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Test Code COSY Cobalt, Synovial Fluid

Reporting Name

Cobalt, Synovial Fl

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Useful For

Monitoring metallic prosthetic implant wear and local tissue destruction in failed hip arthroplasty constructs

 

This test is not useful for assessment of nutritional status or potential cobalt toxicity.

Method Name

Inductively Coupled Plasma-Mass Spectrometry (ICP-MS)


Ordering Guidance


This test should only be used in individuals with metallic prosthetic implants. The significance of cobalt concentrations in synovial fluid in patients without implants is unknown.



Specimen Required


Patient Preparation:  High concentrations of gadolinium and iodine are known to interfere with most inductively coupled plasma mass spectrometry-based metal tests. If either gadolinium- or iodine-containing contrast media has been administered, a specimen should not be collected for at least 96 hours.

Supplies: Metal Free B-D Tube (EDTA), 6 mL (T183)

Container/Tube: Royal blue top (metal-free EDTA)

Specimen Volume: 1 mL

Collection Instructions: See Metals Analysis Specimen Collection and Transport for complete instructions.

Additional Information: Cobalt is present in the black rubber plunger seals found in most disposable syringes. As a result, synovial fluid should not be collected in these devices as contamination may occur.


Specimen Type

Synovial Fluid

Specimen Minimum Volume

0.4 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Synovial Fluid Refrigerated (preferred) 90 days
  Ambient  90 days
  Frozen  90 days

Reject Due To

Gross hemolysis OK
Gross lipemia OK
Gross icterus OK

Reference Values

0-17 years: Not established

≥18 years: <19.8 ng/mL

Interpretation

Based on an internal study, synovial fluid cobalt concentrations of 19.8 ng/mL or above were more likely due to a metal reaction (eg, adverse local tissue reaction [ALTR]/adverse reaction to metal debris [ARMD]) versus a nonmetal reaction in patients undergoing metal-on-metal revision (sensitivity of 92.3% and specificity of 96.3%).

Day(s) Performed

Friday

Report Available

2 to 8 days

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information

83018

LOINC Code Information

Test ID Test Order Name Order LOINC Value
COSY Cobalt, Synovial Fl 23842-8

 

Result ID Test Result Name Result LOINC Value
606352 Cobalt, Synovial Fl 23842-8