title: Prosthetic hip-associated cobalt toxicity.
abstract: Prosthetic hip-associated cobalt toxicity (PHACT) is gaining recognition due to the use of metal-on-metal total hip replacements. Identifying true toxicity from merely elevated cobalt levels can be extremely difficult due to the lack of available data. An extensive review of the medical literature was undertaken to characterize cobalt toxicity from prosthetic hips. As an objective approach to making the diagnosis of PHACT, we suggest the following criteria: (1) elevated serum or whole blood cobalt levels due to a prosthetic hip, (2) at least two test-confirmed findings consistent with cobalt toxicity, and (3) exclusion of other etiologies. Adhering to objective diagnostic data for PHACT is a realistic and prudent method by which to eliminate the subjectivity of vague or difficult to identify complaints. These diagnostic criteria are not meant to evaluate prosthetic hardware failure, but as a means to identify systemic cobalt toxicity. Finally, assessment of cobalt toxicity from prosthetic hips should be done in conjunction with a medical toxicologist.
authors.affiliation: Division of Medical Toxicology, Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA, pizonaf@upmc.edu.
authors.forename: Anthony F
authors.initials: AF
authors.lastname: Pizon
authors.forename: Michael
authors.initials: M
authors.lastname: Abesamis
authors.forename: Andrew M
authors.initials: AM
authors.lastname: King
authors.forename: Nathan
authors.initials: N
authors.lastname: Menke
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000295:instrumentation*; D015415:Biomarkers / Q000378:metabolism; D002614:Chelating Agents / Q000627:therapeutic use; D015913:Chelation Therapy; D003035:Cobalt / Q000378:metabolism / Q000506:poisoning*; D020878:Device Removal; D000075322:Heavy Metal Poisoning; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D061825:Metal-on-Metal Joint Prostheses / Q000009:adverse effects*; D019216:Metals, Heavy / Q000378:metabolism; D011041:Poisoning / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism / Q000628:therapy; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D002614:Chelating Agents; D019216:Metals, Heavy; D003035:Cobalt