Assessing for Cardiotoxicity from Metal-on-Metal Hip Implants with Advanced Multimodality Imaging Techniques

The Journal of Bone and Joint Surgery. American Volume
Reshid BerberA J Hart

Abstract

High 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. Ninety 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. Blood cobalt levels differed significa...Continue Reading

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Citations

Jan 7, 2018·The Bone & Joint Journal·J A Skinner, F S Haddad
Jan 7, 2018·The Bone & Joint Journal·S A SabahC Manisty
Mar 2, 2018·Acta Orthopaedica·Gulraj S MatharuDavid W Murray
Sep 18, 2020·Zeitschrift für Orthopädie und Unfallchirurgie·Anastasia Rakow, Janosch Schoon
Sep 21, 2018·The Journal of Bone and Joint Surgery. American Volume·Mengnai Li, Andrew H Glassman
Apr 1, 2021·Environmental Science and Pollution Research International·Qingqing ZhuXinli Li
Jun 1, 2021·Bone & Joint Research·Mark R J JenkinsonSusan Currie
Jun 2, 2021·Bone & Joint Research·John A SkinnerAlister J Hart

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