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Laboratory, Endocrine, & Neurotransmitter Symposium
October 4 - 6, 2019
CMES will be available
Gain additional clinical insight and treatment considerations to evaluate some of the most prevalent and challenging conditions that patients present with, including depression, anxiety, altered mental focus and stamina, sexual dysfunction, sleep disturbances, addictions and dependencies, weight management, and chronic disease. Click the button below to be the first to know when registration for LENS 2019 opens.
Topic: Melatonin: An Introduction
By: Krista Anderson Ross, ND
May 1, 2019
Join Labrix clinical staff and special guests on the first Wednesday of every month at 9:30 AM and 12:00 PM PST. This free, live webinar series will cover a variety of neuroendocrine topics that will enhance your knowledge, with clinically applicable testing and treatment considerations. 1 CE credit available upon attendee request.
Phoenix, AZ: May 3-5, 2019
Make sure to visit our booth at ISEAI in Phoenix later this month. Chat with our booth representative to learn what's new.
Orlando, FL: May 17-18, 2019
Come visit our booth at the A4M conference in Orlando, FL, in mid May.
Potential Systemic Toxic Effects of Cobalt Derived from Hip Prostheses
By David Quig, PhD | April 30, 2019
Hip replacements strikingly improve quality of life by mitigating chronic pain and stress, and improving mobility and sleep. However, the inevitable constant release of implant metals, particularly cobalt, after metal-on-metal total hip arthroplasty (MOM THA) may be associated with a continuum of unintended systemic consequences. Recent case studies of extremely excessive release of cobalt indicate that implant-associated cobaltism may be associated with exacerbation of Parkinson’s disease or irreversible cardiomyopathy. Acknowledgement of systemic toxic effects of excess circulating and sequestered metal ions has led to a recommendation that patients with MOM THA should be evaluated annually for circulating levels of cobalt and chromium.
Hip replacements have been attempted since the 1700s with materials ranging from pig bladder and wood to decalcified bones and ivory. Development of durable biocompatible prosthetic materials for long-term use is a daunting and incomplete endeavor. Recently, metal alloys composed of cobalt (Co), chromium (Cr), and molybdenum have been used extensively. In direct physical contact are the bearing acetabula socket and femoral head; the latter is attached to a titanium (Ti) shaft imbedded in the femur. There is perpetual release of the component metal ions in all patients with the prostheses due to both frictional wear and electro-chemical corrosion. A very small coupled Co alloy device weighs about 270 grams (0.6 lbs.) The freed metal ions induce the release of inflammatory mediators which too often result in peri-articular inflammation, soft tissue damage and osteolysis that may lead to aseptic implant loosening and enhanced frictional wear. The local tissue reactions have been reported to occur in up to 59% of patients. High blood Co levels are associated with excessive oxidative stress and a number of sustained neurological and cardiovascular conditions. Cobaltism entails a constellation of reported systemic consequences including: heart failure, arrhythmias, hypothyroidism, paresthesias, auditory and visual deficits, mood/cognitive changes, and gastrointestinal symptoms. Most patients with unflawed implants remain asymptomatic for up to 10-20 years. However cases of MOM THA- induced extreme cobaltism have been recently reported.
Neurological conditions are prevalent with excessive exposure to Co. A 46 year-old male exhibited rapid progression Parkinson’s disease (PD) after MOM THA; a deep brain stimulator (DBS) was implanted. A blood Co level of 116 µg/ml (reference value < 0.8) instigated revision arthroplasty with ceramic-on-polyethylene bearings. After revision circulating Co dropped to 1 µg/ml and the PD symptoms markedly diminished; the setting on the DBS was reduced to the lowest level. Cardiac conditions are prevalent with excessive exposure to Co. In one case, near terminal cardiomyopathy was reported for a 54 year-old male six years after bilateral MOM THA. Presentation included decreased sensation in the feet and difficulty with daily activities secondary to chest pressure. Extensive cardiac testing indicated major cardiomyopathy. Blood Co and Cr levels were more than 100-times greater than normal. Nine months after bilateral revision arthroplasty with ceramic-on-polyethylene bearings the circulating levels of Co and Cr decreased considerably, but were still very high. The lack of improvement of cardiomyopathy after removal of the prostheses supports a diagnosis of permanent myocardial damage, which is consistent with cardiomyopathy of advanced toxic etiology.
All MOM THA patients are chronically exposed to higher than normal circulating levels of Co and Cr ions. Certainly not all patients will experience severe systemic consequences, but the blood levels of Co, Cr and Ti should be evaluated on a regular basis -- annually and semi-annually for asymptomatic and symptomatic patients, respectively. Early detection of metallosis is paramount towards mitigation of compromised health after MOM THA.
Doctor’s Data offers the Implant Metals Profile, which tests the circulating blood levels of six metals (chromium, cobalt, molybdenum, nickel, titanium and vanadium) that are most commonly associated with orthopedic and dental metal prostheses or implants. The test requires only a single blood draw after an overnight fast. Call Doctor’s Data to order test kits at 800.323.2784 or visit https://www.doctorsdata.com/implant-wb/ to learn more about the Implant Metals Profile.
Zywiel MG, Cherian JJ, Banerjee S, et al. Systemic cobalt toxicity from total hip arthroplasties: review of a rare condition Part1 - history, mechanism, measurements, and pathophysiology. Bone Joint J. 2016;98–B:14-20.
Zywiel MG, Cherian JJ, Banerjee S, et al. Systemic cobalt toxicity from total hip arthroplasties: review of a rare condition Part 2. measurement, risk factors, and step-wise approach to treatment. Bone Joint J. 2016;98-B(1):14-20.
Woelber E, Van Citters DW, Steck T et al. Explant analysis from a patient exhibiting rapid acceleration of Parkinson disease symptoms and hypercobaltemia following metal-on-metal total hip arthroplasty- A case report. J Bone Joint Surg. 2016;6:e45 doi 10.2106/JBJS.CC.15.00063
Mosier BA, Maynard L, Nicholas G et al. Progressive cardiomyopathy in a patient with elevated cobalt ion levels and bilateral metal-on-metal hip arthroplasties. Am J Orthop. 2016:45(3):E132-5.