producing neuronal, cardiomyocyte, and thyroid damage through apoptosis, necrosis, and DNA damage) [1]. Numerous cobalt-containing nanoparticles have been identified through hip MoM simulations; however the exact biochemical mechanism through which they are produced remains unclear [6].…”

Section: Discussionmentioning

confidence: 99%

“…Atrial fibrillation and flutter and pericardial effusion have also been linked [1]. The pathophysiology is ill-defined but decreased oxygen uptake resulting in increased intracellular cardiomyocyte calcium levels and sympathetic tone has been suggested [9].…”

Section: Discussionmentioning

confidence: 99%

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Cobalt Cardiomyopathy Secondary to Hip Arthroplasty: An Increasingly Prevalent Problem

Tilney

Burg

Sammut

2017

Case Reports in Cardiology

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A forty-year-old man experienced worsening heart failure four years following bilateral complicated total hip replacement. His condition was extensively worked up but no underlying pathology was immediately evident. Given the cobalt-chromium alloy component present in the hip arthroplasties, the raised cobalt blood levels, and a fitting clinical picture coupled with radiological findings, the patient underwent right hip revision. Evidence of biotribocorrosion was present on direct visualisation intraoperatively. The patient subsequently experienced symptomatic improvement (NYHA class III to class I) and echocardiography showed recovery of ejection fraction. Cobalt exists as a bivalent and trivalent molecule in circulation and produces a cytotoxicity profile similar to nanoparticles, causing neurological, thyroid, and cardiological pathology. Blood levels are not entirely useful as there is no identifiable conversion factor for levels in whole blood, serum, and erythrocytes which seem to act independently of each other. Interestingly cobalt cardiomyopathy is frequently compounded by other possible causes of cardiomyopathy such as alcohol and a link has been postulated. Definitive treatment is revision of the arthroplasty as other treatments are unproven.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Cobalt Cardiomyopathy Secondary to Hip Arthroplasty: An Increasingly Prevalent Problem

Tilney

Burg

Sammut

2017

Case Reports in Cardiology

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“…The development of systemic cobalt toxicity after total hip arthroplasty (THA) appears to be very rare [1, 2]. Case reports have highlighted systemic cobalt toxicity after failed metal-on-metal (MoM) articulations [1, 3, 4].…”

Section: Introductionmentioning

confidence: 99%

“…Case reports have highlighted systemic cobalt toxicity after failed metal-on-metal (MoM) articulations [1, 3, 4]. Therefore, most practicing orthopedic surgeons probably associate systemic cobalt toxicity only with MoM bearings.…”

Section: Introductionmentioning

confidence: 99%

Fatal Cobalt Toxicity after a Non-Metal-on-Metal Total Hip Arthroplasty

Peters

Willemse

Rijk

et al. 2017

Case Reports in Orthopedics

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This case illustrates the potential for systemic cobalt toxicity in non-metal-on-metal bearings and its potentially devastating consequences. We present a 71-year-old male with grinding sensations in his right hip following ceramic-on-ceramic total hip arthroplasty (THA). After diagnosing a fractured ceramic liner, the hip prosthesis was revised into a metal-on-polyethylene bearing. At one year postoperatively, X-rays and MARS-MRI showed a fixed reversed hybrid THA, with periarticular densities, flattening of the femoral head component, and a pattern of periarticular metal wear debris and pseudotumor formation. Before revision could take place, the patient was admitted with the clinical picture of systemic cobalt toxicity, supported by excessively high serum cobalt and chromium levels, and ultimately died. At autopsy dilated cardiomyopathy as cause of death was hypothesized. A third body wear reaction between ceramic remnants and the metal femoral head very likely led to excessive metal wear, which contributed systemic cobalt toxicity leading to neurotoxicity and heart failure. This case emphasizes that fractured ceramic-on-ceramic bearings should be revised to ceramic-on-ceramic or ceramic-on-polyethylene bearings, but not to metal-on-polyethylene bearings. We aim to increase awareness among orthopedic surgeons for clinical clues for systemic cobalt intoxication, even when there is no metal-on-metal bearing surface.

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Long-term Cognitive Trajectory After Total Joint Arthroplasty

et al. 2022

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ImportanceIndividuals with total joint arthroplasty (TJA) have long-term exposure to metal-containing implants; however, whether long-term exposure to artificial implants is associated with cognitive function is unknown.ObjectiveTo compare long-term cognitive trajectories in individuals with and without TJA.Design, Setting, and ParticipantsThis population-based cohort study assessed serial cognitive evaluations of 5550 participants (≥50 years of age) from the Mayo Clinic Study of Aging between November 1, 2004, and December 31, 2020.ExposuresTotal joint arthroplasty of the hip or the knee.Main Outcomes and MeasuresLinear mixed-effects models were used to compare the annualized rate of change in global and domain-specific cognitive scores in participants with and without TJA, adjusting for age, sex, educational level, apolipoprotein E ε4 carrier status, and cognitive test practice effects.ResultsA total of 5550 participants (mean [SD] age at baseline, 73.04 [10.02] years; 2830 [51.0%] male) were evaluated. A total of 952 participants had undergone at least 1 TJA of the hip (THA, n = 430) or the knee (TKA, n = 626) before or after entry into the cohort. Participants with TJA were older, more likely to be female, and had a higher body mass index than participants without TJA. No difference was observed in the rate of cognitive decline in participants with and without TJA until 80 years of age. A slightly faster cognitive decline at 80 years or older and more than 8 years from surgery was observed (b = −0.03; 95% CI, −0.04 to −0.02). In stratified analyses by surgery type, the faster decline was observed primarily among older participants with TKA (b = −0.04; 95% CI, −0.06 to −0.02).Conclusions and RelevanceIn this cohort study, long-term cognitive trajectories in individuals with and without TJA were largely similar except for a slightly faster decline among the oldest patients with TKA; however, the magnitude of difference was small and of unknown clinical significance.

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Systemic cobalt toxicity from total hip arthroplasties

Cited by 99 publications

References 81 publications

Cobalt Cardiomyopathy Secondary to Hip Arthroplasty: An Increasingly Prevalent Problem

Cobalt Cardiomyopathy Secondary to Hip Arthroplasty: An Increasingly Prevalent Problem

Fatal Cobalt Toxicity after a Non-Metal-on-Metal Total Hip Arthroplasty

Long-term Cognitive Trajectory After Total Joint Arthroplasty

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