A Systematic Review of Systemic Cobaltism After Wear or Corrosion of Chrome-Cobalt Hip Implants

Title	A Systematic Review of Systemic Cobaltism After Wear or Corrosion of Chrome-Cobalt Hip Implants
Authors	Bradford D. Gessner, Thomas Steck, Erik Woelber, Stephen S. Tower
Magazine	Journal of Patient Safety
Date	06/12/2015
DOI	10.1097/PTS.0000000000000220
Introduction	This systematic review aimed to consolidate information regarding systemic arthroprosthetic cobaltism, a condition arising from the degradation of chrome-cobalt hip implant components. A thorough literature review was performed to collect all documented instances of this syndrome. To evaluate the relationship between blood cobalt concentrations (B[Co]) and patient health, a novel symptom scoring instrument was created, encompassing nine symptom categories and medical service usage. The analysis included 25 patient cases reported from 2001 to 2014, noting a significant rise in reports recently. Patient symptoms varied widely, affecting the hip (84%), cardiovascular system (60%), audiovestibular system (52%), peripheral motor-sensory system (48%), thyroid (48%), psychological state (32%), visual system (32%), and the haematological, oncological, or immune systems (20%). The average time from implant placement to symptom onset or revision surgery was 41 months. The average B[Co] was 324 µg/L, with some patients showing levels below 20 µg/L. A strong correlation was observed between B[Co] and the quantitative severity of overall symptoms, unlike blood chromium levels. Patients undergoing revisions for ceramic-on-ceramic prostheses exhibited notably higher mean B[Co] and symptom scores compared to those with primary metal-on-metal prostheses. The findings underscore systemic arthroprosthetic cobaltism as a growing concern associated with chrome-cobalt hip implants, capable of affecting numerous organ systems even at comparatively low B[Co] levels. Further efforts are essential to characterise the full extent of this issue and to formulate effective screening and treatment approaches.
Quote	Bradford D. Gessner, Thomas Steck and Erik B Woelber et al. A Systematic Review of Systemic Cobaltism After Wear or Corrosion of Chrome-Cobalt Hip Implants. 2015. DOI: 10.1097/PTS.0000000000000220
Element	Cobalt (Co) , Chromium (Cr)
Industry	Medical Devices