Cobalt poisoning in knee replacements

Ross Hauser, MD
Doctors in Finland have released a new troubling study on the release of metal debris from knee replacement hardware. They note:

There has been increasing alarm regarding metal-on-metal joint replacements leading to elevated levels of metal ions and adverse patient’s reactions to metal debris.
There is little information available concerning the prevalence of and risk factors for these adverse reactions in knee replacements as opposed to the widely studied metal-on-metal hip joint replacements.

If you are looking to avoid knee surgery, see our main page Prolotherapy for knee pain for an alternative to surgery.

(The Finnish researchers) determined the levels of metal ions in the blood of 22 patients with metal-on-metal hinge total knee arthroplasty. and the rate of revision (repair surgery) due to adverse patient’s reactions to metal debris in patients treated with metal-on-metal hinge total knee arthroplasty.

22 patients with total knee arthroplasty and metal-on-metal hinge connecting mechanisms were studied for whole-blood chromium and cobalt levels at 6 months, 1 year, and at 2 years or less after surgery.
Possible adverse patient’s reactions to metal debris were investigated by MRI.
The results clearly show that the metal-on-metal hinge knee replacement carries a high risk of increased levels of systemic metal ions and also local adverse patient reactions to metal debris, leading to complicated knee revisions. We, therefore, discourage the use of metal-on-metal hinge knee replacements.1

And if you are sensitive to cobalt and other metals? Then why get a cobalt replacement?

If you have an allergy, imagine carrying that around in your knee.

Doctors in Germany studied patients to determine the prevalence of sensitisation to chromium, cobalt, nickel, or a cement component in patients who received joint replacement surgery.

In this curious study, the doctors “selected patients with a pre-operative known sensitisation to chromium, cobalt, nickel, or a cement component for a post-operative allergic reaction. All patients who received revision surgery because of a potential allergic reaction were followed up post revision surgery.”

Revision surgery was needed in 9.8 % of patients with sensitisation to one of the reviewed components. Potential allergens were strictly avoided in the replaced prosthesis.
CONCLUSION: The allergic patient should be thoroughly informed about potential reactions resulting from implant choice.2

Failed Joint Replacement Components Cause Cancer

November 3, 2016: (National Institute of Health) Seven substances added to 14th Report on Carcinogens

Cobalt and cobalt compounds that release cobalt ions* in the body are being listed as reasonably anticipated to be a human carcinogen.
Cobalt is a naturally occurring element used to make metal alloys and other metal compounds, such as military and industrial equipment, and rechargeable batteries. The highest exposure occurs in the workplace and from failed surgical implants.

*It does not include vitamin B-12, because cobalt in this essential nutrient is bound to protein and does not release cobalt ions.

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1 Laitinen M, Nieminen J, Reito A, et al. High blood metal ion levels in 19 of 22 patients with metal-on-metal hinge knee replacements. Acta Orthop. 2017 Jan 26:1-6. doi: 10.1080/17453674.2017.1283846.[Pubmed]

2 Guenther D, Thomas P, Kendoff D, Omar M, Gehrke T, Haasper C. Allergic reactions in arthroplasty: myth or serious problem? Int Orthop. 2016 Feb;40(2):239-44. doi: 10.1007/s00264-015-3001-6. Epub 2015 Nov 2.[Pubmed]