Fatal Cobalt Toxicity after a Non-Metal-on-Metal Total Hip Arthroplasty
This case illustrates the potential for systemic cobalt toxicity in non-metal-on-metal bearings and its potentially devastating consequences. We present a 71-year-old male with grinding sensations in his right hip following ceramic-on-ceramic total hip arthroplasty (THA). After diagnosing a fracture...
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| Format: | Article |
| Language: | English |
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Wiley
2017-01-01
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| Series: | Case Reports in Orthopedics |
| Online Access: | http://dx.doi.org/10.1155/2017/9123684 |
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| author | Rinne M. Peters Pax Willemse Paul C. Rijk Mels Hoogendoorn Wierd P. Zijlstra |
| author_facet | Rinne M. Peters Pax Willemse Paul C. Rijk Mels Hoogendoorn Wierd P. Zijlstra |
| author_sort | Rinne M. Peters |
| collection | DOAJ |
| description | This case illustrates the potential for systemic cobalt toxicity in non-metal-on-metal bearings and its potentially devastating consequences. We present a 71-year-old male with grinding sensations in his right hip following ceramic-on-ceramic total hip arthroplasty (THA). After diagnosing a fractured ceramic liner, the hip prosthesis was revised into a metal-on-polyethylene bearing. At one year postoperatively, X-rays and MARS-MRI showed a fixed reversed hybrid THA, with periarticular densities, flattening of the femoral head component, and a pattern of periarticular metal wear debris and pseudotumor formation. Before revision could take place, the patient was admitted with the clinical picture of systemic cobalt toxicity, supported by excessively high serum cobalt and chromium levels, and ultimately died. At autopsy dilated cardiomyopathy as cause of death was hypothesized. A third body wear reaction between ceramic remnants and the metal femoral head very likely led to excessive metal wear, which contributed systemic cobalt toxicity leading to neurotoxicity and heart failure. This case emphasizes that fractured ceramic-on-ceramic bearings should be revised to ceramic-on-ceramic or ceramic-on-polyethylene bearings, but not to metal-on-polyethylene bearings. We aim to increase awareness among orthopedic surgeons for clinical clues for systemic cobalt intoxication, even when there is no metal-on-metal bearing surface. |
| format | Article |
| id | doaj-art-e376300a870e498c9fd73eb27b10ee1c |
| institution | Kabale University |
| issn | 2090-6749 2090-6757 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Orthopedics |
| spelling | doaj-art-e376300a870e498c9fd73eb27b10ee1c2025-08-20T03:26:34ZengWileyCase Reports in Orthopedics2090-67492090-67572017-01-01201710.1155/2017/91236849123684Fatal Cobalt Toxicity after a Non-Metal-on-Metal Total Hip ArthroplastyRinne M. Peters0Pax Willemse1Paul C. Rijk2Mels Hoogendoorn3Wierd P. Zijlstra4Department of Orthopedic Surgery, Medical Center Leeuwarden, Henri Dunantweg 2, 8934 AD Leeuwarden, NetherlandsDepartment of Orthopedic Surgery, Medical Center Leeuwarden, Henri Dunantweg 2, 8934 AD Leeuwarden, NetherlandsDepartment of Orthopedic Surgery, Medical Center Leeuwarden, Henri Dunantweg 2, 8934 AD Leeuwarden, NetherlandsDepartment of Internal Medicine, Medical Center Leeuwarden, Henri Dunantweg 2, 8934 AD Leeuwarden, NetherlandsDepartment of Orthopedic Surgery, Medical Center Leeuwarden, Henri Dunantweg 2, 8934 AD Leeuwarden, NetherlandsThis case illustrates the potential for systemic cobalt toxicity in non-metal-on-metal bearings and its potentially devastating consequences. We present a 71-year-old male with grinding sensations in his right hip following ceramic-on-ceramic total hip arthroplasty (THA). After diagnosing a fractured ceramic liner, the hip prosthesis was revised into a metal-on-polyethylene bearing. At one year postoperatively, X-rays and MARS-MRI showed a fixed reversed hybrid THA, with periarticular densities, flattening of the femoral head component, and a pattern of periarticular metal wear debris and pseudotumor formation. Before revision could take place, the patient was admitted with the clinical picture of systemic cobalt toxicity, supported by excessively high serum cobalt and chromium levels, and ultimately died. At autopsy dilated cardiomyopathy as cause of death was hypothesized. A third body wear reaction between ceramic remnants and the metal femoral head very likely led to excessive metal wear, which contributed systemic cobalt toxicity leading to neurotoxicity and heart failure. This case emphasizes that fractured ceramic-on-ceramic bearings should be revised to ceramic-on-ceramic or ceramic-on-polyethylene bearings, but not to metal-on-polyethylene bearings. We aim to increase awareness among orthopedic surgeons for clinical clues for systemic cobalt intoxication, even when there is no metal-on-metal bearing surface.http://dx.doi.org/10.1155/2017/9123684 |
| spellingShingle | Rinne M. Peters Pax Willemse Paul C. Rijk Mels Hoogendoorn Wierd P. Zijlstra Fatal Cobalt Toxicity after a Non-Metal-on-Metal Total Hip Arthroplasty Case Reports in Orthopedics |
| title | Fatal Cobalt Toxicity after a Non-Metal-on-Metal Total Hip Arthroplasty |
| title_full | Fatal Cobalt Toxicity after a Non-Metal-on-Metal Total Hip Arthroplasty |
| title_fullStr | Fatal Cobalt Toxicity after a Non-Metal-on-Metal Total Hip Arthroplasty |
| title_full_unstemmed | Fatal Cobalt Toxicity after a Non-Metal-on-Metal Total Hip Arthroplasty |
| title_short | Fatal Cobalt Toxicity after a Non-Metal-on-Metal Total Hip Arthroplasty |
| title_sort | fatal cobalt toxicity after a non metal on metal total hip arthroplasty |
| url | http://dx.doi.org/10.1155/2017/9123684 |
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