Metal-on-Metal Hip Joint Prostheses: a Retrospective Case Series Investigating the Association of Systemic Toxicity with Serum Cobalt and Chromium Concentrations

被引:19
|
作者
Ho J.H. [1 ]
Leikin J.B. [2 ,3 ]
Dargan P.I. [1 ,4 ]
Archer J.R.H. [1 ,4 ]
Wood D.M. [1 ,4 ]
Brent J. [5 ]
机构
[1] Clinical Toxicology, Guy’s and St Thomas’ NHS Foundation Trust and King’s Health Partners, Westminster Bridge Road, London
[2] Medical Toxicology, Glenbrook Hospital, NorthShore University Health System—OMEGA, Glenview, IL
[3] Pritzker School of Medicine, University of Chicago, Chicago, IL
[4] Faculty of Life Sciences and Medicine, King’s College London, London
[5] School of Medicine, University of Colorado, Aurora, CO
关键词
Chromium; Cobalt; Metal-on-metal hip prosthesis; Toxicity;
D O I
10.1007/s13181-017-0629-1
中图分类号
学科分类号
摘要
Introduction: There have been concerns about prosthesis failure and the potential for systemic toxicity due to release of cobalt and chromium from metal-on-metal hip joint prostheses (MoM-HP). There is conflicting evidence on whether there is a correlation between higher cobalt and chromium concentrations and systemic toxicity. Methods: We undertook a retrospective review of consecutive patients with MoM-HP referred for outpatient review in toxicology clinics in London, UK, and in the USA recorded in the Toxicology Investigators Consortium (ToxIC) Registry from June 2011 to June 2015. Results: Thirty-one cases were identified; the median (IQR) serum cobalt concentration was 10.0 (3.8–32.8) mcg/L, and the median (IQR) serum chromium concentration was 6.9 (3.7–18.7) mcg/L. Twenty-three (74.2%) had symptoms, most commonly lethargy, hearing loss, and tinnitus. The odds ratios of symptomatic/asymptomatic patients for metal ion concentrations above/below 7 mcg/L were 1.87 (95% CI 0.37–9.57, p = 0.45) and 0.60 (95% CI 0.10–3.50, p = 0.57) for cobalt and chromium, respectively. Two (6.5%) patients with systemic cobalt toxicity had median (IQR) serum cobalt concentrations significantly higher than those without systemic features (630.4 [397.6–863.2] mcg/L versus 9.8 [2.9–16.4] mcg/L; p = 0.017). However, overall, there were no differences between cobalt (p = 0.38) or chromium (p = 0.92) concentrations between symptomatic and asymptomatic patients and no clinical features or investigation results correlated with cobalt or chromium concentration. Conclusion: Two (6.5%) of 31 individuals referred for assessment of MoM-HP were diagnosed with systemic cobalt toxicity. However, despite a high prevalence of reported symptoms, neither symptoms nor investigation results correlated with serum cobalt or chromium concentrations. © 2017, American College of Medical Toxicology.
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页码:321 / 328
页数:7
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