Systemic Cobaltism is a Growing Problem for Patients Implanted with Hip Replacement Systems

Systemic cobaltism, or metallosis, is on the increase among patients who have hip implants. The condition is caused by the wear or corrosion of chrome-cobalt hip devices, which shed metal ions into the bloodstream.

Using a review of systematic literature, researchers have been able to develop a symptom scoring tool to evaluate nine different symptom categories and a category of medical utilization to assess the epidemiological association between blood cobalt levels (B[Co]). Scientists identified 25 patients who reported symptoms of cobaltism between 2001 and 2014, and found a substantial increase in case reports over the last three years.

Patients reported the following symptoms:

-Hip (84 percent)

-Cardiovascular system (60 percent)

-Audiovestibular system (52 percent)

-Peripheral motor-sensory system (48 percent)

-Thyroid (48 percent)

-Psychological functioning (32 percent)

-Visual system (32 percent)

-Hematological, oncological, or immune system (20 percent)

It generally took a mean of 41 months from implantation or revision for symptoms to appear. The mean B[Co] was 324 μg/L and 4 patients had levels less than 20 μg/L. The B[Co] but not blood chromium level was highly associated with a quantitative measure of overall symptom severity (r, 0.81; P < 0.001). Patients who had revision surgery for failed ceramic-on-ceramic implants had substantially higher mean B[Co] and symptom scores than patients with primary metal-on-metal devices.

Researchers concluded that cobaltism is becoming more common among patients implanted with chrome-cobalt hip devices, and that symptoms of the condition involve numerous organ systems and may occur with relatively low B[Co]. Further research is necessary to determine the full expanse of the problem and to develop screening and management strategies.

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