1
|
Sánchez-Dalmau BF, Spencer F, Sánchez-Vela L, Camós-Carreras A, Nogué Xarau S, Fernández-Valencia JA. Visual impairment induced by prosthetic cobaltism. ARCHIVOS DE LA SOCIEDAD ESPAÑOLA DE OFTALMOLOGÍA 2020; 96:316-320. [PMID: 34092285 DOI: 10.1016/j.oftale.2020.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/18/2020] [Indexed: 11/19/2022]
Abstract
The case of a 68-year-old patient with visual loss secondary to prosthetic cobaltism is reported. The degeneration of the metallic hip prosthesis can produce a systemic absorption of cobalt with cardiac, neurological, endocrine, auditory, and visual manifestations. The diagnostic suspicion is confirmed by serum cobalt measurements. Treatment with early surgery and chelating agents can lead to improvement of the visual, and the other disorders.
Collapse
Affiliation(s)
| | - F Spencer
- Institut Clínic d'Oftalmología, Hospital Clínic, Barcelona, Spain
| | - L Sánchez-Vela
- Servicio de Oftalmología, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - A Camós-Carreras
- Institut Clínic d'Oftalmología, Hospital Clínic, Barcelona, Spain
| | - S Nogué Xarau
- Servicio de Toxicología de Urgencias, Hospital Clínic, Barcelona, Spain
| | | |
Collapse
|
2
|
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: 19] [Impact Index Per Article: 4.8] [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.
Collapse
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.
| |
Collapse
|
3
|
Tarpada SP, Loloi J, Schwechter EM. A Case of Titanium Pseudotumor and Systemic Toxicity After Total Hip Arthroplasty Polyethylene Failure. Arthroplast Today 2020; 6:710-715. [PMID: 32923555 PMCID: PMC7475049 DOI: 10.1016/j.artd.2020.07.033] [Citation(s) in RCA: 4] [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: 05/01/2020] [Revised: 06/26/2020] [Accepted: 07/21/2020] [Indexed: 12/28/2022] Open
Abstract
We describe the case of a 57-year-old female who underwent bilateral ceramic-on-polyethylene total hip arthroplasties performed in 2015. She presented to us in 2018 with headaches, fatigue, and right hip pain 5 months after an atraumatic right polyethylene liner failure for which she did not seek treatment. She was found to have imaging consistent with an adverse local tissue reaction and massive pseudotumor formation. During revision surgery, fracture of the acetabular liner was noted, with ceramic head wear through the titanium cup. In the months after her debridement and prosthesis revision, the patient continued to complain of systemic symptoms including weakness, fatigue, headaches, and vision problems. Serum titanium levels were found to be 100 times higher than normal. This case serves as a rarely reported example of titanium toxicity and titanium pseudotumor formation in the setting of polyethylene failure.
Collapse
Affiliation(s)
- Sandip P Tarpada
- Department of Orthopaedic Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Jeremy Loloi
- Department of Orthopaedic Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Evan M Schwechter
- Department of Orthopaedic Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| |
Collapse
|
4
|
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.
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Jonitz-Heincke A, Sellin ML, Seyfarth A, Peters K, Mueller-Hilke B, Fiedler T, Bader R, Klinder A. Analysis of Cellular Activity Short-Term Exposure to Cobalt and Chromium Ions in Mature Human Osteoblasts. MATERIALS 2019; 12:ma12172771. [PMID: 31466377 PMCID: PMC6747798 DOI: 10.3390/ma12172771] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/23/2019] [Accepted: 08/26/2019] [Indexed: 01/19/2023]
Abstract
In aseptic loosening of endoprosthetic implants, metal particles, as well as their corrosion products, have been shown to elicit a biological response. Due to different metal alloy components, the response may vary depending on the nature of the released corrosion product. Our study aimed to compare the biological effects of different ions released from metal alloys. In order to mimic the corrosion products, different metal salts (CoCl2, NiCl2 and CrCl3 × 6H2O) were dissolved and allowed to equilibrate. Human osteoblasts were incubated with concentrations of 10 µM to 500 µM metal salt solutions under cell culture conditions, whereas untreated cells served as negative controls. Cells exposed to CoCr28Mo6 particles served as positive controls. The cell activity and expression of osteogenic differentiation and pro-osteolytic mediators were determined. Osteoblastic activity revealed concentration- and material-dependent influences. Collagen 1 synthesis was reduced after treatment with Co(2+) and Ni(2+). Additionally, exposure to these ions (500 µM) resulted in significantly reduced OPG protein synthesis, whereas RANKL as well as IL-6 and IL-8 secretion were increased. TLR4 mRNA was significantly induced by Co(2+) and CoCr28Mo6 particles. The results demonstrate the pro-osteolytic capacity of metal ions in osteoblasts. Compared to CoCr28Mo6 particles, the results indicated that metal ions intervene much earlier in inflammatory processes.
Collapse
Affiliation(s)
- Anika Jonitz-Heincke
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Centre, Doberaner Strasse 142, 18057 Rostock, Germany.
| | - Marie-Luise Sellin
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Centre, Doberaner Strasse 142, 18057 Rostock, Germany
| | - Anika Seyfarth
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Centre, Doberaner Strasse 142, 18057 Rostock, Germany
| | - Kirsten Peters
- Department of Cell Biology, Rostock University Medical Center, Schillingallee 69, 18057 Rostock, Germany
| | - Brigitte Mueller-Hilke
- Institute for Immunology, Rostock University Medical Center, Schillingallee 70, 18057 Rostock, Germany
| | - Tomas Fiedler
- Institute for Medical Microbiology, Virology and Hygiene, Rostock University Medical Center, Schillingallee 70, 18057 Rostock, Germany
| | - Rainer Bader
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Centre, Doberaner Strasse 142, 18057 Rostock, Germany
| | - Annett Klinder
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Centre, Doberaner Strasse 142, 18057 Rostock, Germany
| |
Collapse
|
7
|
Thomsen M, Krenn V, Thomas P. [Adverse reactions to metal orthopedic implants after knee arthroplasty]. Hautarzt 2017; 67:347-51. [PMID: 27116434 DOI: 10.1007/s00105-016-3793-3] [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] [Indexed: 02/02/2023]
Abstract
Based on several clinical examples, the range of adverse or hypersensitive reactions to metal implants especially after total knee replacement are presented. In general, we found the patients to generally be women who present with pain, swelling, and local or generalized eczema. Some also present with early aseptic loosening mainly in the first 4 years after implantation. For these patients, a detailed allergy-specific history should be taken and a patch test should be performed; if necessary, blood ion levels should be evaluated to exclude cobaltism. Before revision surgery and exchange of the implant we always perform arthroscopic inspection to obtain biopsies for microbiology and histopathology. Using the Consensus Classification a good evaluation for planning revision with the different implant options is possible.
Collapse
Affiliation(s)
- M Thomsen
- Klinik für Orthopädie und Unfallchirurgie, Klinikum Mittelbaden Baden-Baden, Balger Str. 50, 76532, Baden-Baden, Deutschland.
| | - V Krenn
- Zentrum für Histologie, Zytologie und Molekulare Diagnostik, Max-Planck-Str. 5, 54296, Trier, Deutschland
| | - P Thomas
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München, Frauenlobstr. 9-11, 80337, München, Deutschland
| |
Collapse
|
8
|
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
| |
Collapse
|
9
|
Severe Periprosthetic Metallosis and Polyethylene Liner Failure Complicating Total Hip Replacement: The Cloud Sign. Radiol Case Rep 2015; 2:115. [PMID: 27303496 PMCID: PMC4895867 DOI: 10.2484/rcr.v2i4.115] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
We present a case of an 85-year-old woman with extensive metallosis of the left hip joint secondary to prosthetic polyethelene liner dislocation and wear. Radiographs demonstrated amorphous cloudy radiodensities surrounding the prosthesis, a feature we have called the “cloud sign.” The presence of amorphous cloudy radiodensities as a radiographic sign of metallosis has not been previously described to our knowledge.
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Serum metal ion concentrations in paediatric patients following total knee arthroplasty using megaprostheses. BIOMED RESEARCH INTERNATIONAL 2014; 2014:817257. [PMID: 25276819 PMCID: PMC4172978 DOI: 10.1155/2014/817257] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 07/17/2014] [Accepted: 08/11/2014] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to determine the concentrations of cobalt, chromium, and molybdenum in the serum of paediatric tumour patients after fixed hinge total knee arthroplasty. Further, these metal ion levels were compared with serum metal ion levels of patients with other orthopaedic devices such as hip and knee prostheses with metal-on-metal or metal-on-polyethylene articulation to find differences between anatomical locations, abrasion characteristics, and bearing surfaces. After an average follow-up of 108 months (range: 67 to 163) of 11 paediatric patients with fixed hinge total knee arthroplasty, the mean concentrations for Co and Cr were significantly increased while Mo was within the limits compared to the upper values from the reference laboratory. Furthermore, these serum concentrations were significantly higher compared to patients with a standard rotating hinge device (P = 0.002 and P < 0.001) and preoperative controls (P < 0.001). On the other hand, the serum levels of patients following MoM THA or rotating hinge arthroplasty using megaprostheses were higher. Therefore, periodic long-term follow-ups are recommended due to the rising concerns about systemic metal ion exposure in the literature. Upon the occurrence of adverse reactions to metal debris the revision of the fixed hinge implant should be considered.
Collapse
|
12
|
Abstract
INTRODUCTION One in eight of all total hip replacements requires revision within 10 years, 60% because of wear-related complications. The bearing surfaces may be made of cobalt/chromium, stainless steel, ceramic, or polyethylene. Friction between bearing surfaces and corrosion of non-moving parts can result in increased local and systemic metal concentrations. OBJECTIVES To identify and systematically review published reports of systemic toxicity attributed to metal released from hip implants and to propose criteria for the assessment of these patients. METHODS Medline (from 1950) and Embase (from 1980) were searched to 28 February 2014 using the search terms (text/abstract) chrom* or cobalt* and [toxic* or intox* or poison* or adverse effect or complication] and [prosthes* or 'joint replacement' or hip or arthroplast*] and PubMed (all available years) was searched using the search term (("Chromium/adverse effects"[Mesh] OR "Chromium/poisoning"[Mesh] OR "Chromium/toxicity"[Mesh]) OR ("Cobalt/adverse effects"[Mesh] OR "Cobalt/poisoning"[Mesh] OR "Cobalt/toxicity"[Mesh])) AND ("Arthroplasty, Replacement, Hip"[Mesh] OR "Hip Prosthesis"[Mesh]). These searches identified 281 unique references, of which 23 contained original case data. Three further reports were identified from the bibliographies of these papers. As some cases were reported repeatedly the 26 papers described only 18 individual cases. Systemic toxicity. Ten of these eighteen patients had undergone revision from a ceramic-containing bearing to one containing a metal component. The other eight had metal-on-metal prostheses. Systemic toxicity was first manifest months and often several years after placement of the metal-containing joint. The reported systemic features fell into three main categories: neuro-ocular toxicity (14 patients), cardiotoxicity (11 patients) and thyroid toxicity (9 patients). Neurotoxicity was manifest as peripheral neuropathy (8 cases), sensorineural hearing loss (7) and cognitive decline (5); ocular toxicity presented as visual impairment (6). All these neurological features, except cognitive decline, have been associated with cobalt poisoning previously. Type of prosthesis and blood metal concentrations. Where blood or serum metal concentrations were reported (n = 17 for cobalt and n = 14 for chromium), the median cobalt concentration was 398 (range, 13.6-6521) μg/L and the median chromium concentration was 48 μg/L (in whole blood) (range, 4.1-221 μg/L including serum and blood values). Those patients reported to have systemic features who had received a metal-on-metal prosthesis (n = 8) had a median peak blood cobalt concentration of 34.5 (range, 13.6-398.6) μg/L; those with a metal-containing revision of a failed ceramic prosthesis (n = 10) had a median blood cobalt concentration of 506 (range, 353-6521) μg/L. Management. The most common treatment was removal of the metal-containing prosthesis, undertaken in all but 2 patients. This was usually associated with a fall in circulating cobalt concentration and improvement in some or all features. Clinical and toxicological assessment of systemic features. We propose the following criteria for assessing the likelihood that clinical features are related to cobalt toxicity: clinical effects consistent with the known neurological, cardiac, or thyroidal effects of cobalt, and for which any other explanation is less likely; increased blood cobalt concentrations (substantially higher than those in patients with well-functioning prostheses) several months after hip replacement; a fall in the blood cobalt concentration, usually accompanied by signs of improvement in features. When judged by these criteria, the systemic features in 10 of the reported cases are likely to be related to cobalt exposure from a metal-containing hip prosthesis. CONCLUSIONS Rarely, patients exposed to high circulating concentrations of cobalt from failed hip replacements develop neurological damage, hypothyroidism and/or cardiomyopathy, which may not resolve completely even after removal of the prosthesis. The greatest risk of systemic cobalt toxicity seems to result from accelerated wear of a cobalt-containing revision of a failed ceramic prosthesis, rather than from primary failure of a metal-on-metal prosthesis.
Collapse
Affiliation(s)
- S M Bradberry
- West Midlands Poisons Unit, City Hospital , Birmingham , UK
| | | | | |
Collapse
|
13
|
Reinders J, Sonntag R, Heisel C, Reiner T, Vot L, Kretzer JP. Wear performance of ceramic-on-metal hip bearings. PLoS One 2013; 8:e73252. [PMID: 24009743 PMCID: PMC3756941 DOI: 10.1371/journal.pone.0073252] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 07/23/2013] [Indexed: 12/26/2022] Open
Abstract
Ceramic-on-metal (CoM) bearings are considered to be a promising alternative to polyethylene-based bearings or hard-on-hard bearings (Ceramic-on-Ceramic (CoC) and Metal-on-Metal (MoM)). Although, CoM shows lower wear rates than MoM, in-vitro wear testing of CoM shows widely varying results. This may be related to limitations of wear-measuring methods. Therefore, the aim of this study was to improve the gravimetric measurement technique and to test wear behaviour of CoM bearings compared to CoC bearings. Level walking according to ISO-14242 was simulated for four CoM and four CoC bearings. Prior to simulation, errors in measurement of gravimetric wear were detected and improvements in measurement technique incorporated. The results showed no differences in mean wear rates between CoM and CoC bearings. However, the CoM bearings showed wear results over a wide range of wear performance. High reliability of wear results was recorded for the CoC bearings. Material transfer was observed on the ceramic heads of the CoM bearings. Therefore, for level walking a partial mixed or boundary lubrication has to be assumed for this type of bearing. CoM is a highly sensitive wear-couple. The reasons for the observed behaviour cannot be clarified from this study. Simulator studies have to be considered as an ideal loading condition. Therefore, high variations in wear rates as seen in this study, even at low levels, may have an adverse effect on the in-vivo wear behavior. Careful clinical use may be advisable until the reasons for the variation are fully clarified and understood.
Collapse
Affiliation(s)
- Jörn Reinders
- Laboratory of Biomechanics and Implant Research, Department of Orthopedics and Traumatology, Heidelberg University Hospital, Heidelberg, Germany.
| | | | | | | | | | | |
Collapse
|
14
|
Maurer-Ertl W, Friesenbichler J, Sadoghi P, Pechmann M, Trennheuser M, Leithner A. Metal ion levels in large-diameter total hip and resurfacing hip arthroplasty--preliminary results of a prospective five year study after two years of follow-up. BMC Musculoskelet Disord 2012; 13:56. [PMID: 22494794 PMCID: PMC3490776 DOI: 10.1186/1471-2474-13-56] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 03/27/2012] [Indexed: 01/15/2023] Open
Abstract
Background Metal-on-metal hip resurfacing is an alternative to metal-on-metal total hip arthroplasty, especially for young and physically active patients. However, wear which might be detected by increased serum ion levels is a matter of concern. Methods The aims of this preliminary study were to determine the raise of metal ion levels at 2-years follow-up in a prospective setting and to evaluate differences between patients with either resurfacing or total hip arthroplasty. Furthermore we investigated if the inclination of the acetabular component and the arc of cover would influence these findings. Therefore, 36 patients were followed prospectively. Results The results showed increments for Co and Cr in both implant groups. Patients treated with large-diameter total hip arthroplasty showed fourfold and threefold, respectively, higher levels for Co and Cr compared to the resurfacing group (Co: p < 0,001 and Cr: p = 0,005). Nevertheless, we observed no significant correlation between serum ion levels, inclination and arc of cover. Discussion In order to clarify the biologic effects of ion dissemination and to identify risks concerning long-term toxicity of metals, the exposure should be monitored carefully. Therefore, long-term studies have to be done to determine adverse effects of Co and Cr following metal-on-metal hip replacement.
Collapse
Affiliation(s)
- W Maurer-Ertl
- Department of Orthopaedic Surgery, Medical University of Graz, Graz, Austria
| | | | | | | | | | | |
Collapse
|
15
|
Pelclova D, Sklensky M, Janicek P, Lach K. Severe cobalt intoxication following hip replacement revision: Clinical features and outcome. Clin Toxicol (Phila) 2012; 50:262-5. [DOI: 10.3109/15563650.2012.670244] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
16
|
Pazzaglia UE, Apostoli P, Congiu T, Catalani S, Marchese M, Zarattini G. Cobalt, chromium and molybdenum ions kinetics in the human body: data gained from a total hip replacement with massive third body wear of the head and neuropathy by cobalt intoxication. Arch Orthop Trauma Surg 2011; 131:1299-308. [PMID: 21298277 DOI: 10.1007/s00402-011-1268-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2010] [Indexed: 11/29/2022]
Abstract
INTRODUCTION A patient with a total hip replacement developed optic, acoustic and peripheral neuropathy from metal ions intoxication, due to the wear products released from the prosthesis. Subsequently the kinetics of the metal ions was studied. MATERIALS AND METHODS Massive wear and acute intoxication allowed a study of the metal ions kinetics and of EDTA treatment. RESULTS Plasma and other organic fluids were saturated by each of the metal ions released from the exposed surface according to the solubility of each ion; a larger fraction of Co ions was bound within red cells, while the plasmatic fraction appeared more movable. In a patient with a prosthesis subjected to wear, the ions released are from the prosthetic and from the debris surface (spread in the body). The latter is a function of the number and size of particles. DISCUSSION Revision of the prosthesis from the point of view of the metal ions kinetics corresponded to a reduction of the releasing surface because of debris washed out by irrigation and tissue excision; however, the metal particles spread by lymphatic circulation continued to release ions even though the source of wear had been removed. Early diagnosis of high metal wear can be ascertained with mass spectrometry and after revision high levels of metal ions can only be reduced with repeated chelating treatment. It is preferable not to revise fractured ceramic components with a polyethylene-metal articulation.
Collapse
|
17
|
Catalani S, Leone R, Rizzetti MC, Padovani A, Apostoli P. The role of albumin in human toxicology of cobalt: contribution from a clinical case. ISRN HEMATOLOGY 2010; 2011:690620. [PMID: 22084701 PMCID: PMC3198613 DOI: 10.5402/2011/690620] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Accepted: 10/21/2010] [Indexed: 11/23/2022]
Abstract
The distribution and adverse effects, especially to optic and acoustic nerves, of cobalt released from a hip arthroplasty and its association with albumin were studied. The analysis of cobalt was performed in plasma, whole blood, urine, and cerebrospinal fluid by inductively coupled plasma mass spectrometry (ICP-MS). The fraction of albumin binding the metal was determined by colorimetric assay using dithiothreitol (DTT). In all the biological matrices very high levels of cobalt were measured, but contrary to expected, a higher concentration in whole blood than in plasma was observed. The determination of altered albumin confirmed this hypothesis. This evidence might indicate an alteration in the binding of cobalt to albumin and a consequent increase in the concentration of the diffusible (free) fraction of the metal. This appears an interesting starting point for further investigations for identifying and better understanding cobalt neurotoxicity, apparently not so frequent in occupational medicine and clinical practice.
Collapse
Affiliation(s)
- Simona Catalani
- Section of Occupational Health and Industrial Hygiene, Department of Experimental and Applied Medicine, University of Brescia, P.le Spedali Civili 1, 25123 Brescia, Italy
| | | | | | | | | |
Collapse
|
18
|
Oldenburg M, Wegner R, Baur X. Severe cobalt intoxication due to prosthesis wear in repeated total hip arthroplasty. J Arthroplasty 2009; 24:825.e15-20. [PMID: 18835128 DOI: 10.1016/j.arth.2008.07.017] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Revised: 02/13/2008] [Accepted: 07/01/2008] [Indexed: 02/01/2023] Open
Abstract
Our study describes a 55-year-old man with a total hip prosthesis (ceramic femoral head and polyethylene [PE] inlay). After a fall, the ceramic head broke into several pieces, and a subsequent revision surgery with metal femoral head and PE inlay was performed. Three months later, the so far healthy patient complained of multiorgan symptoms. The subsequent clinical examinations revealed hypothyroidism, peripheral neuropathy, and cardiomyopathy for the first time. In a second revision surgery, a massive deterioration of the metal femoral head by overlooked particles of the broken ceramic head was found. The cobalt concentration in blood exceeded a never before observed level. After replacement of the scraped femoral head, the cobalt concentration decreased considerably, and most of the symptoms disappeared.
Collapse
Affiliation(s)
- Marcus Oldenburg
- Department of Maritime Medicine, University of Hamburg, Hamburg State Department for Social Affairs, Family, Health and Consumer Protection, Hamburg, Germany
| | | | | |
Collapse
|
19
|
Busse B, Hahn M, Niecke M, Jobke B, Püschel K, Delling G, Katzer A. Allocation of nonbirefringent wear debris: Darkfield illumination associated with PIXE microanalysis reveals cobalt deposition in mineralized bone matrix adjacent to CoCr implants. J Biomed Mater Res A 2008; 87:536-45. [DOI: 10.1002/jbm.a.31794] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
20
|
Abstract
Modern metal-on-metal bearings show very low wear rates but release particles and ions from the articulating surfaces into the joint and the whole organism. Especially during the run-in period an increased number of particles is produced. The released metal ions potentially trigger cytotoxic, cancerogenic and allergic reactions, which can impair the patient's health locally or systemically. Many surgeons fear a hypersensitivity reaction to the metal ions of the CoCr alloy in their patients. Today it is assumed that the incidence of these implant-related complications is very low but in some cases it will lead to early failure of the implant. Because the available alternative bearing combinations (ceramic-on-polyethylene and ceramic-on-ceramic) also bear the risk of severe complications, a final statement on the best and safest bearing choice for the patient cannot be made based on the currently existing data.
Collapse
|
21
|
Tan GM, Lynne G, Sarbjit S. Osteolysis and wear debris after total knee arthroplasty presenting with extra-articular metallosis in the calf. J Arthroplasty 2008; 23:775-80. [PMID: 18534390 DOI: 10.1016/j.arth.2007.05.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2006] [Accepted: 05/17/2007] [Indexed: 02/01/2023] Open
Abstract
Component wear after total knee arthroplasty (TKA) with extruded metallosis in the extra-articular tissue of the calf secondary to a periprosthetic fracture is a rare complication. A 77-year-old man with a failed Insall-Burstein II TKA prosthesis presented with calf cellulitis after a fall. Radiologic evaluation revealed severe osteolysis and loosening of prosthetic components and an intramuscular abscess communicating with the medullary canal of the tibia through an undisplaced periprosthetic fracture. The patient developed rhabdomyolysis with acute renal failure. Drainage of the calf abscess showed staining of the muscles with wear debris and metallosis. The patient subsequently had debridement and excision of the infected TKA implant. Prompt diagnosis of this condition should be suspected in cases of failed arthroplasty with osteolysis and periprosthetic fracture.
Collapse
Affiliation(s)
- Gek Meng Tan
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | | | | |
Collapse
|