ArticleThe Journal of bone and joint surgery. American volume2017
Assessing for Cardiotoxicity from Metal-on-Metal Hip Implants with Advanced Multimodality Imaging Techniques.
Article in The Journal of bone and joint surgery. American volume, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed, 33 citations in OpenAlex.
- Long-Term Risk of Heart Failure in Total Joint Arthroplasty: A Population-Based Cohort Study.The Journal of arthroplasty · 2025Article
- Cardiotoxicity concerns in total joint arthroplasty.World journal of orthopedics · 2024Article
- Blood metal concentrations and cardiac structure and function in total joint arthroplasty patients.World journal of orthopedics · 2024Article
- Association between metallic implants and stroke in US adults from NHANES 2015-2023 a cross-sectional study.Frontiers in aging neuroscience · 2024Article
- The association of cobalturia with cobaltism symptoms a prospective blinded study of 229 post-arthroplasty patients.PloS one · 2023Article
- Cobalt exposure in relation to cardiovascular disease in the United States general population.Environmental science and pollution research international · 2021Article
- Cobalt-induced cardiomyopathy - do circulating cobalt levels matter?Bone & joint research · 2021Article
- Metal ion toxicity : is it still a problem in 2021?Bone & joint research · 2021Article
- Letter to the Editor: Is There a Cardiotoxicity Associated With Metallic Head Hip Prostheses? A Cohort Study in the French National Health Insurance Databases.Clinical orthopaedics and related research · 2018Article
- Revision surgery of metal-on-metal hip arthroplasties for adverse reactions to metal debris.Acta orthopaedica · 2018Article
- The risk of cardiac failure following metal-on-metal hip arthroplasty.The bone & joint journal · 2018Article
Corrections and comments
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Authors and funding
13 authors at 5 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundHigh failure rates of metal-on-metal (MoM) hip implants prompted regulatory authorities to issue worldwide safety alerts. Circulating cobalt from these implants causes rare but fatal autopsy-diagnosed cardiotoxicity. There is concern that milder cardiotoxicity may be common and underrecognized. Although blood metal ion levels are easily measured and can be used to track local toxicity, there are no noninvasive tests for organ deposition. We sought to detect correlation between blood metal ions and a comprehensive panel of established markers of early cardiotoxicity.
methodsNinety patients were recruited into this prospective single-center blinded study. Patients were divided into 3 age and sex-matched groups according to implant type and whole-blood metal ion levels. Group-A patients had a ceramic-on-ceramic [CoC] bearing; Group B, an MoM bearing and low blood metal ion levels; and Group C, an MoM bearing and high blood metal-ion levels. All patients underwent detailed cardiovascular phenotyping using cardiac magnetic resonance imaging (CMR) with T2*, T1, and extracellular volume mapping; echocardiography; and cardiac blood biomarker sampling. T2* is a novel CMR biomarker of tissue metal loading.
resultsBlood cobalt levels differed significantly among groups A, B, and C (mean and standard deviation [SD], 0.17 ± 0.08, 2.47 ± 1.81, and 30.0 ± 29.1 ppb, respectively) and between group A and groups B and C combined. No significant between-group differences were found in the left atrial or ventricle size, ejection fraction (on CMR or echocardiography), T1 or T2* values, extracellular volume, B-type natriuretic peptide level, or troponin level, and all values were within normal ranges. There was no relationship between cobalt levels and ejection fraction (R = 0.022, 95% confidence interval [CI] = -0.185 to 0.229) or T2* values (R = 0.108, 95% CI = -0.105 to 0.312).
conclusionsUsing the best available technologies, we did not find that high (but not extreme) blood cobalt and chromium levels had any significant cardiotoxic effect on patients with an MoM hip implant. There were negligible-to-weak correlations between elevated blood metal ion levels and ejection fraction even at the extremes of the 95% CI, which excludes any clinically important association. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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