Normal Levels of Cobalt and Chromium after Hip Resurfacing
Studies were searched for in the Medline database, Embase, and the Cochrane Database of Systematic Reviews. Highest mean or median ion concentrations of Cr and Co after a minimum of 1 year of follow-up were extracted and grouped according to sample- and articulation type, and average values were calculated…
…43 studies were included and 16 different MoM implants were identified. For the different types of bearings, average ion concentrations and range were calculated from the mean or median ion concentration. The average Cr concentration ranged between 0.5 and 2.5 μg/L in blood and between 0.8 and 5.1 μg/L in serum. For Co, the range was 0.7–3.4 μg/L in blood and 0.3–7.5 μg/L in serum…
Additional Information
The MHRA (medicines and healthcare products regulatory agency) the statutory body that regulates resurfacing devices in the UK advocates the figure of 119 nmol/L cobalt (or 7 parts per billion, ppb) for resurfacings. This was not arrived at by performing the kind of pharmacokinetic tests that are carried out for drug toxicity. It was based on the distribution and variations of cobalt levels in patients with well-functioning metal-on-metal (MoM) resurfacing. Levels above this do not indicate systemic toxicity. They have used it more as a rough guide to identify potential cases for local debris related reactions only.
It is suggested that it is reasonable to reassure patients with less than 7ppb that they had a well functioning MOM hip and monitor those with greater than 7ppb. It does not mean that this level causes systemic toxicity. It only implies that among patients who develop a local reaction the blood levels are often greater than 7ppb.