Systemic toxicity related to metal hip prostheses

Abstract

Rarely, patients exposed to high circulating concentrations of cobalt from failed hip replacements develop neurological damage, hypothyroidism and/or cardiomyopathy, which may not resolve completely even after removal of the prosthesis. The greatest risk of systemic cobalt toxicity seems to result from accelerated wear of a cobalt-containing revision of a failed ceramic prosthesis, rather than from primary failure of a metal-on-metal prosthesis.

Morphology and Dissolution Rate of Wear Debris from Silicon Nitride Coatings

“…[16][17][18][19] It should be noted, however, that ceramic debris, while scarce, could be abrasive, and hence increase the wear of other implant parts as well as any following revision prostheses. 20 Hip simulator studies have also investigated CoCr parts coated with titanium nitride and chromium nitride (TiNoTiN and CrNoCrN), where the debris was generally less than 30 nm in size, with some shards greater than 100 nm. 21 Ceramic coatings on metallic implants could be beneficial both in a hard-on-hard (coating against coating or against a ceramic) and a hard-on-soft (coating against HXLPE) setting, since they would give: 1) a hard, wear-resistant surface, on a tough bulk material (i.e.…”

Les prothèses de hanche au cobalt sont-elles dangereuses ?

“…Ces effets indésirables ont été constatés en moyenne 41 mois après l'implantation de la prothèse et étaient associés à une cobaltémie moyenne de 324 μg/l, bien que quatre patients présentaient un taux de cobalt inférieur à 20 μg/l [22]. Les manifestations de toxicité systémique qui ne surviennent généralement pas au-dessous de 100 μg/l, voire 300 μg/l de cobalt sanguin, apparaissent d'abord sous forme de troubles hématologiques et thyroïdiens [23,24]. Si la cobaltémie est supérieure à 700 μg/l, le risque d'effets systémiques neurologiques et cardiaques augmente [25].…”

“…Si la cobaltémie est supérieure à 700 μg/l, le risque d'effets systémiques neurologiques et cardiaques augmente [25]. Après le retrait de la prothèse chez les patients intoxiqués par le cobalt, l'état clinique s'améliore même si certains symptômes peuvent persister [22,24]. Plusieurs études ont démontré que le risque cancérogène n'est pas significativement différent de celui de la population générale [7,26].…”

Management of metal-on-metal hip implant patients: Who, when and how to revise?

“…Several cases of systemic effects from metal hip implants have been reported, including cardiac, endocrine, neurological and dermatological complications, however this remains a relatively rare occurrence [44] . There is a mixture of cases reported in both fractured ceramic hips and in primary MOM hip patients [44] .…”