Prevalence of Cobalturia Among Adults With Joint Replacements

Twenty million North Americans have cobalt-chrome arthroprosthetic components, and 1 million have metal-on-metal hip replacements.¹ Cobalt is a mitochondrial toxin—encephalopathy and cardiomyopathy (cobaltism) may occur from iatrogenic, industrial, dietary, or arthroprosthetic cobalt exposure.^2,3 In unexposed populations, the 95th percentile of cobalt levels in urine and blood are 1 part per billion (ppb) and 0.4 ppb, respectively.³

Wear and corrosion of cobalt-chrome joint implantations can result in periprosthetic tissue inflammation or necrosis, also known clinically as adverse reactions to metallic debris.^1,4 Periprosthetic cobalt-chrome metallosis is disseminated systemically and may result in arthroprosthetic cobaltism.^1,3,4 Systemic cobalt dissemination can result in brain hypometabolism and atrophy; patients with levels of cobalt in blood as low as 1.1 ppb and in urine as low as 4.1 ppb are reported as having cobalt encephalopathy.^5,6