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Systemic toxicity related to metal hip prostheses. Bradberry et al. Clin Toxicol (Phila). 2014; 52(8):837-47 Bradberry et al propose the following criteria for assessing the likelihood that clinical features are related to cobalt toxicity: 1. Clinical effects consistent with the known neurological, cardiac, or thyroidal effects of cobalt, and for which any other explanation is less likely, 2. Increased blood cobalt concentrations (substantially higher than those in patients with wellfunctioning prostheses) several months after hip replacement, 3. After new hip replacement, a fall in the blood cobalt concentration, usually accompanied by signs of improvement in features. 4. When judged by these criteria, the systemic features in 10 of the reported cases are likely to be related to cobalt exposure from a metal-containing hip prosthesis

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