Wednesday, May 9, 2012

A Study of Metal-On-Metal Hip Replacement Implants: Part One: What is Cobalt and how is it Used?

Unfortunately, a large number of metal-on-metal hip replacement implants have had negative outcomes, from relatively minor to very severe. Tissue damage due to metallosis from the cobalt used in the hip implants can severely compromise any subsequent recommended revision surgery. Many recipients of the metal-on-metal hip implant have reported significant levels of pain, implants which have shifted position, or an overall failure of the implant. Prior to considering revision surgery, these patients are strongly urged to have their serum cobalt levels tested. Periprosthetic metallosis occurs when the metal-on-metal construction of the hip implant releases a tremendous amount of particulate debris. Those particles then stimulate the destruction of the soft tissue which surrounds the hip implant.

What is Cobalt?

Normal cobalt levels in the body are approximately 0.19 µgl--.019 micrograms per deciliter—and those who have no exposure history to cobalt will have a value of less than 0.41µgl. In other words, a healthy person will have less than one microgram of cobalt in their entire body—less than a single grain of sand. Any level of serum cobalt above 1µgl is considered excessive, and levels above 5µl are considered toxic. Even at these highly toxic levels, the cobalt would appear about the size of five grains of sand in a huge bucket of water. Although this sounds miniscule, those tiny grains of cobalt can disrupt the entire chemistry of the body.

Excess levels of cobalt can have extremely serious consequences, blocking normal cell metabolism and damaging many organs in the body.While cobalt can be both beneficial and detrimental to the health of humans, the variable is the amount of cobalt the body is subjected to. In its “natural” form, cobalt is found in the chemical makeup of vitamin B12 however when the body comes in contact with excessive levels of cobalt, the heart and lungs can suffer damage. Cobalt can be used in the treatment of anemia in pregnant women since it is known to stimulate the production of red blood cells, however the majority of cobalt will pass through the body unabsorbed.

Britain has implemented regulations which require close monitoring in patients who have undergone hip implant with a metal-on-metal device, dictating that those with cobalt levels above 0.7 micrograms per deciliter be kept under close observation. Patients whose cobalt levels are above this 0.7 range often experience hip pain, necrotic tissue and masses under the skin known as pseudotumors. If the cobalt levels exceed 1.9 micrograms per deciliter doctors recommend hip revision surgery. Keep in mind that this is roughly a hundred times the normal levels of cobalt in the body even considering that twenty-five times the normal levels are considered toxic.

How is Cobalt Used?

Cobalt is an extremely hard metal, similar in properties to iron and nickel and like iron it can be magnetized. Cobalt is most often used in the manufacturing of magnets as well as varnishes, paints and inks where it is used as a drying agent. Cobalt blue is a vital part of any artist’s palette and also used by those who work in porcelain, pottery, enamel jewelry and stained glass. Cobalt is used in common items such as batteries, drill bits and machine tools, dyes and pigments, tires and chemistry sets. Cobalt is also used in the medical industry in the form of Cobalt-60—a radioactive metal used to sterilize medical equipment or for use in radiotherapy. Cobalt can also be used in the irradiation of food and in certain aspects of plastics manufacturing. While cobalt is stable in air and not affected by water, dilute acids will slowly attack the composition of cobalt.

While we are exposed to cobalt on a daily basis, this exposure is largely in trace amounts and totally harmless. Metalworking industries can offer workers a higher level of cobalt exposure when ores which feature cobalt are ground, refined and processed. This causes fine particles of cobalt to be released into the air where they are breathed in by workers. Workers in nuclear facilities or nuclear waste storage sites can also be exposed to high levels of cobalt. Finally, those who are undergoing radiation therapy for cancer will be exposed to some level of radioactive cobalt.

In soils near mining facilities, high amounts of cobalt can be found in surrounding soil and animals that eat plants grown in these soils can suffer ill health effects from the accumulation of cobalt in the system. Cobalt is not believed to bio-magnify in the food chain, however, meaning the fruits, vegetables, fish and animals consumed by humans will usually not contain excessively high amounts of cobalt.

Author: Sullo & Sullo Attorneys

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