Cobalt May Be The New Mercury: Failed Surgical Implants Are Releasing Toxic Nanoparticles

(PreventDisease) – Hip replacement surgery has skyrocketed in the last few decades and surgical intervention to replace the arthritic ball and socket joints has used some questionable materials. Scientists have now discovered that the inflammation in tissue surrounding   failing chromium-cobalt metal-on-metal (MOM) implants is caused by the   release of cobalt ions  from metal debris that wears away from   replacement joints. These ions are known to cause genetic damage and will eventually  lead   to further medical complications.

Most hip replacements consist of cobalt and chromium alloys, or   titanium. Stainless steel is no longer used. All implants release their   constituent ions into the blood. Surgeons have been telling patients for years that these ions  are excreted in the   urine, but in certain individuals the ions can accumulate in the body.   In implants which involve metal-on-metal contact, microscopic fragments  of cobalt and chromium can be absorbed into the patient’s bloodstream causing a host of illnesses.
Tens of thousands of  patients have had cobalt-chromium alloy  MOM hip implants. The  rubbing between   the components causes nanoscopic metal debris to be released into   surrounding tissue, causing chronic inflammation and loss of mobility in   patients.
Now, researchers from Imperial College London and Ohio State University   have used a new approach that combines high resolution X-ray and   electron microscopy to determine the cause of the chronic inflammation   in tissue samples from affected patients. They discovered that residual   chromium is oxidised and cobalt ions are released as the nanoparticles   corrodes in the tissue, which is the cause of the inflammation. Previous   studies have shown that cobalt ions are genotoxic, which could potentially   damage DNA and lead to further long-term medical complications in   patients.
The study, published online this month in the journal Chemical Communication,   is one of the first to look at the effects of nano-particles in humans   and raises questions about how materials are tested before they are used   as implantable materials.

Dr Mary Ryan, co-author of the paper from the Department of Materials at Imperial College London, says:

“We   were able to meet patients who had these failing implants and we could   see first-hand the chronic inflammation, pain and loss of mobility they   experienced. Even though a huge number of patients have benefited from   replacement surgery, we still don’t fully understand the long-term   impacts that implantable materials have on our bodies. Our work is one   of the first to study these nanoparticles and the effects that they have   on damaged cells and tissue. This has enabled us to understand in much   more detail the side effects that these materials may have in patients.”
Dr Alexandra Porter,   co-author also from the Department of Materials at Imperial, adds:   “There is a double edged sword to these findings because on the one   hand, we’ve found a root cause of inflammation, which may lead to better   intervention therapies for patients. On the other, although we still   need to do more work to understand the full impact, our results suggest   that these nano-particles may have a long-term genotoxic impact on   patients.”

The researchers in the study found the   nano-particles accumulate in white blood cells, whose job it is to clean   up debris in the body. Here they undergo a corrosion process where the   cobalt dissolves rapidly and is released into the surrounding tissue and   blood stream. The less soluble chromium forms a solid residue that   remains in the tissue.

By 2010, reports in the orthopaedic literature have increasingly cited   the problem of early failure of metal on metal prostheses in a small   percentage of patients. Failures may relate to release of minute metallic particles or metal   ions from wear of the implants, causing pain and disability severe   enough to require revision surgery in many patients.
Metal-on-metal designs have not fared as well, where some   reports show 76% to 100% of the people with these metal-on-metal   implants and have aseptic implant failures requiring revision also have   evidence of histological inflammation accompanied by extensive   lymphocyte infiltrates, characteristic of delayed type hypersensitivity   responses.
The team needed to understand the chemical make-up of the   nanoparticles in the tissue as well as structural information about   their size and distribution. They took tissue samples to the Canadian   Light Source — Canada’s national synchrotron research facility and one   of the few facilities in the world where materials can be studied at a   high enough resolution to see the nano-particles. They used the high   resolution X-ray microscopes to scan the tissue to determine the   chemistry of the nano-particles. The researchers then analysed the same   samples in the Titan microscope at Imperial in the UK, which uses   electrons to image the size of the nanoparticles. This two-step process,   which hasn’t been used before, enabled the researchers to build a   highly detailed picture of how the nano-particles corroded in the tissue   samples.

The next step will see the team carrying out further   research to understand why the nanoparticles are corroding while the   bulk of the alloy in MOM hip implants is corrosion resistant. The   researchers also aim to use this correlative approach to explore other   diseases where nanoscale materials may have an impact on human health,   such as Alzheimer’s disease.

Jonathan Hamilton is a researcher and author with an interest in chemical toxicity, sustainability and natural living.

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