Cobalt Chromium Toxicity

cobalt and chromium

Do Elevated Cobalt Levels Lead to Long-Term Health Risks?


Photo of Surgeons Working at the Operating Table

Cobalt exposure can lead to significant health problems. Patients with metal-on-metal hip implants that contain cobalt can develop numerous short and long-term health complications.

What Health Conditions Can Metal-On-Metal Hip Implants Cause?

Metal-on-metal hip implants can release metal ions into the bloodstream, which can result in many long-term health issues. These symptoms can be devastating, causing health issues that can keep patients from working, walking or enjoying life. The Food and Drug Administration (FDA) lists these issues as:

  • Hip and groin pain
  • Swelling
  • Changes in your ability to walk
  • Deterioration of tissue around the joint
  • Reactions to metal ions

Patients may experience implant loosening, implant failure, metallosis or pseudotumors. Removal of the offending prosthetic may be necessary in order to relieve these symptoms. This is why it is important to communicate with your doctor after a hip replacement. When following up with your orthopaedic surgeon, be sure to mention any changes in your health. You should also let the surgeon know if you are seeing another physician for a new condition.

You can also contact an attorney if you suspect that your hip implant is defective. The experience of the product liability attorneys at Kershaw, Cook & Talley, P.C. can help you with this process. Call us at (888)817-2527 if you have questions about your metal-on-metal hip implant.

Metal Implants and Hypersensitivity


Metal Hypersensitivity

Metal hypersensitivity is an immune mediated response resulting from exposure to certain metals such as cobalt and chromium. An immune mediated response occurs when there is a trigger, like a foreign agent, that causes an immune reaction. These triggers can range from seasonal allergies to specific cells responding to an exposure of metals. It is important to differentiate between the immune reaction from an allergen, like pollen, and a metalloid material. Whereas a seasonal allergy generates immediate symptoms, like itching, watery eyes, and sneezing, a metal allergy induces a delayed response to the exposure of these elements.

Once your immune system is exposed to new metals, your body creates an immunological memory. This occurs because certain cells called T-lymphocytes recognize the metals as a foreign body and want to create a memory in order to activate immune responses. This is the body’s defense mechanism if the metals continue to be present, or are reintroduced, in the body. After formation of immunological memory, if you are exposed to the metal again, the body will activate an inflammatory reaction in order to better defend against this foreign object. This gives the delayed response of metal hypersensitivity. The symptoms of delayed hypersensitivity are analogous to the reaction you would get from a food allergy or insect sting.

 

Symptoms of Metal Hypersensitivity

Contact dermatitis, most commonly known as a skin rash, is the most suitable way to describe the main symptom of metal hypersensitivity. Other symptoms include but are not limited to: blisters, vesicles, erythema (redness), pruritis (itching), and inflammation around the area of exposure. Due to its delayed nature, symptoms may not appear until a day after contact with the metal and may take many days to return back to normal.

Metal implant devices, such as Metal on metal (MOM) hip prostheses, lead to a more complicated metal hypersensitivity. It is difficult to describe the effects of a MOM implant because the field of visualization is restricted since the device is implanted within the body. However, studies demonstrated an immune response and hypersensitivity in the tissue areas interacting with the debris from implanted devices. Wear debris is the result of movement, friction, metal corrosion (metal oxidation), and metal ions released from the device. This can cause severe pain, swelling, limited range of motion, joint effusion (abnormal buildup of fluid between layers of tissue in or around joints), inflammation, and osteolysis (bone loss).

What happens to my device if I have a metal hypersensitivity?

Wear debris is a by product of corrosion of the implant material. Metal ions and particles are released into the surrounding tissue over time. People with a hypersensitivity to the metals of their implant will react differently compared to those who don’t have an allergy due to the triggering of an adverse response. As previously mentioned, an inflammatory response is triggered when the immune cells are exposed to the metals like cobalt and chromium. The response ranges from mild to severe depending on the extent of the sensitivity, levels of metals within the body, and wear debris. Persistent inflammation, due to the MOM implant, can cause muscle spasms, myofascial pain, headaches, tinnitus (ringing in the ear), vertigo (dizziness), and angioedema (swelling under the skin). A chronic inflammatory reaction from continued exposure, from a MOM device, can lead to loss of bone strength, implant loosening or fracturing, and osteolysis (bone loss).

Testing for Metal Hypersensitivity

It is difficult to test because the environment on the skin is different than the periprosthetic area deep within the tissues. There is a blood test called lymphocyte transformation test (LTT) which determines if a patient suffers from metal hypersensitivity. The LTT measures the proliferation of T lymphocytes which are the immune specific cells that form the immunological memory in response to metal exposure. The blood is collected and put within special tubes in order to decrease the risk of contamination. Similarly, it is tested within a laboratory that follows strict procedural protocols and standards to avoid contaminating the sample.

 Metal Hypersensitivity and Implant Performance

Approximately 25% of people with properly functioning MOM devices have a metal hypersensitivity and more than 60% of people with malfunctioning MOM devices have a metal hypersensitivity. This is a stark and alarming contrast which is attributed to the poor implantation. There is also a greater failure rate as a result of metallosis, hypersensitivity, and adverse local tissue reactions (ALTR). Hypersensitivity is strongly correlated with poor implant performance and generally makes revision difficult and risky as a result of the body’s reaction.

Source: Metal Hypersensitivity to Implant Materials By: Marco Caicedo, Ph.D

http://www.tmj.org/site/pdf/Metal_Hypersensitivity.pdf

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