Archives of Orthopaedic and Trauma Surgery

, Volume 131, Issue 9, pp 1299–1308 | Cite as

Cobalt, chromium and molybdenum ions kinetics in the human body: data gained from a total hip replacement with massive third body wear of the head and neuropathy by cobalt intoxication

  • U. E. Pazzaglia
  • P. Apostoli
  • T. Congiu
  • S. Catalani
  • M. Marchese
  • G. Zarattini
Hip Arthroplasty

Abstract

Introduction

A patient with a total hip replacement developed optic, acoustic and peripheral neuropathy from metal ions intoxication, due to the wear products released from the prosthesis. Subsequently the kinetics of the metal ions was studied.

Materials and methods

Massive wear and acute intoxication allowed a study of the metal ions kinetics and of EDTA treatment.

Results

Plasma and other organic fluids were saturated by each of the metal ions released from the exposed surface according to the solubility of each ion; a larger fraction of Co ions was bound within red cells, while the plasmatic fraction appeared more movable. In a patient with a prosthesis subjected to wear, the ions released are from the prosthetic and from the debris surface (spread in the body). The latter is a function of the number and size of particles.

Discussion

Revision of the prosthesis from the point of view of the metal ions kinetics corresponded to a reduction of the releasing surface because of debris washed out by irrigation and tissue excision; however, the metal particles spread by lymphatic circulation continued to release ions even though the source of wear had been removed. Early diagnosis of high metal wear can be ascertained with mass spectrometry and after revision high levels of metal ions can only be reduced with repeated chelating treatment. It is preferable not to revise fractured ceramic components with a polyethylene–metal articulation.

Keywords

Total hip replacement Cobalt intoxication Metal ions Foreign body reaction Prosthetic wear 

Notes

Acknowledgments

The SEM study of particles was performed with an instrument of Centro Grandi Strumenti University of Insubria, Varese (I). The authors are grateful to Prof. A. Padovani, Dr P. Liberini and Dr M.C. Rizzetti of the Neurology Department of the University of Brescia for referring and allowing to consult the patient’s clinical record.

Supplementary material

402_2011_1268_MOESM1_ESM.pdf (168 kb)
Supplementary material 1 (PDF 168 kb)

References

  1. 1.
    Black J (1988) Does corrosion matter? J Bone Jt Surg Br 70(4):517–520Google Scholar
  2. 2.
    Michel R, Nolte M, Reich M, Löer F (1991) Systemic effects of implanted prostheses made of cobalt–chromium alloys. Arch Orthop Trauma Surg 110:61–74PubMedCrossRefGoogle Scholar
  3. 3.
    Savarino L, Granchi D, Ciapetti G, Stea S, Donati ME, Zinghi G, Fontanesi G, Rotini R, Montanaro L (1999) Effects of metal ions on white blood cells of patients with failed total joint arthroplasties. J Biomed Mater Res 47(4):543–550PubMedCrossRefGoogle Scholar
  4. 4.
    Visuri T, Pukkala E, Paavalainen P, Pulkkinen P, Riska EB (1996) Cancer risk after metal-on-metal and polyethylene-on-metal total hip arthroplasty. Clin Orthop Relat Res 329S:280–289CrossRefGoogle Scholar
  5. 5.
    Clarke MT, Lee PTH, Arora A, Viller RN (2003) Levels of metal ions after small and large diameter metal-on-metal hip arthroplasty. J Bone Jt Surg Br 85-B:913–917Google Scholar
  6. 6.
    Hart AJ, Hester T, Sinclair K, Powell JJ, Goodship AE, Pele L, Fersht NL, Skinner J (2006) The association between metal ions from hip resurfacing and reduced T-cell counts. J Bone Jt Surg Br 88-B(4):449–454CrossRefGoogle Scholar
  7. 7.
    Heisel C, Streich N, Krachler M, Jakubowitz E, Kretzer JP (2008) Characterization of the running-in period in total hip resurfacing arthroplasty—an in vivo and in vitro metal ion analysis. J Bone Jt Surg 90(S3):125–133CrossRefGoogle Scholar
  8. 8.
    Jacobs JJ, Skipor AK, Patterson LM, Hallab NJ, Paprosky WG, Black J, Galante JO (1998) Metal release in patients who have had a primary total hip arthroplasty. J Bone Jt Surg Am 80-A(10):1447–1458Google Scholar
  9. 9.
    Lhotka C, Szekeres T, Steffan I, Zhuber K, Zweymüller K (2003) Four-year study of cobalt and chromium blood levels in patients managed with two different metal-on-metal total hip replacements. J Orthop Res 21(2):189–195PubMedCrossRefGoogle Scholar
  10. 10.
    Sauvé P, Mountney J, Khan T, De Beer J, Higgins B, Grover M (2007) Metal ion levels after metal-on-metal ring total hop replacement. J Bone Jt Surg Br 89-B:586–590CrossRefGoogle Scholar
  11. 11.
    Savarino L, Granchi D, Ciapetti G, Cenni E, Nardi Pantoli A, Rotini R, Veronesi CA, Baldini N, Giunti A (2002) Ion release in patients with metal-on-metal hip bearings in total joint replacement: a comparison with metal-on-polyethylene bearings. J Biomed Mater Res 63:467–474PubMedCrossRefGoogle Scholar
  12. 12.
    Skipor AK, Campbell PA, Patterson LM, Anstutz HC, Schmalzried TP, Jacobs JJ (2002) Serum and urine metal levels in patients with metal-on-metal surface arthroplasty. J Mater Sci Mater Med 13(12):1227–1234PubMedCrossRefGoogle Scholar
  13. 13.
    Witzleb WC, Ziegler J, Krummenauer F, Neumeister V, Guenther KP (2006) Exposure to chromium, cobalt and molybdenum from metal-on-metal total hip replacement and hip resurfacing arthroplasty. Acta Orthop 77(5):697–705PubMedCrossRefGoogle Scholar
  14. 14.
    Kreibich DN, Moran CG, Delves HT, Owen TD, Pinder IM (1996) Systemic release of cobalt and chromium after uncemented total hip replacement. J Bone Jt Surg Br 78-B:18–21Google Scholar
  15. 15.
    Maezawa K, Nozawa M, Hirose T, Matsuda K, Yasuma M, Shitoto K, Kurosawa H (2002) Cobalt and chromium concentrations in patients with metal-on-metal and other cementless total hip arthroplasty. Arch Orthop Trauma Surg 122:283–287PubMedCrossRefGoogle Scholar
  16. 16.
    Apostoli P (2002) Elements in environmental and occupational medicine. J Chromatogr B Anal Technol Biomed Life Sci 778(1–2):63–97CrossRefGoogle Scholar
  17. 17.
    Scansetti G, Maina G, Botta GC, Bambace P, Spinelli P (1998) Exposure to cobalt and nickel in the hard-metal production industry. Int Arch Occup Environ Health 71(1):60–63PubMedCrossRefGoogle Scholar
  18. 18.
    Yokota K, Johyama Y, Kunitani Y, Michitsuji H, Yamada S (2007) Urinary elimination of nickel and cobalt in relation to airborne nickel and cobalt exposure in a battery plant. Int Arch Occup Environ Health 80(6):527–531PubMedCrossRefGoogle Scholar
  19. 19.
    Oldenburg M, Wegner R, Baur X (2009) Severe cobalt intoxication due to prosthesis wear in repeated total hip arthroplasty. J Arthroplasty 24:15–20CrossRefGoogle Scholar
  20. 20.
    Rizzetti MC, Liberini P, Zarattini G, Catalani S, Pazzaglia UE, Apostoli P, Padovani A (2009) Loss of sight and sound. Could it be the hip? Lancet 373:1052–1053PubMedCrossRefGoogle Scholar
  21. 21.
    Steens W, Loehr JF, Von Foerster G, Katzer A (2006) Chronic cobalt poisoning in endoprosthetic replacement. Orthopade 35(8):860–864PubMedCrossRefGoogle Scholar
  22. 22.
    Case CP, Langkamer VG, James C, Palmer MR, Kemp AJ, Heap PF, Salomon L (1994) Widespread dissemination of metal debris from implants. J Bone Jt Surg Br 76-B:701–712Google Scholar
  23. 23.
    Coleman RF, Herrington J, Scales JT (1973) Concentration of wear products in hair, blood, and urine after total hip replacement. Br Med J 1(5852):527–529PubMedCrossRefGoogle Scholar
  24. 24.
    Urban RM, Jacobs JJ, Tomlinson MJ, Gavrilovic J, Black J, Peoc’h M (2000) Dissemination of wear particles to the liver, spleen, and abdominal lymph nodes of patients with hip or knee replacement. J Bone Jt Surg Am 82-A:457–477Google Scholar
  25. 25.
    Nordberg G, Fowler B, Nordberg M, Friberg L (2007) Handbook on the toxicology of metals, 3rd edn. Academic Press, LondonGoogle Scholar
  26. 26.
    Krachler M, Heisel C, Kretzer JP (2009) Validation of ultratrace analysis of Co, Cr, Ni and Mo in whole blood, serum and urine using ICP-SMS. J Anal Atom Spectrom 24:605–610CrossRefGoogle Scholar
  27. 27.
    Mears DC (1979) Materials and orthopaedic surgery. Williams and Wilkins Co (ed), Baltimore, pp 107–135Google Scholar
  28. 28.
    Pazzaglia UE, Ceciliani L, Wilkinson MJ, Dell’Orbo C (1985) Involvement of metal particles in loosening of metal–plastic total hip prosthesis. Arch Orthop Trauma Surg 104:164–174PubMedCrossRefGoogle Scholar
  29. 29.
    Pazzaglia UE, Dell’Orbo C, Wilkinson MJ (1987) The foreign body reaction in total hip arthroplasties. A correlated light microscopy, SEM and TEM study. Arch Orthop Trauma Surg 106:209–219PubMedCrossRefGoogle Scholar
  30. 30.
    Sodl JF, Bassora R, Huffmann GR, Keenan MA (2008) Traumatic miositis ossificans as a result of collagen fraternity hazing. Clin Orthop Rel Res 466:225–230CrossRefGoogle Scholar
  31. 31.
    Kempf I, Semlitsch M (1990) Massive wear of a steel ball head by ceramic fragments in the polyethylene acetabular cup after revision of a total hip prosthesis with fractured ceramic ball. Arch Orthop Trauma Surg 109(5):284–287PubMedCrossRefGoogle Scholar
  32. 32.
    Kleinhans JA, Jakubowitz E, Seeger JB, Heisel C, Kretzer JP (2009) Macroscopic third-body wear caused by porous metal surface fragments in total hip arthroplasty. Orthopedics 32(5):364PubMedCrossRefGoogle Scholar
  33. 33.
    Leggett RW (2008) The biokinetics of inorganic cobalt in the human body. Sci Total Environ 389(2–3):259–269PubMedGoogle Scholar
  34. 34.
    Steinemann SG (1994) Corrosion of implant alloys. In: Buchhorn GH, Willert HG (eds) Technical principles. Design and safety of joint implants. Hogrefe and Huber, Seattle, pp 168–179Google Scholar
  35. 35.
    Jordan C, Whitman RD, Harbut M et al (1990) Memory deficits in workers suffering from hand metal disease. Toxicol Lett 54:241–243PubMedCrossRefGoogle Scholar
  36. 36.
    Meecham HM, Humphrey P (1991) Industrial exposure to cobalt causing optic atrophy and nerve deafness: a case report. J Neural Neurosurg Psychiatry 54(4):374–375CrossRefGoogle Scholar
  37. 37.
    Licht A, Oliver M, Rachmilewitz EA (1972) Optic atrophy following treatment with cobalt chloride in a patient with pancytopenia and hypercellular marrow. Isr J Med Sci 8(1):61–66PubMedGoogle Scholar
  38. 38.
    Schirrmacher UO (1967) Case of cobalt poisoning. Br Med J 1(5539):544–545PubMedCrossRefGoogle Scholar
  39. 39.
    Ikeda T, Takahashi K, Kabata T, Sakagoshi D, Tomita K, Yamada M (2010) Polyneuropathy caused by cobalt–chromium metallosis after total hip replacement. Muscle Nerve 42(1):140–143PubMedCrossRefGoogle Scholar
  40. 40.
    Tower SS (2010) Cobalt toxicity in two hip replacement patients. Epidemiol Bull 14. http://www.epi.alaska.gov/bulletins/bltndate.jsp. Accessed 28 May 2010

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • U. E. Pazzaglia
    • 1
  • P. Apostoli
    • 2
  • T. Congiu
    • 3
  • S. Catalani
    • 2
  • M. Marchese
    • 1
  • G. Zarattini
    • 1
  1. 1.Orthopaedic ClinicUniversity of BresciaBresciaItaly
  2. 2.Department of Experimental and Applied Medicine, Section of Industrial HygieneUniversity of BresciaBresciaItaly
  3. 3.Department of Human MorphologyUniversity of InsubriaVareseItaly

Personalised recommendations