Hip arthroplasty with high chromium and cobalt blood levels – Case report of a patient followed during pregnancy and lactation period

• Published in: Reproductive toxicology (Elmsford, N.Y.) N.Y.), 2015-06, Vol.53, p.51-53
• Main Authors: Oppermann, Marc, Borisch, Cornelia, Schaefer, Christof
• Format: Article
• Language: English
• Subjects: Adult; Arthroplasty, Replacement, Hip; Chromium; Chromium - blood; Cobalt; Cobalt - blood; Female; Fetal Blood - chemistry; Humans; Hypospadias - blood; Infant, Newborn; Lactation; Male; Metal-on-metal arthroplasty; Milk, Human - chemistry; Pregnancy; Pregnancy - blood
• ISSN: 0890-6238; 1873-1708
• DOI: 10.1016/j.reprotox.2015.03.009

•High chromium/cobalt blood levels may arise from metal-on-metal hip arthroplasty.•We present a case report with very high levels of these metals throughout pregnancy.•The course of the pregnancy was uneventful.•The male infant was healthy aside from a mild hypospadias.•Chromium/cobalt from hip arthroplasty does not justify termination of pregnancy. Metal-on-metal arthroplasty may lead to elevated blood chromium (Cr) and cobalt (Co) levels (>7μg/l). Since carcinogenic, mutagenic, and teratogenic effects have been suggested, there is concern of pregnancy hazards for women with this condition. The 34-year-old patient has had a unilateral hip replacement for seven years. Before her pregnancy high Cr (47μg/l) and Co (103μg/l) blood concentrations were measured, but she did not develop any symptoms. A male infant was delivered after 41 weeks with first degree hypospadias. His levels were increased at 3 weeks of age: 14μg/l (Cr) and 20μg/l (Co), but decreased by 9 weeks to 6.7μg/l (Cr) and 10.0μg/l (Co). Maternal levels at delivery were 25μg/l (Cr) and 51μg/l (Co). The child was fully breast-fed and developed normally. An association between hypospadias and Cr/Co has to be considered speculative. The otherwise favorable outcome of this case may be reassuring for pregnant and breast-feeding patients with metal-on-metal hip replacements.