In 1966, a curious case of cobalt poisoning occurred in Canada. June 8, 2018 – San Diego, CA. He knew that a hip replacement would be inevitable, if he wanted to continue his life without pain. Increased cobalt levels have been reported to be associated with neurological3,4 (hand tremor, incoordination, cognitive decline, depression, vertigo, hearing loss and visual changes), cardiac (arrhythmias and cardiomyopathy) and endocrine5,6 symptoms. The silver lining to cobalt poisoning is that the symptoms and damage, if caught in time, may be completely reversible. Others symptoms of Cobalt poisoning are reduced vision and amnesia. The friction releases tiny metal particles into your bloodstream that could trigger a hypersensitive immune response in your body. A good, close friend had hip replacement a few years back. even as it was being abandoned by surgeons who worked as consultants to the company. Since the advent of proper brewing techniques “beer-drinkers cobalt toxicity” is also a relatively rare occurrence [21-23]. He had significantly improved exercise tolerance and was able to walk without restriction. It allowed the company to design a hip replacement based on earlier designs and products (called “predicate devices”), and then claim that their product was “substantially equivalent” to those previous models. Cobalt Chromium Metal Poisoning from Hip Replacements. In the Netflix documentary, The Bleeding Edge, you meet an orthopedic surgeon named Dr. Stephen Tower. Conventional total hip prostheses consist of a metal head that fits into a polyethylene cup. Some of the hip replacement parts can cause cobalt to leak into the bloodstream, causing symptoms similar to toxic levels of cobalt ingestion. The journal also explained that as far back as 1996, “patients with metal-on-metal hips found to be at increased risk of cancer compared with those with metal-on-plastic hips.”. Although cobalt toxicity is a relatively rare occurrence it should still is noted as a complication of total knee and hip replacement surgical procedures especially when a cobalt alloy is used as the replacement graft. Clinically significant effects of cobalt poisoning rarely The patient’s serum cobalt level had been measured in September 2010 and found to be 185 nmol/L, and subsequently remained consistently elevated at between 213 nmol/L and 258 nmol/L. When the metal is smelted, it becomes very hard. He had a terrible time. In the worst cases of cobalt poisoning, a patient may suffer permanent, disabling side effects, including cardiomyopathy (degenerative heart disease), blindness, deafness, memory loss, and more. The devices are manufactured from blended metals that could include titanium, nickel, cobalt, chromium, and molybdenum. Metallosis is a type of metal poisoning that can occur as a side effect of joint replacement devices with metal components, such as metal-on-metal hip implants or some knee implants. In particular, cobalt poisoning can lead to: The silver lining to cobalt poisoning is that the symptoms and damage, if caught in time, may be completely reversible. The neurological symptoms that occur with cobalt metal poisoning include: tremors The British Hip Society recommends regular follow-up of patients with metal-on-metal hip replacements for at least 5 years and probably for the life of the prosthesis.2 Clinical manifestations of cobalt toxicity may occur many years after implantation of the prosthesis and appear to stay elevated over extended periods of time.13 Long-term exposure to cobalt may also be associated with cancer.14 Patients should therefore be followed up carefully, with specific questioning about alterations in neurological, cardiac, respiratory and endocrine function. These include metal-on-metal knee and hip joint implants. An individual is exposed to this chemical element via inhalation, ingestion, or dermal exposure and, in general, chronic exposure is required for most of the adverse effects to develop.. Cobalt is also component of cyanocobalamin also known as vitamin B12, which is widely consumed. In this condition, a skin rash that looks like eczema can occur. Cobalt Chromium Metal Poisoning from Hip Replacements. The Australian National Joint Replacement Registry (NJRR) notes large differences in the performance of different types of metal-on-metal hip prostheses. As it turns out, their local brewer had started using a form of cobalt sulfate to create a better foam on top. In February 2011, the patient had a revision total hip replacement performed because of his systemic symptoms, in spite of having no hip symptoms. Do Stryker Hip Systems Cause Metallosis or Metal Poisoning - Charlotte Product Liability Lawyer Patients with elevated chromium levels often show similar symptoms as those with elevated cobalt levels. The medical devices used are often a blend of metals like chromium, nickel, titanium and cobalt. The ASR metal cup and head were removed and the stem retained. Randy has also been awarded the distinction of being a “Super Lawyer” 10 times in the last decade. Below is the list of symptoms related to toxicity for both: Box 1: Some reported symptoms of arthroprosthetic cobaltism 7 Metal poisoning is a serious concern for all hip replacement patients, but it is not the only one. A knee infection is a serious condition that needs to be treated by a doctor right away in order to avoid serious and life-threatening complications. Ross Crawford has received consultancy fees and royalties from Stryker, a manufacturer of joint replacement prostheses. X-ray of Patient 1’s right metal-on-metal articulation hip replacement, with well fixed cementless femoral and acetabular implant. What Dr. Tower experienced – what so many patients have experienced – is the effects of cobalt poisoning. Frances, 47, was 39 when the cobalt alloy hips were implanted. Finally the doctor replaced the devise with one that had already proven reliable. Because it turns out that anyone who submits to joint-replacement surgery is at risk for developing a condition called arthroplasty cobalt encephalopathy, or ACE, but they may not know it — because the symptoms mimic those of Parkinson’s and even dementia! (MJA 2011; 194: 649-651). Woman's Metal Allergy Causes Severe Symptoms After Knee Replacement Patient suffers nine-month ordeal while searching for answers to severe pain, weakness and fatigue after knee replacement. That is eight times the failure rate of most orthopedic implants. Your doctor will perform a blood test to confirm whether you do indeed have metallosis. Metallosis is a medical condition that involves metal debris building up in the soft tissue, usually around the site of a metal-on-metal implant, such as a hip replacement or knee implant. The soft tissue destruction is often irreparable, resulting in many patients doing poorly after revision procedures,” per The BMJ. Exposure to cobalt ions was found to significantly inhibit osteoblast function by reducing alkaline phosphatase activity and calcium deposition, and to rapidly induce the secretion of proteins IL-8 and MCP-1 in primary human osteoblasts.8 This may have implications for bone ingrowth onto implants and osteolysis around the hip replacement. However many may face a side effect know as metallosis from the hip replacement or a similar side effect called cobalt poisoning. Almost 3 years later, it was replaced by metal implant containing cobalt, chromium, and titanium. A group of 48 beer drinkers developed a form of heart disease (cardiomyopathy) unique to that group. Dr. Tower tells the story of how he started to experience pain in his hips, and how he was afraid that he would not be able to compete in a bike race he participated in every year. Given the patient’s constellation of symptoms and lack of other significant past medical history, the differential in this case was relatively limited. Cobalt poisoning can also occur from the wear and tear of some cobalt/chromium metal-on-metal hip implants. Xinzhan Mao, Andrew A Wong and Ross W Crawford, Email me when people comment on this article, Online responses are no longer available. Her acetabulum was revised with an all-polyethylene cemented cup and the head was changed to a ceramic one. Concerns have been raised, particularly in younger patients, that the plastic cup suffers wear and tear with time and may require revision. These symptoms are possible in people who have a metal allergy and undergo replacement of knee, hip or other joints, states the Arthritis Foundation. At the time of surgery, 30 mL of turbid fluid was aspirated from the joint and debridement of metal stained tissue was undertaken. He had a terrible time. If you or your loved one suffered cobalt poisoning, developed an infection or cancer, sustained permanent tissue or bone damage, or were harmed in any way because of a defective metal-on-metal implant, we want to help. The worry is that the metal-on-metal contacts in the hip replacements grind off tiny metal molecules -- chromium and cobalt ions -- that might be toxic. DePuy executives discussed ways of fixing the defect, the records suggest, but they apparently never did so. Metallosis is a reputed blood poisoning condition that often develops when high levels of toxic metals are present in the blood. After revision surgeries, the patients’ symptoms improved. He had no hip symptoms, but an x-ray showed quite marked bone loss around the acetabular component. ACE is meant to identify a brain disease or associated neurological symptoms caused by elevated levels of cobalt from a metal artificial hip. Skin discoloration and joint effusion (arrow) after knee arthroplasty failure, prior to revision surgery. We report two Australian patients with possible cobalt toxicity related to metal-on-metal total hip replacements. In less than 1 percent of joint replacement … She had particularly noted difficulty in remembering names and registering information (both written and aural), headaches and cerebellar signs (ataxia and dysdiadochokinesis). There are over 28 different known isotopes for cobalt including some that are radioactive. Before his hip replacement surgery, the patient had been working full time and enjoyed excellent general health, apart from pain and stiffness in his right hip secondary to osteoarthritis. Metal allergy, a little-known problem, caused systemic pain, severe weakness and fatigue for a woman after knee replacement. Reports of patient reactions to these ions have spurred the FDA to order the … It would seem logical to simply monitor knee replacement patients for raised metal levels, but this is not as simple as it seems. The important lesson from this case is the need to identify symptoms of cobalt toxicity early in patients with prior hip arthroplasty. The first is a skin reaction called dermatitis. 1539 Health Care Drive Another rare form of cobalt poisoning is from a hip replacement. A 2017 study in BMC Psychiatry looked at ten cases of metal-on-metal hip replacements. At 8-week follow-up after the revision surgery, the patient felt much improved. The doctor chose to use a new type of devise for the replacement. Learn about the symptoms, sources, diagnosis and treatment for heavy metal poisoning and toxicity. Cerebrospinal fluid (CSF) collected at surgery showed a cobalt level of 9 nmol/L and a chromium level of 13 nmol/L (no reference ranges for these in CSF), showing that the ions had crossed the blood–brain barrier. We believe our patients’ symptoms were related to their elevated cobalt levels, resulting from cobalt leaching out of their hip prostheses. This type of implant is an artificial hip socket that is created by fitting a … Hip replacement surgery is a viable option for people who suffer from limited mobility due to hip pain. She had been admitted to the stroke unit and treated with ongoing clopidogrel. The most notable difference is that cobalt poisoning can cause cardiomyopathy while elevated chromium levels do not appear to cause heart problems but can cause problems with the reproductive system. Metallosis, or metal poisoning, is a medical condition involving the build-up of toxic levels of metal debris in the soft tissue of the human body. A 60-year-old male professor of engineering presented in January 2011 with systemic symptoms, for follow-up after a right total hip replacement with a DePuy ASR XL Acetabular Hip System prosthesis 4 years previously. In The Bleeding Edge, Dr. Tower wonders if some elderly patients – the ones most likely to need a hip transplant – might have been wrongfully diagnosed with a form of dementia, when in fact they were showing signs of a reversible condition, instead. The main objective of treatment is to eliminate the exposure to cobalt and to treat the systemic symptoms supportively, such as thyroid replacement therapy, beta-blockers, angiotensin-converting enzyme inhibitors (ACE inhibitors), diuresis, corticosteroid therapy, etc[1]. Neurologic dysfunction: There are various neurotoxic symptoms described in patients with presumed cobalt toxicity, including hearing loss, tinnitus, optic nerve atrophy, visual impairment, convulsions, vertigo, headaches, tremors, polyneuropathy, incoordination, cognitive decline, and depression. A computed tomography (CT) scan at this time showed a hypodensity in the right anterior commissure, although it could not be confirmed whether this represented a lacunar infarct or a perivascular space. Symptoms of cobaltism have been previously described when cobalt was used to treat refractory anaemia in patients 40 years ago.7 The term “arthroprosthetic cobaltism” has been coined to describe these manifestations in patients with joint replacements.3. The risk to the patient occurs with any artificial hip containing a cobalt component.” Conventional wisdom has been that eliminating the metal on metal contact should eliminate the risk of metallosis, but Dr. Tower at least does not accept this thinking. The other danger for cobalt poisoning is that it could mimic other conditions. subject to the Medical Journal of Australia's editorial discretion. This blog post provides general information to help the reader better understand regenerative medicine, musculoskeletal health, and related subjects. Cobalt chromium poisoning is a risk for anyone with a metal on metal (MoM) hip replacement. Cobalt chromium poisoning is a risk for anyone with a metal on metal (MoM) hip replacement. Its revision rate reported on the NJRR in 2010 was 6.4% at 3 years when inserted with a Corail stem and 10.9% at 5 years when inserted as a resurfacing.1 Updated guidance from the British Hip Society’s 2011 conference noted a, higher than anticipated early failure rate [in large-diameter metal-on-metal hip replacements]. Both patients were treated for osteoarthritis with a DePuy ASR (articular surface replacement) XL Acetabular Hip System prosthesis, which contains cobalt and chromium, and which has recently been recalled from the market. will be notified by email within five working days should your response be We are finding cobalt poisoning in too many patients with metal-on-plastic and metal-on-ceramic hips. The effects of the cobalt alloy hips were life-altering for Frances. of publication, Information for librarians and institutions. Many metal-on-metal (MoM) total hip replacement implants have been recalled due to high failure rates. Metallosis is a type of metal poisoning that can occur as a side effect of joint replacement devices with metal components, such as metal-on-metal hip replacements or other metal implants. This was the result of a hip replacement she had undergone several years prior. This type of implant is an artificial hip socket that is created by fitting a … Another rare form of cobalt poisoning is from a hip replacement. Metallosis is the putative medical condition involving deposition and build-up of metal debris in the soft tissues of the body.. Metallosis has been known to occur when metallic components in medical implants, specifically joint replacements, abrade against one another. Any of these symptoms can be signs of cobalt poisoning. Not only will more people need implants, but all the victims of defective implants will require revision surgeries. Metallosis is a formal poisoning caused by exposure to metal that is often a side effect that occurs after a metal joint replacement device has been implanted during hip or knee replacement surgery. Total hip replacement is generally a successful operation, with a long clinical history of good outcomes. They knew, and they did nothing. Case Studies. accepted. He has over 25 years of experience helping injured people fight back against corporations, hospitals and wrong-doers. Case 2 The case presented in The Lancet involved a 55-year-old man. The patient’s original hip replacement had been done in 2006 with an ASR (articular surface replacement) hip prosthesis (ASR XL Acetabular Hip System [DePuy Orthopaedics, Warsaw, Ind, USA]), comprising a large-diameter metal (cobalt and chromium) cup with a large modular metal head on a titanium Corail stem (Box). Another study in 1994 reviewed the “dissemination of cobalt and chromium ions into lymph, liver, and spleen,” per The BMJ (formerly the British Medical Journal). The doctor chose to use a new type of devise for the replacement. In addition, if the cobalt toxicity is from a metal hip implant, there may be additional symptoms related to chromium poisoning. metal-on-metal hip replacement was] projected to fail within five years in about 40 percent of patients who received one. You 2 He underwent hip surgery in November 2010 to replace his left hip ceramic implant with a metal-on-polyethylene implant. On last night's 'Grey's Anatomy,' Richard Webber was diagnosed with cobalt poisoning due to a hip replacement. Blood levels. Free Consultation - Call (855) 370-2828 - Arnold & Smith helps victims and their families receive compensation for their injuries in Product Liability and Defective Product cases. Metallosis is the putative medical condition involving deposition and build-up of metal debris in the soft tissues of the body.. Metallosis has been known to occur when metallic components in medical implants, specifically joint replacements, abrade against one another. Within weeks, her skin broke out in boils that would crack open and bleed. They knew it had failed the tests. DePuy used the same 510(k) submission process that so many manufacturers use. What is Arthroplasty Cobalt Encephalopathy (ACE)? Her serum cobalt level had reduced to 60 nmol/L. However, cobalt can also be highly toxic, and over-exposure to the metal can lead to heavy metals poisoning. At 8-week follow-up after the revision surgery, the patient reported significant improvement in his energy levels and a decrease in muscle pains. The cerebrovascular episode had occurred in July 2010, when the patient experienced symptoms consistent with a stroke: dizziness, disorientation, nausea, vomiting and being “off balance on the left side”. A good, close friend had hip replacement a few years back. The authors called for a larger group study to define the prevalence and spectrum of cobalt poisoning due to hip replacement surgery. A 73-year-old woman presented to our orthopaedic clinic in February 2011 for follow-up of a right total hip replacement that had been performed 5 years previously because of osteoarthritis. At review, she had neurological symptoms, including cognitive decline, memory difficulties and depression, which had been present for 7 months since a cerebrovascular episode. Effects of cobalt on the thyroid can cause fatigue, weight gain, and other thyroid dysfunctional symptoms. There was no metal debris or localised tissue reaction. The direct effect of cobalt on cells has recently been explored. We will be measuring his cobalt levels, as these two go in tandem for hip replacement patients. S. Randall Hood Some of the hip replacement parts can cause cobalt to leak into the bloodstream, causing symptoms similar to toxic levels of cobalt ingestion. He is shown biking around Anchorage, Alaska, where he lives and practices. X-rays showed a well fixed, well aligned implant, with mild osteopaenia around the acetabular component. His chromium level was never elevated. Provenance: Not commissioned; externally peer reviewed. Hip replacement surgery is a viable option for people who suffer from limited mobility due to hip pain. Title: “Neuropsychiatric symptoms following metal-on-metal implant failure with cobalt and chromium toxicity” Abstract. Cobalt is an essential element for health in animals in minute amounts as a component of Vitamin B 12.A deficiency of cobalt, which is very rare, is also potentially lethal, leading to pernicious anemia. It is a veritable gold mine for the medical device industry – and not one of them cares who they hurt in the process. Rock Hill, SC 29732, https://www.mcgowanhood.com/testimonials/12306625/, https://www.mcgowanhood.com/testimonials/17250000/, https://www.mcgowanhood.com/testimonials/122000000/, https://www.mcgowanhood.com/testimonials/489000000/, https://www.mcgowanhood.com/testimonials/13-75-million-medical-malpractice-verdict-against-aiken-regional-medical-centers-for-delayed-sepsis-treatment-leading-to-amputation/, Minimal Medical Device Regulations Pose Serious Dangers to Metal Hip Implant Patients, Johnson and Johnson Dodges Bad Press through Use of Subsidiaries, Defective Medical Devices – Hip Replacement Recall Lawsuits in South Carolina, Life On The Bleeding Edge: How The FDA Won’t Help Keep You Safe, Fashion Exec Peter Nygard Charged with Sex Trafficking by FBI, Stevens-Johnsons Syndrome, TEN & Medical Malpractice: The Facts, Signs of Physical Abuse at Residential Treatment Facilities, Relapsed Alcoholic Doctor Accused of Wrongdoing at Anderson County Hospital in Lawsuit by McGowan, Hood & Felder, LLC, Racism in Health Care – Finding Equity Through Education. Treatment for swallowed cobalt: The health care team will treat your symptoms and order some blood tests. The first implants hit the U.S. market in 2005. The Data on Cobalt Poisoning and Neuropsychiatric Complications. Our defective medical device lawyers have been fighting against medical device manufacturing companies for many years. Context: Cobalt intoxication has become more frequent due to the wide use of metal hip implants. He has been certified by the American Board of Professional Liability as a specialist in Medical Malpractice Law which is recognized by the South Carolina Bar. The silver lining to cobalt poisoning is that the symptoms and damage, if caught in time, may be completely reversible. Finally the doctor replaced the devise with one that had already proven reliable. Some symptoms of titanium implants can be an autoimmune response or allergic reactions that can include inflammation, blistering and a rash around the implant site. That is why, if you were critically injured because of a defective cobalt hip replacement, you need an advocate like McGowan, Hood & Felder, LLC on your side. Please refer to our, Statistics, epidemiology and research design, View this article on Wiley Online Library, http://www.dmac.adelaide.edu.au/aoanjrr/documents/aoanjrrreport_2010.pdf, http://www.britishhipsociety.com/pdfs/BHS_MOM_THR.pdf, Conditions The authors called for a larger group study to define the prevalence and spectrum of cobalt poisoning due to hip replacement surgery. According to the FDA, metal on metal artificial joints produces shavings when they rub against each other during their normal functioning such as walking. In sum, metal-on-metal hip replacements, which have been under review since at least 1975, can lead to: Yet despite all of these risks, DePuy went ahead with developing and manufacturing their metal-on-metal hop implants. Both chromium and cobalt are metals that, over time, can poison an individual who has too much of them built up in his or her body. These elevated levels of serum cobalt and chromium are for real, so if you’ve had a joint replacement, getting them checked may be a good idea. He particularly noted problems with remembering names and poor concentration. Metallosis is linked to artificial joint replacement devices with metal components, such as metal-on-metal hip and knee implants. Within s short time, though, he started to experience some strange side effects, culminating in (as his wife put it) a mental break that led him to trash a hotel room. Chromium Chromium poisoning is as dangerous as cobalt poisoning. Cobalt; Poisoning; Literature review; Neurotoxicology;Cobalt poisoning; Beer drinkers; Cobalt cardiomyopathy The devise dislocated at will several times and he developed cobalt poisoning. Metal-on-metal hip replacements release metal ions into the bloodstream. Still, executives in Johnson & Johnson’s DePuy Orthopaedics unit kept selling the A.S.R. Because of this, metal-on-metal hop replacements with chromium and cobalt were able to enter the market without the rigorous testing required for new Class II and Class III devices. She had mild groin pain but otherwise no symptoms related to her hip. Besides the symptoms associated with other forms of metallosis, cobalt toxicity can cause patients to suffer from fever, inflammation, and low thyroid levels. Symptoms include: * fever higher than 100 degrees F * shaking * chills * drainage from the surgical site or redness * swelling * tenderness It has a number of uses, and we even need a small amount of cobalt in our systems, or we can suffer from a particularly severe form of anemia. Infection can occur years after knee replacement surgery, when bacteria enter the bloodstream and infect the surgical site, according to MayoClinic.com 1. 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