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Vielee ST, Isibor J, Buchanan WJ, Roof SH, Patel M, Meaza I, Williams A, Toyoda JH, Lu H, Wise SS, Kouokam JC, Young Wise J, Abouiessa AM, Cai J, Cai L, Wise JP. Employing a Toxic Aging Coin approach to assess hexavalent chromium (Cr[VI])-induced neurotoxic effects on behavior: Heads for age differences. Toxicol Appl Pharmacol 2024; 489:117007. [PMID: 38901695 PMCID: PMC11342792 DOI: 10.1016/j.taap.2024.117007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/05/2024] [Accepted: 06/14/2024] [Indexed: 06/22/2024]
Abstract
We are facing a rapidly growing geriatric population (65+) that will live for multiple decades and are challenged with environmental pollution far exceeding that of previous generations. Consequently, we currently have a poor understanding of how environmental pollution will impact geriatric health distinctly from younger populations. Few toxicology studies have considered age differences with geriatric individuals. Critically, all top ten most prevalent age-related diseases are linked to metal exposures. Hexavalent chromium [Cr(VI)] is a metal of major environmental health concern that can induce aging phenotypes and neurotoxicity. However, there are many knowledge gaps for Cr(VI) neurotoxicity, including how Cr(VI) impacts behavior. To address this, we exposed male rats across three ages (3-, 7-, and 18-months old) to Cr(VI) in drinking water (0, 0.05, 0.1 mg/L) for 90 days. These levels reflect the maximum contaminant levels determined by the World Health Organization (WHO) and the U.S. Environmental Protection Agency (US EPA). Here, we report how these Cr(VI) drinking water levels impacted rat behaviors using a battery of behavior tests, including grip strength, open field assay, elevated plus maze, Y-maze, and 3-chamber assay. We observed adult rats were the most affected age group and memory assays (spatial and social) exhibited the most significant effects. Critically, the significant effects were surprising as rats should be particularly resistant to these Cr(VI) drinking water levels due to the adjustments applied in risk assessment from rodent studies to human safety, and because rats endogenously synthesize vitamin C in their livers (vitamin C is a primary reducer of Cr[VI] to Cr[III]). Our results emphasize the need to broaden the scope of toxicology research to consider multiple life stages and suggest the current regulations for Cr(VI) in drinking water need to be revisited.
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Affiliation(s)
- Samuel T Vielee
- Pediatric Research Institute, the Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40292, USA; Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40292, USA
| | - Jessica Isibor
- Pediatric Research Institute, the Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40292, USA
| | - William J Buchanan
- Pediatric Research Institute, the Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40292, USA
| | - Spencer H Roof
- Pediatric Research Institute, the Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40292, USA
| | - Maitri Patel
- Pediatric Research Institute, the Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40292, USA
| | - Idoia Meaza
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40292, USA
| | - Aggie Williams
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40292, USA
| | - Jennifer H Toyoda
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40292, USA
| | - Haiyan Lu
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40292, USA
| | - Sandra S Wise
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40292, USA
| | - J Calvin Kouokam
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40292, USA
| | - Jamie Young Wise
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40292, USA
| | | | - Jun Cai
- Pediatric Research Institute, the Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40292, USA; Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40292, USA
| | - Lu Cai
- Pediatric Research Institute, the Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40292, USA; Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40292, USA
| | - John P Wise
- Pediatric Research Institute, the Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40292, USA; Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40292, USA.
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Ajibo DN, Orish CN, Ruggieri F, Bocca B, Battistini B, Frazzoli C, Orish FC, Orisakwe OE. An Update Overview on Mechanistic Data and Biomarker Levels in Cobalt and Chromium-Induced Neurodegenerative Diseases. Biol Trace Elem Res 2024; 202:3538-3564. [PMID: 38017235 DOI: 10.1007/s12011-023-03965-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/12/2023] [Indexed: 11/30/2023]
Abstract
There is increasing evidence that the imbalance of metals as cobalt (Co) and chromium (Cr) may increase the risk of development and progression of neurodegenerative diseases (NDDs). The human exposure to Co and Cr is derived mostly from industry, orthopedic implants, and polluted environments. Neurological effects of Co and Cr include memory deficit, olfactory dysfunction, spatial disorientation, motor neuron disease, and brain cancer. Mechanisms of Co and Cr neurotoxicity included DNA damage and genomic instability, epigenetic changes, mitochondrial disturbance, lipid peroxidation, oxidative stress, inflammation, and apoptosis. This paper seeks to overview the Co and Cr sources, the mechanisms by which these metals induce NDDs, and their levels in fluids of the general population and patients affected by NDDs. To this end, evidence of Co and Cr unbalance in the human body, mechanistic data, and neurological symptoms were collected using in vivo mammalian studies and human samples.
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Affiliation(s)
- Doris Nnena Ajibo
- Department of Experimental Pharmacology & Toxicology, Faculty of Pharmacy, University of Port Harcourt, PMB, 5323, Port Harcourt, Rivers State, Nigeria
| | - Chinna Nneka Orish
- Department of Anatomy, College of Health Sciences University of Port Harcourt, PMB, 5323, Port Harcourt, Rivers State, Nigeria
| | - Flavia Ruggieri
- Department of Environment and Health, Istituto Superiore Di Sanità, Rome, Italy
| | - Beatrice Bocca
- Department of Environment and Health, Istituto Superiore Di Sanità, Rome, Italy
| | - Beatrice Battistini
- Department of Environment and Health, Istituto Superiore Di Sanità, Rome, Italy
| | - Chiara Frazzoli
- Department for Cardiovascular, Endocrine-Metabolic Diseases, and Aging, Istituto Superiore Di Sanità, Rome Viale Regina Elena, 29900161, Rome, Italy
| | | | - Orish E Orisakwe
- Department of Experimental Pharmacology & Toxicology, Faculty of Pharmacy, University of Port Harcourt, PMB, 5323, Port Harcourt, Rivers State, Nigeria.
- African Centre of Excellence for Public Health and Toxicological Research (ACE-PUTOR), University of Port Harcourt, PMB, 5323, Port Harcourt, Rivers State, Nigeria.
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3
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Zhong Q, Pan X, Chen Y, Lian Q, Gao J, Xu Y, Wang J, Shi Z, Cheng H. Prosthetic Metals: Release, Metabolism and Toxicity. Int J Nanomedicine 2024; 19:5245-5267. [PMID: 38855732 PMCID: PMC11162637 DOI: 10.2147/ijn.s459255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/13/2024] [Indexed: 06/11/2024] Open
Abstract
The development of metallic joint prostheses has been ongoing for more than a century alongside advancements in hip and knee arthroplasty. Among the materials utilized, the Cobalt-Chromium-Molybdenum (Co-Cr-Mo) and Titanium-Aluminum-Vanadium (Ti-Al-V) alloys are predominant in joint prosthesis construction, predominantly due to their commendable biocompatibility, mechanical strength, and corrosion resistance. Nonetheless, over time, the physical wear, electrochemical corrosion, and inflammation induced by these alloys that occur post-implantation can cause the release of various metallic components. The released metals can then flow and metabolize in vivo, subsequently causing potential local or systemic harm. This review first details joint prosthesis development and acknowledges the release of prosthetic metals. Second, we outline the metallic concentration, biodistribution, and elimination pathways of the released prosthetic metals. Lastly, we discuss the possible organ, cellular, critical biomolecules, and significant signaling pathway toxicities and adverse effects that arise from exposure to these metals.
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Affiliation(s)
- Qiang Zhong
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Xin Pan
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Yuhang Chen
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Qiang Lian
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Jian Gao
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Yixin Xu
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Jian Wang
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Zhanjun Shi
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Hao Cheng
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
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Taleb S, Varela-Mattatall G, Allen A, Haast R, Khan AR, Kalia V, Howard JL, MacDonald SJ, Menon RS, Lanting BA, Teeter MG. Assessing brain integrity in patients with long-term and well-functioning metal-based hip implants. J Orthop Res 2024; 42:1292-1302. [PMID: 38235918 DOI: 10.1002/jor.25785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/08/2023] [Accepted: 01/03/2024] [Indexed: 01/19/2024]
Abstract
Production of metal debris from implant wear and corrosion processes is now a well understood occurrence following hip arthroplasty. Evidence has shown that metal ions can enter the bloodstream and travel to distant organs including the brain, and in extreme cases, can induce sensorial and neurological diseases. Our objective was tosimultaneously analyze brain anatomy and physiology in patients with long-term and well-functioning implants. Included were subjects who had received total hip or hip resurfacing arthroplastywith an implantation time of a minimum of 7 years (n = 28) and age- and sex-matched controls (n = 32). Blood samples were obtained to measure ion concentrations of cobalt and chromium, and the Montreal Cognitive Assessment was performed. 3T MRI brain scans were completed with an MPRAGE sequence for ROI segmentation and multiecho gradient echo sequences to generate QSM and R2* maps. Mean QSM and R2* values were recorded for five deep brain and four middle and cortical brain structures on both hemispheres: pallidum, putamen, caudate, amygdala, hippocampus, anterior cingulate, inferior temporal, and cerebellum. No differences in QSM or R2* or cognition scores were found between both groups (p > 0.6654). No correlation was found between susceptibility and blood ion levels for cobalt or chromium in any region of the brain. No correlation was found between blood ion levels and cognition scores. Clinical significance: Results suggest that metal ions released by long-term and well-functioning implants do not affect brain integrity.
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Affiliation(s)
- Shahnaz Taleb
- Schulich School of Medicine & Dentistry, Imaging Group, Robarts Research Institute, Western University, London, Ontario, Canada
| | - Gabriel Varela-Mattatall
- Schulich School of Medicine & Dentistry, Imaging Group, Robarts Research Institute, Western University, London, Ontario, Canada
| | - Abbigail Allen
- Department of Surgery, London Health Sciences Centre, Division of Orthopaedic Surgery, London, Ontario, Canada
| | - Roy Haast
- Schulich School of Medicine & Dentistry, Imaging Group, Robarts Research Institute, Western University, London, Ontario, Canada
| | - Ali R Khan
- Schulich School of Medicine & Dentistry, Imaging Group, Robarts Research Institute, Western University, London, Ontario, Canada
| | - Vishal Kalia
- Department of Medical Imaging, Schulich School of Medicine & Dentistry, Division of Musculoskeletal Imaging, Western University, London, Ontario, Canada
| | - James L Howard
- Department of Surgery, London Health Sciences Centre, Division of Orthopaedic Surgery, London, Ontario, Canada
| | - Steven J MacDonald
- Department of Surgery, London Health Sciences Centre, Division of Orthopaedic Surgery, London, Ontario, Canada
| | - Ravi S Menon
- Schulich School of Medicine & Dentistry, Imaging Group, Robarts Research Institute, Western University, London, Ontario, Canada
| | - Brent A Lanting
- Department of Surgery, London Health Sciences Centre, Division of Orthopaedic Surgery, London, Ontario, Canada
| | - Matthew G Teeter
- Schulich School of Medicine & Dentistry, Imaging Group, Robarts Research Institute, Western University, London, Ontario, Canada
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Li Y, Han H, You K, Ma C, Fan X. Investigating the association between blood cobalt and gallstones: a cross-sectional study utilizing NHANES data. Front Public Health 2024; 12:1363815. [PMID: 38384872 PMCID: PMC10879586 DOI: 10.3389/fpubh.2024.1363815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 01/26/2024] [Indexed: 02/23/2024] Open
Abstract
Background With the use of cobalt alloys in medical prosthetics, the risk of cobalt exposure has increased. The objective of this study was to investigate the correlation between blood cobalt levels and the occurrence of gallstones utilizing data from the National Health and Nutrition Examination Survey (NHANES). Methods Data collected between 2017 and 2020 were analyzed, encompassing a total of 5,610 participants. Cobalt concentrations in whole blood specimens were directly measured using inductively coupled plasma mass spectrometry (ICP-MS). The presence of gallstones was ascertained through a standardized questionnaire. To assess the association between blood cobalt levels and the presence of gallstones, logistic regression analysis, restricted cubic spline analysis, and subgroup analysis were utilized. Results The results of logistic regression analysis revealed a heightened risk of developing gallstones in the Quartiles 2 and Quartiles 4 groups based on blood cobalt levels when compared to the Quartiles 1 group (OR = 1.54, 95% CI: 1.15-2.07; OR = 1.35, 95% CI: 1.03-1.77). The restricted cubic spline analysis exhibited a positive linear correlation between blood cobalt levels and the occurrence of gallstones. Subgroup analyses further demonstrated a statistically significant correlation between the Quartiles 4 category of blood cobalt levels and an elevated risk of gallstones, particularly among individuals aged 60 years or older, females, those with a body mass index (BMI) equal to or exceeding 25, serum total cholesterol levels below 200 mg/dL, as well as individuals diagnosed with hypertension or diabetes. Conclusion Our study findings indicate a notable association between elevated blood cobalt levels and an increased risk of gallstones. To establish a causal relationship between blood cobalt levels and the elevated risk of developing gallstones, further prospective cohort studies are warranted.
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Affiliation(s)
| | | | | | | | - Xin Fan
- Department of General Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, China
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Tower SS, Gessner BD, Cho CS, Bridges RL. The association of cobalturia with cobaltism symptoms a prospective blinded study of 229 post-arthroplasty patients. PLoS One 2023; 18:e0295203. [PMID: 38127904 PMCID: PMC10734948 DOI: 10.1371/journal.pone.0295203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/15/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION Cobalt is a mitochondrial toxin, clinical cobaltism manifests with constitutional, neurologic, and cardiovascular symptomatology. Cobalt's severe toxidrome is known through case reports from extreme wear or corrosion of cobalt-chromium arthroplasty components. However, the spectrum and epidemiology of orthopedic-implant cobaltism and its relationship to duration and degree of cobalt exposure are not well defined. METHODS The relationship of urine-cobalt concentration and duration of exposure to cobalt-chromium joint implants and cobaltism symptomatology were prospectively studied in 229 patients. Subjects received a Cobaltism-Symptom-Inventory-Score (CSIS) based on a protocolized interview and examination followed by a spot urine-cobalt measurement. RESULTS 129 (56%) subjects were cobalturic (urine-cobalt ≥1.0 ppb). 122 (53%) subjects had a CSIS of >2, this status significantly associates with cobalturia. Median [IQR] urine-cobalt in the subjects with a CSIS >2 was 4.1[1.1-17.0] ppb compared to 0.5[0.5-1.4] ppb in subjects with CSIS ≤ 2. Cobalturia has a sensitivity of 0.69, a specificity of 0.77, and a positive predictive value of 0.74 for a CSIS of >2. The product of years-exposed to a cobalt-chromium implant and urine-cobalt by quartiles significantly positively associates with the Cobaltism-Symptom-Inventory-Score. CONCLUSION A urine-cobalt of ≥1 ppb likely indicates adverse systemic exposure to orthopedic-implant generated cobalt. Cobaltism severity as quantified by the CSIS significantly correlates with the product of spot urine-cobalt concentration and years-exposed to a cobalt-chromium orthopedic-implant indicating a dose-response relationship. Medical provider and public awareness of orthopedic-implant cobaltism is vital because tens-of-millions are at-risk and early cobaltism is reversible. Further use of cobalt-chromium orthopedic-implants should be questioned given cobaltism becomes clinically apparent at a spot urine-cobalt of 1 ppb or greater. Monitoring of patients with high-risk cobalt-chromium orthopedic-implants appears to be indicated.
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Affiliation(s)
- Stephen S. Tower
- University of Alaska, Medical School, Anchorage, Alaska, United States of America
| | | | - Christina S. Cho
- University of Alaska, Medical School, Anchorage, Alaska, United States of America
| | - Robert L. Bridges
- Aegis Imaging Consultants, Girdwood, Alaska, United States of America
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Bonanni R, Abbondante L, Cariati I, Gasbarra E, Tarantino U. Metallosis after Hip Arthroplasty Damages Skeletal Muscle: A Case Report. Geriatrics (Basel) 2023; 8:92. [PMID: 37736892 PMCID: PMC10514854 DOI: 10.3390/geriatrics8050092] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023] Open
Abstract
Good musculoskeletal quality dramatically influences the outcome of an arthroplasty operation in geriatric patients, as well as is a key element for optimal osseointegration. In this context, metallosis is a complication associated with the type of prosthesis used, as implants with a chromium-cobalt interface are known to alter the bone microarchitecture and reduce the ratio of muscle to fat, resulting in lipid accumulation. Therefore, the aim of our study was to investigate possible muscle changes by histological, morphometric, and immunohistochemical analyses in a patient undergoing hip replacement revision with elevated blood and urinary concentrations of chromium and cobalt. Interestingly, the muscle tissue showed significant structural changes and a massive infiltration of adipose tissue between muscle fibers in association with an altered expression pattern of important biomarkers of musculoskeletal health and oxidative stress, such as myostatin and NADPH Oxidase 4. Overall, our results confirm the very serious impact of metallosis on musculoskeletal health, suggesting the need for further studies to adopt a diagnostic approach to identify the cause of metallosis early and eliminate it as part of the prosthesis revision surgery.
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Affiliation(s)
- Roberto Bonanni
- Department of Biomedicine and Prevention, “Tor Vergata” University of Rome, Via Montpellier 1, 00133 Rome, Italy;
| | - Lorenzo Abbondante
- Department of Orthopaedics and Traumatology, “Policlinico Tor Vergata” Foundation, Viale Oxford 81, 00133 Rome, Italy; (L.A.); (E.G.); (U.T.)
| | - Ida Cariati
- Department of Systems Medicine, “Tor Vergata” University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | - Elena Gasbarra
- Department of Orthopaedics and Traumatology, “Policlinico Tor Vergata” Foundation, Viale Oxford 81, 00133 Rome, Italy; (L.A.); (E.G.); (U.T.)
| | - Umberto Tarantino
- Department of Orthopaedics and Traumatology, “Policlinico Tor Vergata” Foundation, Viale Oxford 81, 00133 Rome, Italy; (L.A.); (E.G.); (U.T.)
- Department of Clinical Sciences and Translational Medicine, “Tor Vergata” University of Rome, Via Montpellier 1, 00133 Rome, Italy
- Centre of Space Bio-Medicine, “Tor Vergata” University of Rome, Via Montpellier 1, 00133 Rome, Italy
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Vielee ST, Wise JP. Among Gerontogens, Heavy Metals Are a Class of Their Own: A Review of the Evidence for Cellular Senescence. Brain Sci 2023; 13:500. [PMID: 36979310 PMCID: PMC10046019 DOI: 10.3390/brainsci13030500] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023] Open
Abstract
Advancements in modern medicine have improved the quality of life across the globe and increased the average lifespan of our population by multiple decades. Current estimates predict by 2030, 12% of the global population will reach a geriatric age and live another 3-4 decades. This swelling geriatric population will place critical stress on healthcare infrastructures due to accompanying increases in age-related diseases and comorbidities. While much research focused on long-lived individuals seeks to answer questions regarding how to age healthier, there is a deficit in research investigating what aspects of our lives accelerate or exacerbate aging. In particular, heavy metals are recognized as a significant threat to human health with links to a plethora of age-related diseases, and have widespread human exposures from occupational, medical, or environmental settings. We believe heavy metals ought to be classified as a class of gerontogens (i.e., chemicals that accelerate biological aging in cells and tissues). Gerontogens may be best studied through their effects on the "Hallmarks of Aging", nine physiological hallmarks demonstrated to occur in aged cells, tissues, and bodies. Evidence suggests that cellular senescence-a permanent growth arrest in cells-is one of the most pertinent hallmarks of aging and is a useful indicator of aging in tissues. Here, we discuss the roles of heavy metals in brain aging. We briefly discuss brain aging in general, then expand upon observations for heavy metals contributing to age-related neurodegenerative disorders. We particularly emphasize the roles and observations of cellular senescence in neurodegenerative diseases. Finally, we discuss the observations for heavy metals inducing cellular senescence. The glaring lack of knowledge about gerontogens and gerontogenic mechanisms necessitates greater research in the field, especially in the context of the global aging crisis.
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Affiliation(s)
- Samuel T. Vielee
- Pediatrics Research Institute, Department of Pediatrics, University of Louisville, Louisville, KY 40202, USA
- Department of Pharmacology and Toxicology, University of Louisville, Louisville, KY 40202, USA
| | - John P. Wise
- Pediatrics Research Institute, Department of Pediatrics, University of Louisville, Louisville, KY 40202, USA
- Department of Pharmacology and Toxicology, University of Louisville, Louisville, KY 40202, USA
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Microglial Activation in Metal Neurotoxicity: Impact in Neurodegenerative Diseases. BIOMED RESEARCH INTERNATIONAL 2023; 2023:7389508. [PMID: 36760476 PMCID: PMC9904912 DOI: 10.1155/2023/7389508] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/18/2023] [Accepted: 01/23/2023] [Indexed: 02/04/2023]
Abstract
Neurodegenerative processes encompass a large variety of diseases with different pathological patterns and clinical features, such as Alzheimer's and Parkinson's diseases. Exposure to metals has been hypothesized to increase oxidative stress in brain cells leading to cell death and neurodegeneration. Neurotoxicity of metals has been demonstrated by several in vitro and in vivo experimental studies, and most probably, each metal has its specific pathway to trigger cell death. As a result, exposure to essential metals, such as manganese, iron, copper, zinc, and cobalt, and nonessential metals, including lead, aluminum, and cadmium, perturbs metal homeostasis at the cellular and organism levels leading to neurodegeneration. In this contribution, a comprehensive review of the molecular mechanisms by which metals affect microglia physiology and signaling properties is presented. Furthermore, studies that validate the disruption of microglia activation pathways as an essential mechanism of metal toxicity that can contribute to neurodegenerative disease are also presented and discussed.
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Beba A, Peterson SM, Brennan PC, O’Byrne J, Machulda MM, Jannetto PI, Vemuri P, Lewallen DG, Kremers HM, Vassilaki M. Correlation of Blood Metal Concentrations with Cognitive Scores and Neuroimaging Findings in Patients with Total Joint Arthroplasty. J Alzheimers Dis 2023; 94:1335-1342. [PMID: 37393495 PMCID: PMC10481381 DOI: 10.3233/jad-221182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2023]
Abstract
Total joint arthroplasty (TJA) implants are composed of metals, ceramics, and/or polyethylene. Studies suggest that the debris released from metal implants may possess neurotoxic properties with reports of neuropsychiatric symptoms and memory deficits, which could be relevant to Alzheimer's disease and related dementias. This exploratory study examined the cross-sectional correlation of blood metal concentrations with cognitive performance and neuroimaging findings in a convenience sample of 113 TJA patients with history of elevated blood metal concentrations of either titanium, cobalt and/or chromium. Associations with neuroimaging measures were observed but not with cognitive scores. Larger studies with longitudinal follow-up are warranted.
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Affiliation(s)
- Alican Beba
- George Washington University, Columbian College of Arts and Sciences, Washington, DC, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Peter C. Brennan
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jamie O’Byrne
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Mary M. Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Paul I. Jannetto
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Hilal Maradit Kremers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Maria Vassilaki
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
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Vassilaki M, Kremers WK, Machulda MM, Knopman DS, Petersen RC, Laporta ML, Berry DJ, Lewallen DG, Maradit Kremers H. Long-term Cognitive Trajectory After Total Joint Arthroplasty. JAMA Netw Open 2022; 5:e2241807. [PMID: 36374499 PMCID: PMC9664257 DOI: 10.1001/jamanetworkopen.2022.41807] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Individuals 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. OBJECTIVE To compare long-term cognitive trajectories in individuals with and without TJA. DESIGN, SETTING, AND PARTICIPANTS This 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. EXPOSURES Total joint arthroplasty of the hip or the knee. MAIN OUTCOMES AND MEASURES Linear 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. RESULTS A 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 RELEVANCE In 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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Affiliation(s)
- Maria Vassilaki
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Walter K Kremers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | | | - Ronald C Petersen
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Mariana L Laporta
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - David G Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Hilal Maradit Kremers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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12
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Hanawa T. Biocompatibility of titanium from the viewpoint of its surface. SCIENCE AND TECHNOLOGY OF ADVANCED MATERIALS 2022; 23:457-472. [PMID: 35990790 PMCID: PMC9389932 DOI: 10.1080/14686996.2022.2106156] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/19/2022] [Indexed: 06/15/2023]
Abstract
Among metals, Ti and majority of its alloys exhibit excellent biocompatibility or tissue compatibility. Although their high corrosion resistance is a factor in the biocompatibility of Ti and Ti alloys, it is clear that other factors exist. In this review, the corrosion resistance and passive film of Ti are compared to those of other metallic biomaterials, and their band gap energies, Egs, are compared to discuss the role of Eg in the reactivity with living tissues. From the perspective of the material's surface, it is possible to explain the excellent biocompatibility of Ti by considering the following factors: Ti ions are immediately stabilized not to show toxicity if it is released to body fluids; good balance of positive and negative charges by the dissociation of surface hydroxyl groups on the passive film; low electrostatic force of the passive film inducing a natural adsorption of proteins maintaining their natural conformation; strong property as n-type semiconductor; lower band gap energy of the passive film on Ti generating optimal reactivity; and calcium phosphate formation is caused by this reactivity. The results suggest that due to the passive oxide film, the optimal balance between high corrosion resistance and appropriate reactivity of Ti is the predominate solution for the excellent biocompatibility of Ti.
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Affiliation(s)
- Takao Hanawa
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, Tokyo, Japan
- Center for Advanced Medical Engineering Research and Development, Kobe University, Kobe, Japan
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, Osaka, Japan
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13
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Abdel Hamid OI, Attia ME, Hirshon JM, El-Shinawi M, El-Hussaini M, El-Setouhy M. Psychiatric Disorders and Genotoxicity Following Primary Metal on Polyethylene Total Hip Arthroplasty and Their Correlation to Cobalt/Chromium Levels. Drug Healthc Patient Saf 2022; 14:97-111. [PMID: 35880007 PMCID: PMC9308046 DOI: 10.2147/dhps.s360643] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 07/04/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Hip arthroplasty (HA) using implantable metal components is among the commonest orthopedic interventions. However, it can be followed by several complications following corrosion and the release of metal ions. Several studies proved that damaged genomic DNA may contribute to the pathophysiology of mental disorders. Aim The current work aims to evaluate the psychiatric disorders in metal on polyethylene hip arthroplasty (MOP-HA) patients and its correlation to cobalt/chromium (Co/Cr) levels and genotoxicity. Methods The work was a longitudinal follow-up study including 34 adults with unilateral primary MOP-HA meeting the inclusion and exclusion criteria. Preoperatively, 6, 12-months-postoperatively, patients were examined for cognitive impairment using mini-mental-state-examination (MMSE), depression using major-depressive-inventory (MDI), and blood samples were collected for estimation of Co/Cr, detection of genotoxicity by single-cell-gel-electrophoresis (comet assay) and serum 8-hydroxy-2'-deoxyguanosine (8-OHdG). Results Cognitive impairment was reported in 18.5% and 14.8% at 6-months, and 12-months postoperative, respectively. Depressive disorder was recorded in 22.2% at 6-months and 14.8% at 12-months postoperative. The marginal homogeneity tests proved a non-significant difference. There was a non-significant difference in preoperative, 6-months, 12-months postoperative MMSE, and MDI scores. There were significantly increased Co/Cr levels at 6-months postoperative. The levels decreased at 12-months postoperative, however, still significantly higher than preoperative values. There was a significant increase in serum 8-OHdG and the levels were positively correlated to cobalt levels at both 6 and 12-months-postoperative. There was a non-significant difference among preoperative, 6-months, and 12-months postoperative comet assay measurements. Conclusion From previous findings, we can conclude that will-functioning MOP hip arthroplasty can induce increased ion levels and positively correlated increase in biochemical markers of genotoxicity (8-OHdG).
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Affiliation(s)
- Omaima I Abdel Hamid
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed E Attia
- Orthopedics Departments, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Jon M Hirshon
- Department of Emergency Medicine, University of Maryland, School of Medicine, Baltimore, MD, USA
- Department of Epidemiology and Public Health, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Mohamed El-Shinawi
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Galala University, Galala City, Suez, Egypt
| | - Moustafa El-Hussaini
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Maged El-Setouhy
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Department of Family and Community Medicine, Faculty of Medince, Jazan University, Jazan, Kingdom of Saudi Arabia
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14
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Wise JP, Young JL, Cai J, Cai L. Current understanding of hexavalent chromium [Cr(VI)] neurotoxicity and new perspectives. ENVIRONMENT INTERNATIONAL 2022; 158:106877. [PMID: 34547640 PMCID: PMC8694118 DOI: 10.1016/j.envint.2021.106877] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 05/21/2023]
Abstract
Hexavalent chromium [Cr(VI)] is a global environmental pollutant that increases risk for several types of cancers and is increasingly being recognized as a neurotoxicant. Traditionally, the brain has been viewed as a largely post-mitotic organ due to its specialized composition of neurons, and consequently, clastogenic effects were not considered in neurotoxicology. Today, we understand the brain is composed of at least eight distinct cell types - most of which continue mitotic activity throughout lifespan. We have learned these dividing cells play essential roles in brain and body health. This review focuses on Cr(VI), a potent clastogen and known human carcinogen, as a potentially neurotoxic agent targeting mitotic cells of the brain. Despite its well-established role as a human carcinogen, Cr(VI) neurotoxicity studies have failed to find a significant link to brain cancers. In the few studies that did find a link, Cr(VI) was identified as a risk for gliomas. Instead, in the human brain, Cr(VI) appears to have more subtle deleterious effects that can impair childhood learning and attention development, olfactory function, social memory, and may contribute to motor neuron diseases. Studies of Cr(VI) neurotoxicity with animal and cell culture models have demonstrated elevated markers of oxidative damage and redox stress, with widespread neurodegeneration. One study showed mice exposed to Cr(VI)-laden tannery effluent exhibited longer periods of aggressive behavior toward an "intruder" mouse and took longer to recognize mice previously encountered, recapitulating the social memory deficits observed in humans. Here we conducted a critical review of the available literature on Cr(VI) neurotoxicity and synthesize the collective observations to thoroughly evaluate Cr(VI) neurotoxicity - much remains to be understood and recognized.
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Affiliation(s)
- John P Wise
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40292, USA; Pediatric Research Institute, The Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40292, USA.
| | - Jamie L Young
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40292, USA; Pediatric Research Institute, The Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40292, USA
| | - Jun Cai
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40292, USA; Pediatric Research Institute, The Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40292, USA
| | - Lu Cai
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40292, USA; Pediatric Research Institute, The Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40292, USA
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15
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Ishii S, Homma Y, Matsukawa T, Baba T, Kubota A, Yokoyama K, Kaneko K, Ishijima M. Horror of three synergistic factors in THA: high mechanical stress, dissimilar metals, low elasticity stem: a case report. ARTHROPLASTY 2021; 3:39. [PMID: 35236468 PMCID: PMC8796415 DOI: 10.1186/s42836-021-00091-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 08/06/2021] [Indexed: 02/08/2023] Open
Abstract
Background A large-diameter femoral head is effective in preventing dislocation after total hip arthroplasty. However, although rare, catastrophic stem tribocorrosion may occur at the head-stem junction. Case presentation A 70-year-old woman underwent revision surgery 7.5 years after total hip arthroplasty because of catastrophic stem corrosion with dissociation of the metal head (cobalt/chromium) and stem (TiMo12Zr6Fe2). Abnormal levels of cobalt were found in the intra-articular fluid, capsule, hip muscle, and blood. Revision surgery was performed via the direct anterior approach. The well-fixed femoral stem was explanted, and a cemented stainless stem with stainless head was implanted. Three months after the revision surgery, the cobalt concentration in the blood had decreased to normal. Conclusions Stem dissociation in the present case might have been caused by synergistic combination of a 36-mm-diameter femoral head and long neck length offset with high frictional torque, a cobalt-chromium head with a high risk of galvanic corrosion, and a TMZF (TiMo12Zr6Fe2) alloy stem with a low Young’s modulus of elasticity. The combination of these factors must be avoided.
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16
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Artiaco S, Fusini F, Zoccola K, Massè A, Colzani G. Metallosis in Sequelae of Prosthetic Revision for Ceramic Components Fracture: A Case Report with Clinical Presentation Mimicking Periprosthetic Hip Infection. JOINTS 2021; 7:215-217. [PMID: 34235388 PMCID: PMC8253606 DOI: 10.1055/s-0041-1730981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 04/18/2021] [Indexed: 10/24/2022]
Abstract
Ceramic on ceramic total hip arthroplasties have been developed and widely used during last decades because of their long-term survival and biomechanical properties. One of the most dangerous complication of these implants is the fracture of the ceramic components. The management of this condition should be carefully planned and the choice of the new implant is crucial. We describe a rare case of severe hip synovitis due to massive metallosis in sequelae of mismanaged prosthetic revision for fracture of the ceramic acetabular liner with an unusual clinical presentation that simulate a periprosthetic infection.
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Affiliation(s)
- Stefano Artiaco
- Department of Orthopaedics and Traumatology, Orthopaedic and Trauma Center, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Federico Fusini
- Department of Orthopaedics and Traumatology, Orthopaedic and Trauma Center, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Kristijan Zoccola
- Department of Orthopaedics and Traumatology, Orthopaedic and Trauma Center, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Alessandro Massè
- Department of Orthopaedics and Traumatology, Orthopaedic and Trauma Center, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Giulia Colzani
- Department of Orthopaedics and Traumatology, Policlinico di Modena, Azienda Ospedaliera Universitaria, Modena, Italy
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17
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Course of Metal Ions after a Revision of Malfunctioning Metal-on-Metal Total Hip Prostheses. ACTA ACUST UNITED AC 2021; 57:medicina57020115. [PMID: 33525335 PMCID: PMC7912175 DOI: 10.3390/medicina57020115] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 12/16/2022]
Abstract
The present research evaluated the course of cobalt and chromium in the blood and urine after the revision of metal-on-metal with a ceramic-on-polyethylene total hip arthroplasty. Seven patients were enrolled for hip prosthesis revision owing to ascertained damage of the implant. Metals in the blood and urine were evaluated before and after the hip revision. The double measurement before the total hip revision revealed high levels of metal ions (on average, 88.1 µg/L of cobalt in the blood, 399.0 µg/g of creatinine cobalt in the urine, 46.8 µg/L of chromium in the blood, and 129.6 µg/g of creatinine chromium in the urine at the first measurements), with an increasing trend between the first and second dosage. Within a week after the hip revision, the levels of metal ions significantly decreased by approximately half. Four to six months after the operation, the cobalt levels were found near to the reference values, whereas the chromium levels reached 25% of the values measured before the revision. The revision of malfunctioning metal-on-metal implants produced a dramatic decrease of metal ions in biological fluids, although it did not completely rescue the chromium level.
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18
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Implant-derived CoCrMo alloy nanoparticle disrupts DNA replication dynamics in neuronal cells. Cell Biol Toxicol 2021; 37:833-847. [PMID: 33415469 DOI: 10.1007/s10565-020-09577-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/25/2020] [Indexed: 10/22/2022]
Abstract
The complexity of cobalt-chromium-molybdenum (CoCrMo) nanoparticles generated from the hip modular taper interfaces resulted in inconclusive outcomes on the level of toxicity in orthopedic patients. We used a hip simulator to generate physiologically relevant CoCrMo degradation products (DPs) to demonstrate the variation in the level of toxicity in neurons in comparison to processed degradation products (PDPs). The study outcomes indicate that DP induces a higher level of DNA damage in the form of double- and single-stranded DNA breaks and alkaline labile DNA adducts versus PDPs. The scientific advancements of this study are the following: (i) how DPs mimic more closely to the implant debris from hip implants in terms of bioactivity, (ii) how hip implant debris causes local and systemic issues, and (iii) methods to augment the biologic impact of implant debris. We discovered that DP is bioactive compared with PDP, and this should be considered in the toxicity evaluation related to implants. • The physicochemical characteristics of the CoCrMo is a major factor to consider for implant-related cytotoxicity or genotoxicity experimental design. • Elevated levels of intracellular ROS induced by the physiologically relevant wear particle are detrimental to the neuronal cells. • The DP can induce variation in DNA replication dynamics compared to PDP.
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19
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Salcan I, Dilber M, Bayram R, Suleyman E, Erhan E, Karahan Yi S, Naz Yazici G, Coban A, Suleyman H. Effect of Taxifolin on Cobalt-induced Ototoxicity in Rats: A Biochemical and Histopathological Study. INT J PHARMACOL 2020. [DOI: 10.3923/ijp.2020.522.528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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20
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Homma Y, Morikawa T, Ishii S, Baba T, Kaneko K. Bowing-head sign: rare but detectable in pre-catastrophic hip implant failure. Arch Orthop Trauma Surg 2020; 140:2085-2089. [PMID: 32940804 DOI: 10.1007/s00402-020-03609-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/09/2020] [Indexed: 11/24/2022]
Abstract
Recently, catastrophic failure (i.e., dissociation between the metal femoral head and stem due to stem neck deformation) after total hip arthroplasty (THA) has been reported. Early detection of this complication is very important, because it is accompanied by an increased cobalt concentration in the body, which might influence systemic conditions such as heart failure and immune system diseases. However, early detection of stem neck deformation is considered as difficult. In most cases in the literatures, the diagnosis was made at the time of acute dissociation. We report a case of early detection of stem neck deformation with the 'Bowing-head sign' before acute dissociation. The patient is a 71-year old woman complained of a clicking sensation in the right hip during regular follow-up after THA with a 32-mm cobalt/chromium head with polyethylene insert for osteoarthritis performed 7 years previously. The plain radiograph showed that the angle between the metal femoral head and the axis of the stem neck was not perpendicular ('Bowing-head sign'). Dynamic evaluation under fluoroscopy showed movement of the stem neck in the metal femoral head with hip abduction and adduction. Laboratory data showed abnormal serum cobalt (6.3 μg/L, normal < 1 μg/L) and chromium (3.8 μg/L, normal < 5 μg/L) levels. Considering those radiographic findings, deformation of the stem neck due to trunnionosis was diagnosed, and elective revision surgery was performed without any complications. Plain radiographs after THA should be assessed with attention to this complication, 'Bowing-head sign' must not be overlooked.
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Affiliation(s)
- Yasuhiro Homma
- Department of Orthopedic Surgery, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Takahiro Morikawa
- Department of Orthopedic Surgery, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Seiya Ishii
- Department of Orthopedic Surgery, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Tomonori Baba
- Department of Orthopedic Surgery, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kazuo Kaneko
- Department of Orthopedic Surgery, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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21
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Tang J, Zheng C, Zheng F, Li Y, Wang YL, Aschner M, Guo Z, Yu G, Wu S, Li H. Global N6-methyladenosine profiling of cobalt-exposed cortex and human neuroblastoma H4 cells presents epitranscriptomics alterations in neurodegenerative disease-associated genes. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2020; 266:115326. [PMID: 32827984 DOI: 10.1016/j.envpol.2020.115326] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 07/19/2020] [Accepted: 07/27/2020] [Indexed: 06/11/2023]
Abstract
Excessive exposure to cobalt (Co) is known to make adverse impact on the nervous system, but its detailed mechanisms of neurotoxicity have yet to be determined. In this study, C57BL/6 mice (0, 4, 8, 16 mg/kg CoCl2, 30 days) and human neuroblastoma H4 cells (0, 100, 400, 600 μM CoCl2) were used as in vivo and in vitro models. Our results revealed that CoCl2 intraperitoneal injection caused significant impairments in learning and memory, as well as pathological damage in the nervous system. We further certificated the alteration of m6A methylation induced by CoCl2 exposure. Our findings demonstrate for the first time, significant differences in the degree of m6A modification, the biological function of m6A-modified transcripts between cortex and H4 cell samples. Specifically, MeRIP-seq and RNA-seq elucidate that CoCl2 exposure results in differentially m6A-modified and expressed genes, which were enriched in pathways involving synaptic transmission, and central nervous system (CNS) development. Mechanistic analyses revealed that CoCl2 remarkably changed m6A modification level by affecting the expression of m6A methyltransferase and demethylase, and decreasing the activity of demethylase. We observed variation of m6A modification in neurodegenerative disease-associated genes upon CoCl2 exposure and identified regulatory strategy between m6A and potential targets mRNA. Our novel findings provide novel insight into the functional roles of m6A modification in neurodegenerative damage caused by environmental neurotoxicants and identify Co-mediated specific RNA regulatory strategy for broadening the epigenetic regulatory mechanism of RNA induced by heavy metals.
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Affiliation(s)
- Jianping Tang
- Fujian Key Lab of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, China; Department of Preventive Medicine, School of Public Health, Fujian Medical University, China
| | - Chunyan Zheng
- Fujian Key Lab of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, China; Department of Preventive Medicine, School of Public Health, Fujian Medical University, China
| | - Fuli Zheng
- Fujian Key Lab of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, China; Department of Preventive Medicine, School of Public Health, Fujian Medical University, China; Key Lab of Environment and Health, School of Public Health, Fujian Medical University, China
| | - Yuqing Li
- Fujian Key Lab of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, China; Department of Preventive Medicine, School of Public Health, Fujian Medical University, China
| | - Yuan-Liang Wang
- Fujian Key Lab of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, China; Department of Preventive Medicine, School of Public Health, Fujian Medical University, China; Key Lab of Environment and Health, School of Public Health, Fujian Medical University, China
| | - Michael Aschner
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Zhenkun Guo
- Fujian Key Lab of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, China; Key Lab of Environment and Health, School of Public Health, Fujian Medical University, China
| | - Guangxia Yu
- Fujian Key Lab of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, China; Department of Preventive Medicine, School of Public Health, Fujian Medical University, China; Key Lab of Environment and Health, School of Public Health, Fujian Medical University, China
| | - Siying Wu
- Fujian Key Lab of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, China; Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, China; Key Lab of Environment and Health, School of Public Health, Fujian Medical University, China
| | - Huangyuan Li
- Fujian Key Lab of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, China; Department of Preventive Medicine, School of Public Health, Fujian Medical University, China; Key Lab of Environment and Health, School of Public Health, Fujian Medical University, China.
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22
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Liu Y, Zhu W, Ni D, Zhou Z, Gu JH, Zhang W, Sun H, Liu F. Alpha lipoic acid antagonizes cytotoxicity of cobalt nanoparticles by inhibiting ferroptosis-like cell death. J Nanobiotechnology 2020; 18:141. [PMID: 33008409 PMCID: PMC7532644 DOI: 10.1186/s12951-020-00700-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/24/2020] [Indexed: 12/20/2022] Open
Abstract
As a main element in the hard metal industry, cobalt is one of the major components of human metal implants. Cobalt-containing implants, especially joint prostheses used for artificial joint replacement, can be corroded due to the complex physiological environment in vivo, producing a large number of nanoscale cobalt particles (Cobalt Nanoparticles, CoNPs). These CoNPs can be first accumulated around the implant to cause adverse local reactions and then enter into the blood vessels followed by reaching the liver, heart, brain, kidney, and other organs through systematic circulation, which leads to multi-system toxicity symptoms. To ensure the long-term existence of cobalt-containing implants in the body, it is urgently required to find out a safe and effective detoxification drug. Herein, we have demonstrated that CoNPs could induce the ferroptosis-like cell death through the enhancement of intracellular reactive oxygen species (ROS) level, cytoplasmic Fe2+ level, lipid peroxidation, and consumption of reduced glutathione (GSH) as well as inhibition of glutathione peroxidase 4 (GPX4) activity. Importantly, α-lipoic acid (ALA), a natural antioxidant with the capability to scavenge free radicals and chelate toxic metals, was found to efficiently alleviate the adverse effects of CoNPs. The present study illustrates a new mechanism of CoNPs mediated by ferroptosis-like cytotoxicity and discloses an effective method for the detoxification of CoNPs by employing the natural antioxidant of ALA, providing a basis for further in vivo detoxification study.![]()
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Affiliation(s)
- Yake Liu
- Department of Orthopaedics, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong, 226001, Jiangsu, China.,Orthopaedic Laboratory, Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, China
| | - Wenfeng Zhu
- Department of Orthopaedics, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong, 226001, Jiangsu, China.,Department of Orthopaedics, The Sixth Affiliated Hospital of Nantong University, Yancheng, Jiangsu Province, China
| | - Dalong Ni
- Department of Radiology, University of Wisconsin-Madison, 11111 Highland Avenue, Madison, WI, 53705, USA
| | - Zihua Zhou
- Orthopaedic Laboratory, Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, China
| | - Jin-Hua Gu
- Department of Clinical Pharmacy, Affiliated Maternity and Child Health Care Hospital of Nantong University, Nantong, Jiangsu Province, China
| | - Weinan Zhang
- Department of Orthopaedics, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong, 226001, Jiangsu, China.,Orthopaedic Laboratory, Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, China
| | - Huanjian Sun
- Department of Orthopaedics, The Sixth Affiliated Hospital of Nantong University, Yancheng, Jiangsu Province, China
| | - Fan Liu
- Department of Orthopaedics, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong, 226001, Jiangsu, China.
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A Systematic Review of Systemic Cobaltism After Wear or Corrosion of Chrome-Cobalt Hip Implants. J Patient Saf 2020; 15:97-104. [PMID: 26076080 PMCID: PMC6553976 DOI: 10.1097/pts.0000000000000220] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objectives We sought to synthesize data on systemic arthroprosthetic cobaltism, a recently described syndrome that results from wear or corrosion of chrome-cobalt hip components. Methods We conducted a systematic literature review to identify all reported cases of systemic arthroprosthetic cobaltism. To assess the epidemiologic link between blood cobalt levels (B[Co]), we developed a symptom scoring tool that evaluated 9 different symptom categories and a category of medical utilization. Results We identified 25 patients reported between 2001 and 2014 with a substantial increase in case reports over the past 3 years. Symptoms were diverse and involved the hip (84%), cardiovascular system (60%), audiovestibular system (52%), peripheral motor-sensory system (48%), thyroid (48%), psychological functioning (32%), visual system (32%), and the hematological, oncological, or immune system (20%). The mean latency from implantation to presentation or revision was 41 months (range, 9–99 months). The mean B[Co] was 324 μg/L and 4 patients had levels less than 20 μg/L. The B[Co] but not blood chromium level was highly associated with a quantitative measure of overall symptom severity (r2, 0.81; P < 0.001). Mean B[Co] and symptom scores were substantially higher in patients with revisions of failed ceramic-on-ceramic prostheses than those with primary metal-on-metal prostheses. Conclusions Systemic arthroprosthetic cobaltism is an increasingly recognized complication of wear or corrosion of chrome-cobalt hip implants, may involve a large number of organ systems, and may occur with relatively low B[Co]. There is an urgent need to better define the overall scope of the problem and to develop screening and management strategies.
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Maurer-Ertl W, Fellner A, Reinbacher P, Maier M, Leithner A, Friesenbichler J. Blood Management in Revision Total Hip Arthroplasty for Metal-on-Metal Devices: The Efficiency of an Intraoperative Cell Salvage System. Indian J Orthop 2020; 54:164-167. [PMID: 32257033 PMCID: PMC7096336 DOI: 10.1007/s43465-019-00026-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 07/09/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this series was to investigate the efficiency of an intraoperative cell salvage system (ICS) removing metal ions during revision of metal-on-metal (MoM) devices to proof the possibility of re-transfusion of the collected blood. MATERIALS AND METHODS Between 2014 and 2018, five consecutive patients underwent revision surgery of their MoM total hip arthroplasty due to wear of the polyethylene-metal sandwich inlay or local massive metallosis with aseptic loosing of the cup. Aspiration of joint fluid of all hip prostheses was done and blood was taken to measure the metal ion concentrations, preoperatively. Perioperatively, blood was collected using an ICS before and after filtration and analyzed for Co and Cr concentrations. At that time, there was no re-transfusion of the collected and filtrated blood due to unknown metal ion concentrations. RESULTS The mean preoperative serum Co and Cr concentrations in the blood were 31.28 μg/L (range 0.22-77.47) and 17.33 μg/L (range 0.59-51.31), whereas the mean local concentrations in the aspiration fluid were 728-fold and 822-fold higher. The Co and Cr concentrations measured in the collected blood before filtration were 70.61 μg/L (range 9.40-173.00) and 337.21 μg/L (range 8.76-1383.0) and decreased markedly to average concentrations of 15.49 μg/L and 41.88 μg/L, respectively. These differences were statistically not significant (Co: p = 0.117, Cr: p = 0.175), although the mean reduction rates were 78% and 88% for Co and Cr, respectively. CONCLUSION The current series showed that in case of revision of MoM hip devices, metal ions are still contained in the collected blood following filtration using a modern high-level ICS. Therefore, we would only recommend blood re-transfusion in case of low preoperative Co and Cr concentrations and sufficient renal function to warrant patients' safety.
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Affiliation(s)
- Werner Maurer-Ertl
- grid.11598.340000 0000 8988 2476Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Andreas Fellner
- grid.11598.340000 0000 8988 2476Department of Anaesthesiology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Patrick Reinbacher
- grid.11598.340000 0000 8988 2476Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Michael Maier
- grid.11598.340000 0000 8988 2476Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Andreas Leithner
- grid.11598.340000 0000 8988 2476Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Joerg Friesenbichler
- grid.11598.340000 0000 8988 2476Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
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J Hill M, Qi B, Bayaniahangar R, Araban V, Bakhtiary Z, Doschak M, Goh B, Shokouhimehr M, Vali H, Presley J, Zadpoor A, Harris M, Abadi P, Mahmoudi M. Nanomaterials for bone tissue regeneration: updates and future perspectives. Nanomedicine (Lond) 2019; 14:2987-3006. [DOI: 10.2217/nnm-2018-0445] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Joint replacement and bone reconstructive surgeries are on the rise globally. Current strategies for implants and bone regeneration are associated with poor integration and healing resulting in repeated surgeries. A multidisciplinary approach involving basic biological sciences, tissue engineering, regenerative medicine and clinical research is required to overcome this problem. Considering the nanostructured nature of bone, expertise and resources available through recent advancements in nanobiotechnology enable researchers to design and fabricate devices and drug delivery systems at the nanoscale to be more compatible with the bone tissue environment. The focus of this review is to present the recent progress made in the rationale and design of nanomaterials for tissue engineering and drug delivery relevant to bone regeneration.
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Affiliation(s)
- Michael J Hill
- Department of Mechanical Engineering – Engineering Mechanics, Michigan Technological University, Houghton, MI 49931, USA
| | - Baowen Qi
- Center for Nanomedicine & Department of Anesthesiology, Brigham & Women's Hospital Harvard Medical School, Boston, MA 02115, USA
| | - Rasoul Bayaniahangar
- Department of Mechanical Engineering – Engineering Mechanics, Michigan Technological University, Houghton, MI 49931, USA
| | - Vida Araban
- School of Engineering, University of British Columbia, Kelowna, BC V1V 1V7, Canada
| | - Zahra Bakhtiary
- Research Center for Pharmaceutical Nanotechnology, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Michael R Doschak
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Brian C Goh
- Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Mohammadreza Shokouhimehr
- Department of Materials Science & Engineering, Seoul National University, Seoul 08826, Republic of Korea
| | - Hojatollah Vali
- Department of Anatomy & Cell Biology & Facility for Electron Microscopy Research, McGill University, Montreal, QC H3A 0G4, Canada
| | - John F Presley
- Department of Anatomy & Cell Biology & Facility for Electron Microscopy Research, McGill University, Montreal, QC H3A 0G4, Canada
| | - Amir A Zadpoor
- Department of Biomechanical Engineering, Delft University of Technology (TU Delft), Delft, The Netherlands
| | - Mitchel B Harris
- Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Parisa PSS Abadi
- Department of Mechanical Engineering – Engineering Mechanics, Michigan Technological University, Houghton, MI 49931, USA
| | - Morteza Mahmoudi
- Precision Health Program & Department of Radiology, Michigan State University, East Lansing, MI 48824, USA
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Olmedo-Garcia NI, Zagra L. High risk of complications using metal heads after ceramic fracture in total hip arthroplasty. Hip Int 2019; 29:373-378. [PMID: 30501527 DOI: 10.1177/1120700018813978] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND There is some uncertainty about the bearing to be used to substitute a broken ceramic. Using metal components (head or liner) may lead to catastrophic wear of the metal. AIM The purpose of this article is to describe the long-term follow-up result of ceramic fracture replaced with metal-on-polyethylene (MoP). METHODS We report 3 cases of ceramic head fracture after ceramic-on-ceramic (CoC) total hip arthroplasty (THA) in which the broken ceramic was replaced with MoP. RESULTS All cases developed severe complications due to gross wear of the metal head: one developed a pseudotumour after a few months while the other 2 had significant local metallosis and toxic blood metal levels. CONCLUSIONS When there is a fracture of a ceramic component, we advise caution with the use of metal heads, as small ceramic fragments can cause 3rd-body wear with massive metal debris and severe local and general complications.
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Affiliation(s)
| | - Luigi Zagra
- 2 IRCCS Galeazzi Othopaedic Institute, Milan, Italy
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27
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Kovochich M, Finley BL, Novick R, Monnot AD, Donovan E, Unice KM, Fung ES, Fung D, Paustenbach DJ. Understanding outcomes and toxicological aspects of second generation metal-on-metal hip implants: a state-of-the-art review. Crit Rev Toxicol 2019; 48:853-901. [DOI: 10.1080/10408444.2018.1563048] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Cr(VI)‐induced genotoxicity and cell cycle arrest in human osteoblast cell line MG‐63. J Appl Toxicol 2019; 39:1057-1065. [DOI: 10.1002/jat.3793] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/25/2019] [Accepted: 02/07/2019] [Indexed: 11/07/2022]
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Stepien KM, Abidin Z, Lee G, Cullen R, Logan P, Pastores GM. Metallosis mimicking a metabolic disorder: a case report. Mol Genet Metab Rep 2018; 17:38-41. [PMID: 30271721 PMCID: PMC6159344 DOI: 10.1016/j.ymgmr.2018.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 09/17/2018] [Accepted: 09/17/2018] [Indexed: 11/05/2022] Open
Abstract
Metalic prosthesis or occupational exposure are potential sources of systemic cobalt and chromium ion toxicity. The resultant multisystemic clinical presentation can lead to unnecessary investigations before a final etiologic diagnosis is made; with an average delay of a year or more commonly noted. A 58-year old man presented with cardiomyopathy, pericardial effusion, polycytaemia, polyneuropathy, visual impairment, sudden hearing loss and hypothyroidism over a 2-year period post a metal-on-polyethylene hip replacement surgery. Biochemistry test results showed serum lactate of 3.8 mmol/L (0.5–2.2 mmol/L). Urine organic acid screen showed mild increases in excretion of tricarboxylic acid cycle intermediates and 2-ethylhydracryllate; suggestive of primary or secondary mitochondrial dysfunction. There were also slight increases in excretion of 4-hydroxyphenyllactate and 4-hydroxyphenylpyruvate suggestive of liver dysfunction. Acylcarnitine profile showed slight increase in hydroxybutyrylcarnitine and tetradeceneoylcarnitine that may reflect ketosis. In view of his clinical presentation and abnormal metabolic investigations, the initial working diagnosis was mitochondrial disease. Subsequently, patient presented with hip pain, and radiologic and imaging studies revealed high density collections lateral to the right proximal part of the femur, and medial to the right ilium with signal changes suggestive of metallic content. This prompted toxicology screen which revealed elevated plasma cobalt concentration (903.32 μg/L; reference range: 0.1–0.4) and chromium (71.32 μg/L; <0.5). Six months post right hip prosthesis removal the concentrations have declined and was 61.72 μg/L and chromium 23.97 μg/L. Patient felt some improvement symptomatically, without evident deterioration in his vision or hearing. This case emphasises careful consideration of past medical history, in patients presenting with multisystemic disease suggestive of mitochondrial dysfunction, and potential causality related to exposure to toxic agents. In retrospect, the absence of a family history could be viewed as a pertinent negative finding. Not uncommonly, specialist focus on their favored system and may not search for a unifying diagnosis. It is likely further delays in diagnosis would have occurred had the patient not developed hip pains, and ultimately referred to the orthopedic surgeons more familiar with similar cases.
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Affiliation(s)
- Karolina M Stepien
- Adult Inherited Metabolic Diseases Department, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Zaza Abidin
- National Centre for Inherited Metabolic Diseases, The Mater Misericordiae University Hospital, Dublin, Ireland
| | - Graham Lee
- Clinical Biochemistry and Diagnostic Endocrinology, The Mater Misericordiae University Hospital, Dublin, Ireland
| | - Rachel Cullen
- Clinical Biochemistry and Diagnostic Endocrinology, The Mater Misericordiae University Hospital, Dublin, Ireland
| | - Patricia Logan
- Ophthalmology Department, The Mater Misericordiae University Hospital, Dublin, Ireland
| | - Gregory M Pastores
- National Centre for Inherited Metabolic Diseases, The Mater Misericordiae University Hospital, Dublin, Ireland
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Differential toxicity of processed and non-processed states of CoCrMo degradation products generated from a hip simulator on neural cells. Nanotoxicology 2018; 12:941-956. [PMID: 30251573 DOI: 10.1080/17435390.2018.1498929] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Physico-chemical characteristics of the CoCrMo degradation products have played an important role in cytotoxicity and clinical complications on the orthopedic patients who have metal implants. Previous studies have limited reflection on the physicochemical characteristics of the degradation products generated in vivo, which are very different from individual metal particles and/or ions obtained from different commercial sources. In this study, we aimed to understand the differences in toxicity induced by the degradation products in as-synthesized form as well as those obtained after post-processing. The degradation products were generated using a hip-simulator by maintaining physiological conditions closer to in vivo and separated into two batches, one with processing by washing and drying called processed degradation products (PDP) and another batch as 'as-synthesized' degradation product (DP). We studied the dose-dependent toxicity response by neural cells derived from induced pluripotent stem cells. The results of the study show that as-synthesized DPs are more toxic to neural cells even at lower concentrations studied with evident low TC50 (1-5 μg/ml) concentrations compared to PDP (25 μg/ml). Flow cytometric analysis showed a significant (p<.01) increase in uptake of the particles after 24 h and corresponding ROS production in DP-treated cells. RT-PCR analysis of oxidative specific gene expression showed, elevated mRNA levels of NADPH oxidase-1, nuclear transcription factor, superoxide dismutase-2 and glutaredoxin-2 in DP-treated cells after 6 h. The results of the study provided a clear evidence of the differential response of neural cells on the degradation products as a function of concentrations and their chemical nature.
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31
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Shapiro JA, Eskildsen SM, Del Gaizo DJ. Systemic cobaltism manifesting as oral mucosal discoloration and metallic gustation after metal-on-metal hip resurfacing. Arthroplast Today 2018; 4:436-440. [PMID: 30560172 PMCID: PMC6287233 DOI: 10.1016/j.artd.2018.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/27/2018] [Accepted: 06/27/2018] [Indexed: 01/23/2023] Open
Abstract
Systemic cobaltism is a debilitating complication of metal-on-metal (MoM) arthroplasty. In this report, we review a case of a 54-year-old female with metallosis from a MoM hip resurfacing and varying degrees of black discoloration of her tongue and metallic gustation as a result of systemic cobaltism. After explanting the metal components, thorough debridement, and conversion to ceramic-on-polyethylene arthroplasty, the patient's oral mucosal discoloration and metallic gustation resolved. This represents the first documentation of systemic cobaltism from MoM hip resurfacing manifesting as oral mucosal discoloration and metallic gustation with resolution after explant, debridement, and conversion to ceramic-on-polyethylene total hip arthroplasty.
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Affiliation(s)
- Joshua A Shapiro
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Scott M Eskildsen
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Daniel J Del Gaizo
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC, USA
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Bijukumar DR, Segu A, Souza JCM, Li X, Barba M, Mercuri LG, J Jacobs J, Mathew MT. Systemic and local toxicity of metal debris released from hip prostheses: A review of experimental approaches. NANOMEDICINE : NANOTECHNOLOGY, BIOLOGY, AND MEDICINE 2018; 14:951-963. [PMID: 29339190 PMCID: PMC6017990 DOI: 10.1016/j.nano.2018.01.001] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 12/22/2017] [Accepted: 01/02/2018] [Indexed: 12/12/2022]
Abstract
Despite the technological improvements in orthopedic joint replacement implants, wear and corrosion products associated with the metal components of these implants may result in adverse local tissue and perhaps systemic reactions and toxicities. The current review encompasses a literature review of the local and systemic toxicity studies concerning the effect of CoCrMo wear debris released from wear and corrosion of orthopedic implants and prostheses. Release of metallic debris is mainly in the form of micro- and nano-particles, ions of different valences, and oxides composed of Co and Cr. Though these substances alter human biology, their direct effects of these substances on specific tissue types remain poorly understood. This may partially be the consequence of the multivariate research methodologies employed, leading to inconsistent reports. This review proposes the importance of developing new and more appropriate in-vitro methodologies to study the cellular responses and toxicity mediated by joint replacement wear debris in-vivo.
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Affiliation(s)
- Divya Rani Bijukumar
- Regenerative Medicine and Disability Research Lab, Department of Biomedical Sciences, University of Illinois College of Medicine at Rockford, IL, USA
| | - Abhijith Segu
- Regenerative Medicine and Disability Research Lab, Department of Biomedical Sciences, University of Illinois College of Medicine at Rockford, IL, USA
| | - Júlio C M Souza
- Center for MicroElectromechanical Systems (CMEMS-UMINHO), University of Minho, Guimaraes, Portugal
| | - XueJun Li
- Regenerative Medicine and Disability Research Lab, Department of Biomedical Sciences, University of Illinois College of Medicine at Rockford, IL, USA
| | - Mark Barba
- Regenerative Medicine and Disability Research Lab, Department of Biomedical Sciences, University of Illinois College of Medicine at Rockford, IL, USA; OrthoIllinois, Rockford, IL, USA
| | - Louis G Mercuri
- Department of Orthopedics, Rush University Medical Center, Chicago, IL, USA
| | - Joshua J Jacobs
- Department of Orthopedics, Rush University Medical Center, Chicago, IL, USA
| | - Mathew Thoppil Mathew
- Regenerative Medicine and Disability Research Lab, Department of Biomedical Sciences, University of Illinois College of Medicine at Rockford, IL, USA; Department of Orthopedics, Rush University Medical Center, Chicago, IL, USA; Department of Bioengineering, University of Illinois at Chicago, IL, USA.
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34
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Martin AJ, Seagers KA, Van Citters DW. Assessment of Corrosion, Fretting, and Material Loss of Retrieved Modular Total Knee Arthroplasties. J Arthroplasty 2017; 32:2279-2284. [PMID: 28343824 DOI: 10.1016/j.arth.2017.02.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 02/10/2017] [Accepted: 02/18/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Modular junctions in total hip arthroplasties have been associated with fretting, corrosion, and debris release. The purpose of this study is to analyze damage severity in total knee arthroplasties of a single design by qualitative visual assessment and quantitative material loss measurements to evaluate implant performance and patient impact via material loss. METHODS Twenty-two modular knee retrievals of the same manufacturer were identified from an institutional review board-approved database. Junction designs included tapers with an axial screw and tapers with a radial screw. Constructs consisted of 2 metal alloys: CoCr and Ti6Al4V. Components were qualitatively scored and quantitatively measured for corrosion and fretting. Negative values represent adhered material. Statistical differences were analyzed using sign tests. Correlations were tested with a Spearman rank order test (P < .05). RESULTS The median volumetric material loss and the maximum linear depth for the total population were -0.23 mm3 and 5.84 μm, respectively. CoCr components in mixed metal junctions had higher maximum linear depth (P = .007) than corresponding Ti components. Fretting scores of Ti6Al4V alloy components in mixed metal junctions were statistically higher than the remaining groups. Taper angle did not correlate with material loss. CONCLUSION Results suggest that CoCr components in mixed metal junctions are more vulnerable to corrosion than other components, suggesting preferential corrosion when interfacing with Ti6Al4V. Overall, although corrosion was noted in this series, material loss was low, and none were revised for clinical metal-related reaction. This suggests the clinical impact from corrosion in total knee arthroplasty is low.
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Affiliation(s)
- Audrey J Martin
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Kirsten A Seagers
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
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Cobalt inhibits motility of axonal mitochondria and induces axonal degeneration in cultured dorsal root ganglion cells of rat. Cell Biol Toxicol 2017; 34:93-107. [PMID: 28656345 DOI: 10.1007/s10565-017-9402-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 06/15/2017] [Indexed: 10/19/2022]
Abstract
Cobalt is a trace element that localizes in the human body as cobalamin, also known as vitamin B12. Excessive cobalt exposure induces a peripheral neuropathy, the mechanisms of which are yet to be elucidated. We investigated how cobalt may affect mitochondrial motility in primary cultures of rat dorsal root ganglion (DRG). We observed mitochondrial motility by time-lapse imaging after DsRed2 tagging via lentivirus, mitochondrial structure using transmission electron microscopy (TEM), and axonal swelling using immunocytochemical staining. The concentration of cobaltous ion (Co2+) required to significantly suppress mitochondrial motility is lower than that required to induce axonal swelling following a 24-h treatment. Exposure to relatively low concentrations of Co2+ for 48 h suppressed mitochondrial motility without leading to axonal swelling. TEM images indicated that Co2+ induces mitochondrial destruction. Our results show that destruction of the axonal mitochondria precedes the axonal degeneration induced by Co2+ exposure.
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Leyssens L, Vinck B, Van Der Straeten C, Wuyts F, Maes L. Cobalt toxicity in humans-A review of the potential sources and systemic health effects. Toxicology 2017; 387:43-56. [PMID: 28572025 DOI: 10.1016/j.tox.2017.05.015] [Citation(s) in RCA: 402] [Impact Index Per Article: 57.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/17/2017] [Accepted: 05/24/2017] [Indexed: 12/21/2022]
Abstract
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 B12, 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 Co2+. As the latter is believed to be the primary toxic form, monitoring of the free fraction of Co2+ 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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Affiliation(s)
- Laura Leyssens
- Faculty of Medicine and Health Sciences, University of Ghent (Belgium), Department of Speech, Language and Hearing Sciences, University Hospital Ghent, policlinic 1 floor 2, De Pintelaan 185, 9000 Ghent, Belgium.
| | - Bart Vinck
- Faculty of Medicine and Health Sciences, University of Ghent (Belgium), Department of Speech, Language and Hearing Sciences, University Hospital Ghent, policlinic 1 floor 2, De Pintelaan 185, 9000 Ghent, Belgium; Faculty of Humanities, University of Pretoria (South Africa), Department of Speech-Language Pathology and Audiology, Aula Theatre,University Road, Pretoria, 0001, South Africa.
| | - Catherine Van Der Straeten
- Faculty of Medicine, Imperial College London, Department of Surgery & Cancer, Musculoskeletal Sciences and Technology, Imperial College London, Charing Cross Campus,7L21 Lab Block, London SW7 2AZ, UK; Faculty of Medicine and Health Sciences, University of Ghent (Belgium), De Pintelaan 185, 9000 Ghent, Belgium.
| | - Floris Wuyts
- Antwerp University Research center for Equilibrium and Aerospace (AUREA), Department of Otorhinolaryngology, University Hospital Antwerp, Campus Groenenborger, Groenenborgerlaan 171, 2020 Antwerp, Belgium; Department of Biomedical Physics, University of Antwerp (Belgium), Campus Groenenborger, Groenenborgerlaan 171, 2020 Antwerp, Belgium.
| | - Leen Maes
- Faculty of Medicine and Health Sciences, University of Ghent (Belgium), Department of Speech, Language and Hearing Sciences, University Hospital Ghent, policlinic 1 floor 2, De Pintelaan 185, 9000 Ghent, Belgium; Clinical audiology department, University Hospital Ghent, De Pintelaan 185, 9000 Ghent, Belgium.
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Liu YK, Deng XX, Yang HL. Cytotoxicity and genotoxicity in liver cells induced by cobalt nanoparticles and ions. Bone Joint Res 2016; 5:461-469. [PMID: 27754833 PMCID: PMC5075796 DOI: 10.1302/2046-3758.510.bjr-2016-0016.r1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 07/04/2016] [Indexed: 12/12/2022] Open
Abstract
Objectives The cytotoxicity induced by cobalt ions (Co2+) and cobalt nanoparticles (Co-NPs) which released following the insertion of a total hip prosthesis, has been reported. However, little is known about the underlying mechanisms. In this study, we investigate the toxic effect of Co2+ and Co-NPs on liver cells, and explain further the potential mechanisms. Methods Co-NPs were characterised for size, shape, elemental analysis, and hydrodynamic diameter, and were assessed by Transmission Electron Microscope, Scanning Electron Microscope, Energy Dispersive X-ray Spectroscopy and Dynamic Light Scattering. BRL-3A cells were used in this study. Cytotoxicity was evaluated by MTT and lactate dehydrogenase release assay. In order to clarify the potential mechanisms, reactive oxygen species, Bax/Bcl-2 mRNA expression, IL-8 mRNA expression and DNA damage were assessed on BRL-3A cells after Co2+ or Co-NPs treatment. Results Results showed cytotoxic effects of Co2+ and Co-NPs were dependent upon time and dosage, and the cytotoxicity of Co-NPs was greater than that of Co2+. In addition, Co-NPs elicited a significant (p < 0.05) reduction in cell viability with a concomitant increase in lactic dehydrogenase release, reactive oxygen species generation, IL-8 mRNA expression, Bax/Bcl-2 mRNA expression and DNA damage after 24 hours of exposure. Conclusion Co-NPs induced greater cytotoxicity and genotoxicity in BRL-3A cells than Co2+. Cell membrane damage, oxidative stress, immune inflammation and DNA damage may play an important role in the effects of Co-NPs on liver cells. Cite this article: Y. K. Liu, X. X. Deng, H.L. Yang. Cytotoxicity and genotoxicity in liver cells induced by cobalt nanoparticles and ions. Bone Joint Res 2016;5:461–469. DOI: 10.1302/2046-3758.510.BJR-2016-0016.R1.
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Affiliation(s)
- Y K Liu
- Department of Orthopaedics, The Affiliated Hospital to Soochow University, Jiangsu, China
| | - X X Deng
- Department of Orthopaedics, The Affiliated Hospital to Soochow University, Jiangsu, China
| | - H L Yang
- The Affiliated Hospital to Nantong University, Jiangsu, China
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Abstract
There is no consensus on the bearing of choice in revision for ceramic fracture after total hip arthroplasty (THA). The aim of this study was to evaluate the outcomes using ceramic-on-polyethylene (CoP) articulation in revision for ceramic breakage. Twelve patients who underwent revision hip surgery between 2002 and 2013 were followed-up. Appropriate surgical technique, including accurate synoviectomy, was used. The cup and the head were changed in four patients and only the liner and the head were replaced in the remaining eight patients. At the final follow-up there were no cases of re-revision due to tribological reasons, and only one case of polyethylene (PE) wear and osteolysis was scheduled for a new revision because of clear cup malposition. Complications were four cases of dislocation, one case of loosening and one case of infection. Revision of fractured ceramic is a challenging situation with a high risk of early complications. Using CoP liners with accurate synoviectomy and correction of misalignment can be considered a valuable bearing option at medium-term follow-up.
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Is Metal-On-Metal Total Hip Arthroplasty Associated With Neurotoxicity? J Arthroplasty 2016; 31:233-236.e1. [PMID: 27118351 DOI: 10.1016/j.arth.2016.03.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 03/07/2016] [Accepted: 03/17/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Isolated case reports in the literature describe systemic neurologic side effects associated with metal-on-metal (MOM) bearing surfaces, yet the incidence of these effects have not been evaluated beyond individual cases. The purpose of this study was to compare new diagnoses of these side effects described in isolated cases in large patient cohorts of MOM vs metal on polyethylene (MOP). METHODS We queried the entire Medicare database from 2005 to 2012. Total hip arthroplasty (THA) and bearing surface were determined using International Classification of Diseases, 9th revision procedure codes. Patients with 5-year follow-up were selected. Using International Classification of Diseases, 9th revision codes, we identified new diagnoses of previously reported neurologic side effects: peripheral neuropathy, sensorineural hearing loss, visual impairment, paresthesias, tinnitus, and vertigo. Comorbidities and demographics were collected. Odds ratios, CIs, and P values were calculated. RESULTS Overall, 29,483 MOM THAs and 23,587 age- and gender-matched MOP THAs were identified. The average Charlson Comorbidity Index was 5 for both groups. MOM and MOP patients had 26 of 30 identical prevalence of Elixhauser-measure comorbidities. There was no statistically significant difference in new diagnoses of any of the side effects at any time point between the 2 groups over 5 years. CONCLUSION This study represents, to our knowledge, the first longitudinal analysis of systemic neurotoxicity after THA in a large cohort of patients. The results of our study suggest that on the large scale, neurologic side effects previously described do not occur as a common attributable complication. Rather, these cases may be due to individual patient hypersensitivity to metal ions.
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Yu J, Ding D, Sun H, Salvi R, Roth JA. Trimethyltin-induced cochlear degeneration in rat. J Otol 2016; 11:118-126. [PMID: 29937820 PMCID: PMC6002597 DOI: 10.1016/j.joto.2016.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 07/27/2016] [Accepted: 07/29/2016] [Indexed: 12/28/2022] Open
Abstract
Trimethyltin (TMT) is an occupational and environmental health hazard behaving as a potent neurotoxin known to affect the central nervous system as well as the peripheral auditory system. However, the mechanisms underlying TMT-induced ototoxicity are poorly understood. To elucidate the effects of TMT on the cochlea, a single injection of 4 or 8 mg/kg TMT was administered intraperitoneally to adult rats. The compound action potential (CAP) threshold was used to assess the functional status of the cochlea and histological techniques were used to assess the condition of the hair cells and auditory nerve fibers. TMT at 4 mg/kg produced a temporary CAP threshold elevation of 25–60 dB that recovered by 28 d post-treatment. Although there was no hair cell loss with the 4 mg/kg dose, there was a noticeable loss of auditory nerve fibers particularly beneath the inner hair cells. TMT at 8 mg/kg produced a large permanent CAP threshold shift that was greatest at the high frequencies. The CAP threshold shift was associated with the loss of outer hair cells and inner hair cells in the basal, high-frequency region of the cochlea, considerable loss of auditory nerve fibers and a significant loss of spiral ganglion neurons in the basal turn. Spiral ganglion neurons showed evidence of soma shrinkage and nuclear condensation and fragmentation, morphological features of apoptotic cell death. TMT-induced damage was greatest in the high-frequency, basal region of the cochlea and the nerve fibers beneath the inner hair cells were the most vulnerable structures.
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Affiliation(s)
- Jintao Yu
- Department of Otolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Center for Hearing and Deafness, University at Buffalo, Buffalo, NY 14214, USA
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Dalian Ding
- Center for Hearing and Deafness, University at Buffalo, Buffalo, NY 14214, USA
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
- Corresponding author. Center for Hearing and Deafness, State University at Buffalo, Buffalo, NY 14214, USA. Fax: +1 716 829 2980.
| | - Hong Sun
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Richard Salvi
- Center for Hearing and Deafness, University at Buffalo, Buffalo, NY 14214, USA
| | - Jerome A. Roth
- Department of Pharmacology and Toxicology, University at Buffalo, Buffalo, NY 14214, USA
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Abstract
Hip resurfacing arthroplasty (HRA) presents several advantages over conventional total hip arthroplasty (THA), including conservation and preservation of bone, reduced risk of dislocation, easy replication of hip biomechanics and easy revision if needed. It is a particularly appealing procedure for young patients. HRA has been performed for over 40 years following the same technological advances as THA. The bearing material used by most designs is metal-on-metal (MoM), which has the best compromise between strength and wear properties. However, MoM HRA has a specific set of possible complications. Aseptic femoral failures were initially the most prevalent cause for revision but progress in patient selection and surgical technique seem to have resolved this problem. Wear-related failures (high metal ion levels and adverse local tissue reactions) are now the main concern, and are essentially associated with poor acetabular component design and orientation, to which MoM is more sensitive than other bearing materials. The concept of functional coverage is key to understanding how MoM bearings are affected by edge wear. Only a 3-D assessment of cup position (e.g., the contact patch to rim distance) provides the necessary information to determine the role of cup positioning in relationship with abnormal bearing wear.The concept of hip resurfacing is more valid today than ever as the age of the patients in need of hip arthroplasty keeps getting lower. The recent publication of several excellent long-term survivorship results suggests that selection of a well-designed resurfacing system and accuracy in the placement of the cup can achieve long-term durability.
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Ototoxicity of Divalent Metals. Neurotox Res 2016; 30:268-82. [DOI: 10.1007/s12640-016-9627-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 04/21/2016] [Accepted: 04/22/2016] [Indexed: 12/16/2022]
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Czekaj J, Ehlinger M, Rahme M, Bonnomet F. Metallosis and cobalt - chrome intoxication after hip resurfacing arthroplasty. J Orthop Sci 2016; 21:389-94. [PMID: 26740441 DOI: 10.1016/j.jos.2015.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 10/16/2014] [Accepted: 11/25/2014] [Indexed: 10/23/2022]
Affiliation(s)
- Jaroslaw Czekaj
- Departement of Orthopaedics, Hospital Payerne, Avenue de la Colline 3, 1530 Payerne, Switzerland.
| | - Matthieu Ehlinger
- Department of Orthopaedic Surgery and Traumatology, Hautepierre Hospital, Strasbourg University Hospitals Group, 1 Avenue Molière, 67098 Strasbourg, France
| | - Michel Rahme
- Department of Orthopaedic Surgery and Traumatology, Hautepierre Hospital, Strasbourg University Hospitals Group, 1 Avenue Molière, 67098 Strasbourg, France
| | - Francois Bonnomet
- Department of Orthopaedic Surgery and Traumatology, Hautepierre Hospital, Strasbourg University Hospitals Group, 1 Avenue Molière, 67098 Strasbourg, France
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Silverman EJ, Ashley B, Sheth NP. Metal-on-metal total hip arthroplasty: is there still a role in 2016? Curr Rev Musculoskelet Med 2016; 9:93-6. [PMID: 26791173 DOI: 10.1007/s12178-016-9323-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The use of metal-on-metal (MoM) bearings in total hip arthroplasty (THA) was popularized due to its enhanced wear profile and the ability to use large femoral heads to reduce post-operative instability. However, enthusiasm for the bearing declined following serious complications encountered at the primary articulation. This review discusses the development of MoM and the subsequent unexpected downstream challenges, most notably elevated serum metal ion levels, aseptic lymphocyte-dominated vasculitis-associated lesions (ALVAL), pseudotumor formation, and subsequent soft tissue and bone destruction. Both patient centered risk factors as well as component design led to high early failure rates resulting in product recalls and an overall decline in the use of MoM. In 2016, there is not a role for large-head MoM bearing in THA. Alternatively, the bearing has shown promise in hip resurfacing procedures for carefully selected patients.
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Affiliation(s)
- Edward J Silverman
- Department of Orthopaedics, The University of Pennsylvania Health System, 800 Spruce Street, Philadelphia, PA, 19107, USA.
| | - Blair Ashley
- Department of Orthopaedics, The University of Pennsylvania Health System, 800 Spruce Street, Philadelphia, PA, 19107, USA.
| | - Neil P Sheth
- Department of Orthopaedics, The University of Pennsylvania Health System, 800 Spruce Street, Philadelphia, PA, 19107, USA.
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45
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Zywiel MG, Cherian JJ, Banerjee S, Cheung AC, Wong F, Butany J, Gilbert C, Overgaard C, Syed K, Jacobs JJ, Mont MA. Systemic cobalt toxicity from total hip arthroplasties. Bone Joint J 2016; 98-B:14-20. [PMID: 26733510 DOI: 10.1302/0301-620x.98b1.36712] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
As adverse events related to metal on metal hip arthroplasty have been better understood, there has been increased interest in toxicity related to the high circulating levels of cobalt ions. However, distinguishing true toxicity from benign elevations in cobalt levels can be challenging. The purpose of this review is to examine the use of cobalt alloys in total hip arthroplasty, to review the methods of measuring circulating cobalt levels, to define a level of cobalt which is considered pathological and to review the pathophysiology, risk factors and treatment of cobalt toxicity. To the best of our knowledge, there are 18 published cases where cobalt metal ion toxicity has been attributed to the use of cobalt-chromium alloys in hip arthroplasty. Of these cases, the great majority reported systemic toxic reactions at serum cobalt levels more than 100 μg/L. This review highlights some of the clinical features of cobalt toxicity, with the goal that early awareness may decrease the risk factors for the development of cobalt toxicity and/or reduce its severity. Take home message: Severe adverse events can arise from the release of cobalt from metal-on-metal arthroplasties, and as such, orthopaedic surgeons should not only be aware of the presenting problems, but also have the knowledge to treat appropriately. Cite this article: Bone Joint J 2016;98-B:14–20.
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Affiliation(s)
- M. G. Zywiel
- University of Toronto, 100
College Street Room 302, Toronto, Ontario, M5G
1L5, Canada
| | - J. J. Cherian
- Philadelphia College of Osteopathic Medicine, 4190
City Line Ave, Philadelphia, PA
19131, USA
| | - S. Banerjee
- Sinai Hospital of Baltimore, 2401
West Belvedere Avenue, Baltimore, MD 21215, USA
| | - A. C. Cheung
- University of Toronto, 200
Elizabeth Street, Toronto, Ontario, M5G
2C4, Canada
| | - F. Wong
- University of Toronto, 200
Elizabeth Street, Toronto, Ontario, M5G
2C4, Canada
| | - J. Butany
- University of Toronto, 200
Elizabeth Street, Toronto, Ontario, M5G
2C4, Canada
| | - C. Gilbert
- University of Toronto, 200
Elizabeth Street, Toronto, Ontario, M5G
2C4, Canada
| | - C. Overgaard
- University of Toronto, 200
Elizabeth Street, Toronto, Ontario, M5G
2C4, Canada
| | - K. Syed
- University of Toronto, 100
College Street Room 302, Toronto, Ontario, M5G
1L5, Canada
| | - J. J. Jacobs
- Rush
University, 1611 W. Harrison St., Suite
400, Chicago, IL, 60612, USA
| | - M. A. Mont
- Sinai Hospital of Baltimore, 2401
West Belvedere Avenue, Baltimore, MD 21215, USA
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46
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Cheung AC, Banerjee S, Cherian JJ, Wong F, Butany J, Gilbert C, Overgaard C, Syed K, Zywiel MG, Jacobs JJ, Mont MA. Systemic cobalt toxicity from total hip arthroplasties. Bone Joint J 2016; 98-B:6-13. [PMID: 26733509 DOI: 10.1302/0301-620x.98b1.36374] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Recently, the use of metal-on-metal articulations in total hip arthroplasty (THA) has led to an increase in adverse events owing to local soft-tissue reactions from metal ions and wear debris. While the majority of these implants perform well, it has been increasingly recognised that a small proportion of patients may develop complications secondary to systemic cobalt toxicity when these implants fail. However, distinguishing true toxicity from benign elevations in cobalt ion levels can be challenging. The purpose of this two part series is to review the use of cobalt alloys in THA and to highlight the following related topics of interest: mechanisms of cobalt ion release and their measurement, definitions of pathological cobalt ion levels, and the pathophysiology, risk factors and treatment of cobalt toxicity. Historically, these metal-on-metal arthroplasties are composed of a chromium-cobalt articulation. The release of cobalt is due to the mechanical and oxidative stresses placed on the prosthetic joint. It exerts its pathological effects through direct cellular toxicity. This manuscript will highlight the pathophysiology of cobalt toxicity in patients with metal-on-metal hip arthroplasties. Take home message: Patients with new or evolving hip symptoms with a prior history of THA warrant orthopaedic surgical evaluation. Increased awareness of the range of systemic symptoms associated with cobalt toxicity, coupled with prompt orthopaedic intervention, may forestall the development of further complications. Cite this article: Bone Joint J 2016;98-B:6–13.
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Affiliation(s)
- A. C. Cheung
- University of Toronto, 200
Elizabeth Street, Toronto, Ontario, M5G
2C4, Canada
| | - S. Banerjee
- Sinai Hospital of Baltimore, 2401 West
Belvedere Avenue, Baltimore, Maryland, USA
| | - J. J. Cherian
- Sinai Hospital of Baltimore, 2401 West
Belvedere Avenue, Baltimore, Maryland, USA
| | - F. Wong
- University of Toronto, 200
Elizabeth Street, Toronto, Ontario, M5G
2C4, Canada
| | - J. Butany
- University of Toronto, 200
Elizabeth Street, Toronto, Ontario, M5G
2C4, Canada
| | - C. Gilbert
- University of Toronto, 200
Elizabeth Street, Toronto, Ontario, M5G
2C4, Canada
| | - C. Overgaard
- University of Toronto, 200
Elizabeth Street, Toronto, Ontario, M5G
2C4, Canada
| | - K. Syed
- University of Toronto, 100
College Street Room 302, Toronto, Ontario, M5G
1L5, Canada
| | - M. G. Zywiel
- University of Toronto, 100
College Street Room 302, Toronto, Ontario, M5G
1L5, Canada
| | - J. J. Jacobs
- Rush
University, 1611 W. Harrison St., Suite
400, Chicago, IL60612, USA
| | - M. A. Mont
- Sinai Hospital of Baltimore, 2401 West
Belvedere Avenue, Baltimore, Maryland, USA
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Nam D, Keeney JA, Nunley RM, Johnson SR, Clohisy JC, Barrack RL. Metal Ion Concentrations in Young, Active Patients Following Total Hip Arthroplasty with the Use of Modern Bearing Couples. J Arthroplasty 2015; 30:2227-32. [PMID: 26164561 DOI: 10.1016/j.arth.2015.06.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 06/04/2015] [Accepted: 06/15/2015] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to compare whole blood metal ion levels in young, active patients undergoing primary total hip arthroplasty with the use of a cobalt-alloy (ten patients), ceramic (15 patients), or oxinium (11 patients) femoral head and highly crosslinked polyethylene acetabular liner. At 2 years postoperatively, mean cobalt concentrations were 3.0 times higher in the cobalt-alloy cohort versus the ceramic cohort, and 2.3 times higher versus the oxinium cohort (P=0.3-0.5). Titanium levels were consistently elevated at all postoperative time points versus preoperatively in all cohorts. Young, active patients following THA demonstrate elevated cobalt and titanium concentrations. Use of a ceramic or oxinium femoral head decreased the degree of cobalt elevation versus a cobalt-alloy femoral head, but did not reach statistical significance.
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Affiliation(s)
- Denis Nam
- Washington University School of Medicine/Barnes-Jewish Hospital, Department of Orthopedic Surgery, St. Louis, Missouri
| | - James A Keeney
- University of Missouri, Department of Orthopedic Surgery, Columbia, Missouri
| | - Ryan M Nunley
- Washington University School of Medicine/Barnes-Jewish Hospital, Department of Orthopedic Surgery, St. Louis, Missouri
| | - Staci R Johnson
- Washington University School of Medicine/Barnes-Jewish Hospital, Department of Orthopedic Surgery, St. Louis, Missouri
| | - John C Clohisy
- Washington University School of Medicine/Barnes-Jewish Hospital, Department of Orthopedic Surgery, St. Louis, Missouri
| | - Robert L Barrack
- Washington University School of Medicine/Barnes-Jewish Hospital, Department of Orthopedic Surgery, St. Louis, Missouri
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Cobalt toxicity after revision to a metal-on-polyethylene total hip arthroplasty for fracture of ceramic acetabular component. Arthroplast Today 2015; 1:89-91. [PMID: 28326380 PMCID: PMC4958112 DOI: 10.1016/j.artd.2015.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 09/27/2015] [Accepted: 09/29/2015] [Indexed: 11/21/2022] Open
Abstract
Cobalt metallosis after revision metal-on-polyethylene total hip arthroplasty for catastrophic failure of ceramic components is uncommon but a potentially devastating complication. Common findings associated with heavy metal toxicity include cardiomyopathy, hypothyroidism, skin rashes, visual disturbances, hearing changes, polycythemia, weakness, fatigue, cognitive deterioration, and neuropathy. We report a case of a 57-year-old woman who presented with complaints of progressively worsening hip pain, fatigue, memory loss, lower extremity sensory loss, persistent tachycardia, and ocular changes 5 years after synovectomy and revision of a failed ceramic-on-ceramic total hip arthroplasty to metal-on-polyethylene components. A cobalt level of 788.1 ppb and chromium level of 140 ppb were found on presentation and subsequently decreased to 468.8 ppb and 105.9 ppb, respectively, 2 weeks after revision to a ceramic-on-polyethylene total hip arthroplasty. Improvement of symptoms accompanied this decrease in cobalt and chromium levels. Revision of failed ceramic arthroplasties with later-generation ceramics to avoid this potential complication is recommended.
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Griffiths J, Colvin A, Yates P, Meyerkort D, Kop A, Prosser G. Extreme Cobalt Toxicity: Bearing the Brunt of a Failed Ceramic Liner: A Case Report. JBJS Case Connect 2015; 5:e92. [PMID: 29252798 DOI: 10.2106/jbjs.cc.n.00242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We present a case of systemic cobalt toxicity secondary to third-body wear of a cobalt-chromium (CoCr) femoral head following revision of a fractured ceramic bearing. Removal of the CoCr head was followed by resolution of much of the systemic symptoms. CONCLUSION This case supports previous reports of cobalt toxicity secondary to catastrophic third-body wear of a CoCr femoral head following a fractured ceramic bearing. It also demonstrates the potential reversibility of many systemic sequelae associated with cobalt toxicity. To our knowledge, this case represents the highest documented blood cobalt level (45,840 nmol/L).
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Affiliation(s)
- Jamie Griffiths
- Trauma and Orthopaedic Department, Fremantle Hospital, Alma Street, Fremantle, Perth, WA 6160, Australia. . . . .
| | - Alison Colvin
- Trauma and Orthopaedic Department, Fremantle Hospital, Alma Street, Fremantle, Perth, WA 6160, Australia. . . . .
| | - Piers Yates
- Trauma and Orthopaedic Department, Fremantle Hospital, Alma Street, Fremantle, Perth, WA 6160, Australia. . . . .
| | - Daniel Meyerkort
- Trauma and Orthopaedic Department, Fremantle Hospital, Alma Street, Fremantle, Perth, WA 6160, Australia. . . . .
| | - Alan Kop
- Department of Medical Bioengineering, Royal Perth Hospital, 197 Wellington Street, Perth, WA 6000, Australia.
| | - Gareth Prosser
- Trauma and Orthopaedic Department, Fremantle Hospital, Alma Street, Fremantle, Perth, WA 6160, Australia. . . . .
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50
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In Vitro Analyses of the Toxicity, Immunological, and Gene Expression Effects of Cobalt-Chromium Alloy Wear Debris and Co Ions Derived from Metal-on-Metal Hip Implants. LUBRICANTS 2015. [DOI: 10.3390/lubricants3030539] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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