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

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Abstract

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.

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Correspondence to Paul I. Dargan.

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Conflicts of Interest

Jerrold B. Leikin has been a paid consultant of DePuy Companies, which makes metallic hip prostheses since March 2011. Jeffrey Brent was a paid consultant of DePuy Companies from 2012 to 2013 and since 2016 has been a consultant for Stryker Corporation and Smith and Nephew, both of whom make metallic hip prostheses. The other authors report no declarations of interest.

Additional information

Previous presentation of data/abstract:

Ho J, Wax P, Leikin J, Archer JRH, Wood DM, Dargan PI, Brent J. Metal on metal hip joint prostheses: a retrospective case series investigating association of systemic toxicity with serum cobalt and chromium concentrations. Clin Toxicol (Phila) 2016;54:430–1

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EAPCCT (European Association of Poisons Centres and Clinical Toxicologists) Congress, Madrid, Spain, May 2016

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Ho, J.H., Leikin, J.B., Dargan, P.I. et al. Metal-on-Metal Hip Joint Prostheses: a Retrospective Case Series Investigating the Association of Systemic Toxicity with Serum Cobalt and Chromium Concentrations. J. Med. Toxicol. 13, 321–328 (2017). https://doi.org/10.1007/s13181-017-0629-1

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