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Clinical features, testing, and management of patients with suspected prosthetic hip-associated cobalt toxicity: a systematic review of cases.
- Source :
-
Journal of medical toxicology : official journal of the American College of Medical Toxicology [J Med Toxicol] 2013 Dec; Vol. 9 (4), pp. 405-15. - Publication Year :
- 2013
-
Abstract
- Safety concerns regarding cobalt-containing metal alloy hip prosthetics (Co-HP) have resulted in product recalls, a medical device alert, and issuance of guidance for clinicians. Recently, cases of suspected prosthetic hip-associated cobalt toxicity (PHACT) from Co-HP have been reported. Although little is known about suspected PHACT, these patients may be referred to medical toxicologists for evaluation and management recommendations. We searched MEDLINE, EMBASE, and unpublished abstracts from toxicology scientific meetings for references relevant to PHACT. Authors independently screened publications for inclusion criteria: publication in English, human study population, subject(s) are symptomatic (except for isolated hip pain), and cobalt values in any matrix (blood, serum, urine, CSF, synovial fluid) available for review. Data from 10 cases are reviewed. Patients with suspected PHACT had findings consistent with cobalt toxicity, including thyroid, cardiac, and neurologic dysfunction. Signs and symptoms appeared between 3 and 72 months after arthroplasty (median 19 months). Neurologic symptoms were most common. Ancillary testing varied considerably. All patients had elevated cobalt levels in one or more matrices. Enhanced elimination was attempted in 27 % of patients. At this time, the information currently available regarding patients with suspected PHACT is inadequate to guide clinical decision making. No consensus has been reached regarding the management of Co-HP patients with systemic symptoms. Indications for chelation have not been established and require further study. Improved case definitions, improved surveillance, and controlled studies are needed to elucidate the scope of this problem and guide future investigations.
- Subjects :
- Biomarkers metabolism
Chelating Agents therapeutic use
Chelation Therapy
Cobalt metabolism
Device Removal
Humans
Metals, Heavy metabolism
Poisoning etiology
Poisoning metabolism
Predictive Value of Tests
Prosthesis Design
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Arthroplasty, Replacement, Hip adverse effects
Arthroplasty, Replacement, Hip instrumentation
Cobalt poisoning
Heavy Metal Poisoning
Hip Prosthesis adverse effects
Poisoning diagnosis
Poisoning therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1937-6995
- Volume :
- 9
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Journal of medical toxicology : official journal of the American College of Medical Toxicology
- Publication Type :
- Academic Journal
- Accession number :
- 24222555
- Full Text :
- https://doi.org/10.1007/s13181-013-0320-0