Dr. House Helps Diagnose Heart Failure From Hip Implants
A case of heart failure caused by cobalt intoxication from an artificial hip was solved with the aid of the U.S. television show “House,” according to a report published in a medical journal today.
The patient, a 55-year-old man, arrived at a clinic at the University of Marburg in Germany almost deaf and nearly blind. He had symptoms including fever and enlarged lymph nodes at his left hip. Both hips had been replaced with prostheses.
Recalling the 11th episode of the show’s seventh season, in which medical sleuth Gregory House diagnoses cobalt intoxication in a patient, the clinic’s doctors suspected the same condition as the most probable cause of the patient’s deterioration in health, they wrote in the Lancet medical journal today. Tests showed “severe increases” in levels of cobalt and chromium in his blood, validating their theory.
The case study shows the wide-ranging health impact from certain metal hip implants. They can expose patients to high levels of toxic cobalt and chromium ions that can seep into tissues and destroy muscle and bone, leaving some with long-term disability, the British Medical Journal has said. Studies also show that metal ions can seep into the bloodstream, spreading to the lymph nodes, spleen, liver and kidneys, according to the journal.
“This cobalt intoxication is an increasingly recognized and life-threatening problem,” the doctors wrote.
A separate paper published this week in the New England Journal of Medicine reported a similar case where high levels of cobalt and chromium were discovered in a 59-year-old woman with hip implants made by Johnson & Johnson (JNJ)’s DePuy unit during tests leading up to a heart transplant.
J&J agreed in November to pay at least $2.47 billion to settle thousands of lawsuits over its recalled hip implants. Patients complained in the suits that the metal-on-metal implant made by the DePuy unit caused dislocations, pain and follow-up surgeries. They claimed that debris from the chromium and cobalt device caused tissue death and increased metal ions in the bloodstream.
About a million patients around the world have received metal-on-metal hip implants, mostly between 2003 and 2010, according to the paper.
“Although the regulatory approval and safety surveillance processes for metal-on-metal hip prostheses have garnered recent attention in major medical journals, relatively little attention has been paid to the potential systemic effects of cobalt-chromium ion release,” said the authors, led by Larry Allen at the University of Colorado.
The case suggests that a variety of specialists in fields ranging from orthopedics and cardiology to rheumatology and ophthalmology and their patients “may benefit from improved awareness and multidisciplinary communication regarding the potential risks associated with these devices,” the authors said.
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