Abstract
There is public concern over the long term systemic health effects of metal released from implanted medical devices that use metal alloys. Systemic toxic side effects have been associated with excessive metal ion release from implants into human biological specimen's circulation, in which cobalt and chromium plays an important role. Cobalt intoxication has become more frequent due to the wide use of metallic medical implants. Despite the technological improvements in replacement metallic medical implants, wear and corrosion products associated with the metal compounds of these implants may result in systemic reactions and toxicities. The current review encompasses a literature of the systemic toxicity studies concerning the effect of metallic wear debris released from wear and corrosion of specific types of implanted medical devices, resulting in a postoperative increase in metal ion levels in bodily fluids and at different organ sites. Release of metallic debris is mainly in the form of particles and ions of different valences, and oxides composed of cobalt and chromium. Toxicological, clinically significant, data regarding "potential hazards" of circulating metals after systemic chronic exposure to the metal ions from metals have been included. This review further highlights some of the clinical features of cobalt toxicity.
Highlights
Metal and their compounds have long been recognized as important toxic agents, causing acute and chronic poisoning cases in occupational settings and in environmental high-exposure situations
This review presents an overview of going research regarding the potential related adverse biological effects associated with systemic toxicity attributed to elevated trace metal ions released from metallic medical implants, based on the available in vivo and in vitro clinical studies
The purpose of this review was to summarize the present status of the systemic biological response to metallic implant wear debris, with emphasis on the toxicology of CoCr alloy wear debris
Summary
Metal and their compounds have long been recognized as important toxic agents, causing acute and chronic poisoning cases in occupational settings and in environmental high-exposure situations. The development of systemic toxic effects typically requires the release of chemical compounds from the device and distribution of these compounds to distant target tissue sites where deleterious effects are produced. The ability of metals released from implanted devices to produce adverse toxicological effects, and the challenges associated with assessing these effects, are best illustrated by examining issues associated with the release of metals from specific types of implanted devices. These include implanted orthopedic, cardiovascular, and spinal devices. Toxicological data regarding potential adverse events after local exposure to metals have not been included; detailed reviews are given in several papers [2,3,4,5]
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