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Title: Clinical and imaging assessment of metal on metal hip patients
Author: Berber, Reshid
ISNI:       0000 0004 8507 9255
Awarding Body: UCL (University College London)
Current Institution: University College London (University of London)
Date of Award: 2019
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A high failure rate of metal-on-metal (MoM) hip implants prompted regulatory authorities to issue worldwide product recalls. The cause for their failure and decisions surrounding the need for revision is complex due to poor understanding of the toxic effects of metal debris. In addition to local soft tissue destruction, circulating cobalt can cause rare but fatal cardiotoxicity. This thesis describes the detection of metal cobalt-chromium within the liver of a patient with highly elevated blood cobalt (587ppb) using novel MRI imaging techniques, validated by liver biopsy and micro x-ray fluorescence. The prevalence of tissue metal deposition and potential cardiotoxic effects were assessed through a prospective case controlled cohort study. Ninety patients were recruited into three age and gender-matched groups according to blood metal levels. All underwent detailed cardiovascular and liver phenotyping using MRI (for myocardial volumes and function, T2*, T1 and Extra-Cellular Volume mapping), echocardiography, and blood biomarker sampling. T2* is a novel MRI biomarker of tissue metal deposition. Blood cobalt levels among the cohort ranged 0.1 to 118ppb, which is still seen in patients presenting for clinical follow-up. No significant between-group differences were found for cardiac volume or function, nor was there any difference in tissue characterization using T1, T2* and ECV. Higher blood cobalt levels did not translate to increased metal deposition within the heart or liver. The application of these results were analsyed through a multi-disciplianary team setting designed to aid complex decisions of who, when and how to treat MoM patients surgically. By analysis of MDT recommendations compared to the treatment undertaken it was demonstrated that an MDT approach is an acceptable evidence-based aid to decision-making. This thesis concludes that cobalt tissue deposition can be detected using non-invasive MRI techniques, however metal deposition is not commonly seen with blood cobalt levels upto 118ppb with reassuringly little cardiotoxic effects. These results help reassure clinicians managing MoM patients through an MDT approach.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available