Neuropsychiatric symptoms following metal-on-metal implant failure with cobalt and chromium toxicity

Title	Neuropsychiatric symptoms following metal-on-metal implant failure with cobalt and chromium toxicity
Authors	Ben Green, Emily Griffiths, Solomon Almond
Magazine	BMC Psychiatry
Date	01/24/2017
DOI	10.1186/s12888-016-1174-1
Introduction	The widespread use of metal-on-metal (MoM) hip implants in the UK, with over 31,000 procedures between 2003 and 2011, led to significant rates of implant failure, necessitating recalls and revisions. This study presents ten cases, with an average patient age of 60 years, examining neuropsychiatric morbidity subsequent to MoM hip implant failure and revision. The implants involved were ASR total hip replacements, placed between 2005 and 2009. This case series uniquely details neuropsychiatric complications arising after revision surgery, specifically in contexts of cobalt and chromium toxicity. Prior to revision, nine patients exhibited elevated, toxic levels of chromium (mean 338 nmol/l) and cobalt (mean 669.4 nmol/l). Depression assessments confirmed that all nine patients met the BDI criteria for depression, with three actively receiving treatment. Additionally, seven patients displayed short-term memory deficits, evidenced by a mean Mini Mental State Examination (MMSE) score of 24.2, notably below the expected population mean of 28, and indicative of potential cognitive impairment. The findings establish a link between neurocognitive and depressive impairments and cobalt and chromium metallosis following MoM implant failure. These results underscore the need for more extensive research into neurocognitive impacts within this patient population, highlighting potential public health concerns.
Quote	Ben Green, Emily Griffiths and Solomon Almond. Neuropsychiatric symptoms following metal-on-metal implant failure with cobalt and chromium toxicity. BMC Psychiatry. 2017. Vol. 17. DOI: 10.1186/s12888-016-1174-1
Element	Cobalt (Co) , Chromium (Cr)
Industry	Medical Devices , Research & Laboratory