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Updated: Jul 2, 2025
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Published on: September 4, 2016
Cardiac function may be compromised in patients with elevated blood cobalt levels secondary to metal-on-metal hip
Mark R J Jenkinson1, Dominic R M Meek1, Rothwelle Tate2
1Queen Elizabeth University Hospital, Glasgow, UK.
Insights
Metal-on-metal hip implants can lead to elevated cobalt levels, potentially causing cardiac issues. This study found that global longitudinal strain (GLS), a sensitive measure, revealed impaired heart function in patients with high cobalt levels from these implants.
Area of Science:
- Cardiology
- Biomaterials Science
- Orthopedic Surgery
Background:
- Metal-on-metal (MoM) hip arthroplasties have been associated with elevated blood cobalt levels.
- These elevated cobalt levels are a suspected risk factor for cardiovascular complications, including cardiomyopathy.
- Previous studies using left ventricular ejection fraction (LVEF) have yielded conflicting evidence regarding cobalt-induced cardiomyopathy.
Purpose of the Study:
- To investigate the extent of cardiovascular injury, as measured by global longitudinal strain (GLS), in patients with elevated blood cobalt levels secondary to MoM hip implants.
- To assess the correlation between blood cobalt levels and cardiac function using GLS.
- To compare GLS and LVEF in patients with MoM hip implants and elevated cobalt levels.
Main Methods:
- A cohort of 16 patients with blood cobalt levels >13 µg/l from MoM hip arthroplasties was identified.
- Eight patients awaiting hip arthroplasty served as a control group.
- All patients underwent echocardiography, including GLS and LVEF measurements.
Main Results:
- Patients with MoM hip implants had significantly higher mean blood cobalt levels (29 µg/l) compared to controls (0.01 µg/l).
- Global longitudinal strain (GLS) was significantly lower in the MoM cohort (-15.5%) compared to controls (-18%), indicating impaired cardiac function (p=0.025).
- GLS showed a strong positive correlation with blood cobalt levels (r=0.8521; p<0.001), while LVEF did not differ between groups.
Conclusions:
- Elevated blood cobalt levels (>13 µg/l) in MoM hip implant patients are associated with impaired cardiac function, as detected by GLS.
- This is the first study to utilize GLS, a more sensitive echocardiographic parameter, to identify cardiac contractile dysfunction in patients with MoM hip implants and normal LVEF.
- Further research with larger cohorts is recommended to establish GLS as a predictor of cardiac complications in MoM arthroplasty patients.
Aims:
Elevated blood cobalt levels secondary to metal-on-metal (MoM) hip arthroplasties are a suggested risk factor for developing cardiovascular complications including cardiomyopathy. Clinical studies assessing patients with MoM hips using left ventricular ejection fraction (LVEF) have found conflicting evidence of cobalt-induced cardiomyopathy. Global longitudinal strain (GLS) is an echocardiography measurement known to be more sensitive than LVEF when diagnosing early cardiomyopathies. The extent of cardiovascular injury, as measured by GLS, in patients with elevated blood cobalt levels has not previously been examined.
Methods:
A total of 16 patients with documented blood cobalt ion levels above 13 µg/l (13 ppb, 221 nmol/l) were identified from a regional arthroplasty database. They were matched with eight patients awaiting hip arthroplasty. All patients underwent echocardiography, including GLS, investigating potential signs of cardiomyopathy.
Results:
Patients with MoM hip arthroplasties had a mean blood cobalt level of 29 µg/l (495 nmol/l) compared to 0.01 µg/l (0.2 nmol/l) in the control group. GLS readings were available for seven of the MoM cohort, and were significantly lower when compared with controls (-15.5% vs -18% (MoM vs control); p = 0.025)). Pearson correlation demonstrated that GLS significantly correlated with blood cobalt level (r = 0.8521; p < 0.001). However, there were no differences or correlations for other echocardiography measurements, including LVEF (64.3% vs 63.7% (MoM vs control); p = 0.845).
Conclusion:
This study supports the hypothesis that patients with elevated blood cobalt levels above 13 µg/l in the presence of a MoM hip implant may have impaired cardiac function compared to a control group of patients awaiting hip arthroplasty. It is the first study to use the more sensitive parameter of GLS to assess for any cardiac contractile dysfunction in patients with a MoM hip implant and a normal LVEF. Larger studies should be performed to determine the potential of GLS as a predictor of cardiac complications in patients with MoM arthroplasties.
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