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Cobalt toxicity after revision to a metal-on-polyethylene total hip arthroplasty
for fracture of ceramic acetabular component
#MMPMID28326380
Harris A
; Johnson J
; Mansuripur PK
; Limbird R
Arthroplast Today
2015[Dec]; 1
(4
): 89-91
PMID28326380
show ga
Cobalt metallosis after revision metal-on-polyethylene total hip arthroplasty for
catastrophic failure of ceramic components is uncommon but a potentially
devastating complication. Common findings associated with heavy metal toxicity
include cardiomyopathy, hypothyroidism, skin rashes, visual disturbances, hearing
changes, polycythemia, weakness, fatigue, cognitive deterioration, and
neuropathy. We report a case of a 57-year-old woman who presented with complaints
of progressively worsening hip pain, fatigue, memory loss, lower extremity
sensory loss, persistent tachycardia, and ocular changes 5 years after
synovectomy and revision of a failed ceramic-on-ceramic total hip arthroplasty to
metal-on-polyethylene components. A cobalt level of 788.1 ppb and chromium level
of 140 ppb were found on presentation and subsequently decreased to 468.8 ppb and
105.9 ppb, respectively, 2 weeks after revision to a ceramic-on-polyethylene
total hip arthroplasty. Improvement of symptoms accompanied this decrease in
cobalt and chromium levels. Revision of failed ceramic arthroplasties with
later-generation ceramics to avoid this potential complication is recommended.
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