Prosthetic hip-associated cobalt toxicity (PHACT) is caused by elevated blood cobalt concentrations after hip arthroplasty. The aim of this study is to determine which symptoms are reported most frequently and in what type of bearing. We also try to determine the blood level of cobalt concentrations associated with toxicological symptoms. A systematic review was conducted on the 10th of July according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A methodological quality assessment (risk of bias (RoB)) was performed. Primary outcomes were the reported symptoms of cobalt toxicity and the level of cobalt concentrations in blood. These levels were associated with toxicological symptoms. A total of 7645 references were found of which 67 relevant reports describing 79 patients. The two most used bearings in which PHACT was described were metal-on-metal (MoM) bearings (38 cases) and revised (fractured) ceramic-on-ceramic (CoC) bearings where the former ceramic head was replaced by a metal head (32 cases). Of all reported symptoms, most were seen in the neurological system, of which 24% were in the sensory system and 19.3% were in central/peripheral system, followed by the cardiovascular (22.1%) system. The mean cobalt concentration for MoM-bearings was 123.7 ± 96.8 ppb and 1078.2 ± 1267.5 ppb for the revised fractured CoC-bearings. We recommend not to use a metal-based articulation in the revision of a fractured CoC bearing and suggest close follow-up with yearly blood cobalt concentration controls in patients with a MoM bearing or a revised fractured CoC bearing. Level of Evidence: Level V, systematic review.

中文翻译：

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假体髋关节相关的钴毒性：病例系列和病例报告的系统回顾。

假体髋关节相关钴中毒（PHACT）是由髋关节置换术后血液钴浓度升高引起的。本研究的目的是确定最常报告的症状以及哪种类型的轴承。我们还尝试确定与毒理学症状相关的血液钴浓度水平。根据系统审查和荟萃分析的首选报告项目 (PRISMA) 指南，我们于 7 月 10 日进行了系统审查。进行了方法学质量评估（偏倚风险（RoB））。主要结果是报告的钴中毒症状和血液中钴浓度水平。这些水平与毒理学症状相关。共找到 7645 篇参考文献，其中 67 篇相关报告描述了 79 名患者。描述 PHACT 的两种最常用的轴承是金属对金属 (MoM) 轴承（38 例）和改进的（断裂）陶瓷对陶瓷 (CoC) 轴承，其中以前的陶瓷头被金属头取代（ 32 例）。在所有报告的症状中，大多数出现在神经系统，其中24%出现在感觉系统，19.3%出现在中枢/外周系统，其次是心血管系统（22.1%）。MoM 轴承的平均钴浓度为 123.7 ± 96.8 ppb，修订后的断裂 CoC 轴承的平均钴浓度为 1078.2 ± 1267.5 ppb。我们建议不要在修复断裂 CoC 轴承时使用金属关节，并建议对 MoM 轴承或修复断裂 CoC 轴承的患者进行密切随访，每年进行血液钴浓度控制。证据级别：V 级，系统评价。