Cobalt toxicity after revision total hip replacement due to fracture of a ceramic head

Symptomatic cobalt toxicity from a failed total hip replacement is a rare, but devastating complication. Potential clinical findings include cardiomyopathy, hypothyroidism, skin rash, visual and hearing impairment, polycythaemia, weakness, fatigue, cognitive impairment, and neuropathy. The case is p...

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Bibliographic Details
Published in:Revista española de cirugía ortopédica y traumatología 2017-05, Vol.61 (3), p.203-207
Main Authors: Pelayo-de Tomás, J M, Novoa-Parra, C, Gómez-Barbero, P
Format: Article
Language:eng ; spa
Subjects:
Aged
Arthroplasty, Replacement, Hip - instrumentation
Ceramics
Cobalt - poisoning
Heavy Metal Poisoning - diagnosis
Heavy Metal Poisoning - etiology
Hip Prosthesis - adverse effects
Humans
Male
Prosthesis Failure - adverse effects
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Summary:Symptomatic cobalt toxicity from a failed total hip replacement is a rare, but devastating complication. Potential clinical findings include cardiomyopathy, hypothyroidism, skin rash, visual and hearing impairment, polycythaemia, weakness, fatigue, cognitive impairment, and neuropathy. The case is presented of a 74year-old man in whom, after a ceramic-ceramic replacement and two episodes of prosthetic dislocation, it was decided to replace it with a polyethylene-metal total hip arthroplasty (THA). At 6months after the revision he developed symptoms of cobalt toxicity, confirmed by analytical determination (serum cobalt level=651.2μg/L). After removal of the prosthesis, the levels of chromium and cobalt in blood and urine returned to normal, with the patient currently being asymptomatic. It is recommended to use a new ceramic on ceramic bearing at revision, in order to minimise the risk of wear-related cobalt toxicity following breakage of ceramic components.
ISSN:1988-8856
DOI:10.1016/j.recot.2016.11.001