The association of cobalturia with cobaltism symptoms a prospective blinded study of 229 post-arthroplasty patients.

Introduction: Cobalt is a mitochondrial toxin, clinical cobaltism manifests with constitutional, neurologic, and cardiovascular symptomatology. Cobalt's severe toxidrome is known through case reports from extreme wear or corrosion of cobalt-chromium arthroplasty components. However, the spectrum and epidemiology of orthopedic-implant cobaltism and its relationship to duration and degree of cobalt exposure are not well defined.

Prevalence of Cobalturia Among Adults With Joint Replacements.

This cohort study examines the association of cobalt-chrome arthroprosthetic components with adverse reactions to metallic debris, such as cobaltism.

Corrosion of Polished Cobalt-Chrome Stems Presenting as Cobalt Encephalopathy.

Adverse reactions to metallic debris from corrosion of polished cobalt-chromium-cemented femoral stems are reported. Cobaltism (systemic cobalt poisoning) has not been reported from this phenomenon. Three patients presented to their surgeon for ongoing care 10-20 years after primary metal-on-plastic hip arthroplasty with the same polished cobalt-chromium-cemented femoral stems (Heritage, Zimmer).

F-18 FDG PET brain imaging in symptomatic arthroprosthetic cobaltism.

Purpose: Imaging studies of cobalt toxicity from cobalt-chromium alloy arthroprosthetics have focused on the local intra-articular and peri-articular presentation from failing joint replacements. Most studies investigating neurological findings have been small case series focused on the clinical findings of memory loss, diminished executive function, tremor, hearing and vision loss, depression, and emotional lability. This study utilizes software-based quantitative analysis of brain metabolism to assess the degree of hypometabolism and areas of susceptibility, determine if a pattern of involvement exists, and measure reversibility of findings after prosthetic revision to cobalt-free appliances.

A Perspective on the Principles of Integrity in Infectious Disease Research.

The medical literature is prone to overstating results, a condition not thoroughly recognized among policymakers. This article sets forth examples of potential problems with research integrity in the infectious disease literature. We describe articles that may be spun, categories lumped together in hopes of creating a significant effect (and sometimes an insignificant one), changes in metrics, and how trials may fail because of suboptimal interventions.

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

Objectives: We sought to synthesize data on systemic arthroprosthetic cobaltism, a recently described syndrome that results from wear or corrosion of chrome-cobalt hip components.

Methods: We conducted a systematic literature review to identify all reported cases of systemic arthroprosthetic cobaltism. To assess the epidemiologic link between blood cobalt levels (B[Co]), we developed a symptom scoring tool that evaluated 9 different symptom categories and a category of medical utilization.

Systemic disease after hip replacement: aeromedical implications of arthroprosthetic cobaltism.

Background: A multisystem illness recently reported in recipients of the newest generation of metal-on-metal hip prostheses has been ascribed to toxic effects of cobalt and possibly chromium.

Case Report: We present a case of insidiously developing neurologic illness that occurred in a physically active professional.

Discussion: This case illustrates the potential for a hip prosthesis to occultly impair safe functioning of aviators.

Rim cracking of the cross-linked longevity polyethylene acetabular liner after total hip arthroplasty.

Background: Studies have suggested that cross-linked polyethylene bearings reduce wear rates from 40% to 100% compared with conventional polyethylene. However, the reduced mechanical properties of highly cross-linked polyethylene have the potential to be a limiting factor in device performance. We reviewed a series of retrieved acetabular liners with a fracture of the superior rim to assess the factors that played a role in their failure.