Clinical Features, Testing, and Management of Patients with Suspected Prosthetic Hip-Associated Cobalt Toxicity: a Systematic Review of Cases
John J. Devlin,John J. Devlin,Adam C. Pomerleau,Adam C. Pomerleau,Jeffrey Brent,Brent W. Morgan,Scott Deitchman,Michael D. Schwartz +7 more
TLDR
Patients with suspected PHACT had findings consistent with cobalt toxicity, including thyroid, cardiac, and neurologic dysfunction, and no consensus has been reached regarding the management of Co-HP patients with systemic symptoms.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 We searched MEDLINE, EMBASE, and unpublished abstracts from toxicology scientific meetings for references relevant to PHACT.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.read more
Citations
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Cobalt toxicity in humans—a review of the potential sources and systemic health effects
Laura Leyssens,Bart Vinck,Bart Vinck,Catherine Van Der Straeten,Catherine Van Der Straeten,Floris L. Wuyts,Leen Maes +6 more
TL;DR: Future research should focus on longitudinal studies in the clinical setting of MoM hip implant patients to further elucidate the dose-response discrepancies, and monitoring of the free fraction of Co2+ might be advisable for future risk assessment.
Journal ArticleDOI
Metal Ions, Metal Chelators and Metal Chelating Assay as Antioxidant Method
I Gulcin,Saleh Alwasel +1 more
TL;DR: In this study, a general approach to the bonding and chelating properties of metals is described and basic principles and chemical principles of metal chelation methods, both in vivo and in vitro, are outlined and discussed.
Journal ArticleDOI
Systemic cobalt toxicity from total hip arthroplasties: review of a rare condition Part 2. measurement, risk factors, and step-wise approach to treatment.
Michael G. Zywiel,Jeffrey J. Cherian,Samik Banerjee,A. C. Cheung,Florence Wong,Jagdish Butany,Cameron Gilbert,Christopher B. Overgaard,K. Syed,Joshua J. Jacobs,Michael A. Mont +10 more
TL;DR: 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.
Journal ArticleDOI
Neuropsychiatric symptoms following metal-on-metal implant failure with cobalt and chromium toxicity
TL;DR: Neurocognitive and depressive deficits after cobalt and chromium metallosis following metal-on-metal hip implant failure and revision are found.
Journal ArticleDOI
Cobalt and its compounds: update on genotoxic and carcinogenic activities
TL;DR: Cobalt compounds should be considered as genotoxic carcinogens with a practical threshold, as accumulating evidence indicates that chronic inhalation of cobalt compounds can induce respiratory tumors locally.
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