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Systemic cobalt toxicity from total hip arthroplasties: review of a rare condition Part 1 - history, mechanism, measurements, and pathophysiology.
- Source :
-
The bone & joint journal [Bone Joint J] 2016 Jan; Vol. 98-B (1), pp. 6-13. - Publication Year :
- 2016
-
Abstract
- Unlabelled: 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.<br />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.<br /> (©2016 The British Editorial Society of Bone & Joint Surgery.)
- Subjects :
- Carcinogens
Cobalt pharmacokinetics
Heart Diseases etiology
Hematologic Diseases
Humans
Ions adverse effects
Ions pharmacokinetics
Liver Diseases etiology
Metal-on-Metal Joint Prostheses adverse effects
Neoplasms etiology
Nervous System Diseases etiology
Prosthesis Design
Prosthesis Failure
Thyroid Diseases etiology
Arthroplasty, Replacement, Hip adverse effects
Cobalt adverse effects
Hip Prosthesis adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 2049-4408
- Volume :
- 98-B
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- The bone & joint journal
- Publication Type :
- Academic Journal
- Accession number :
- 26733509
- Full Text :
- https://doi.org/10.1302/0301-620X.98B1.36374