title: Unusual presentation of cobalt hypersensitivity in a patient with a metal-on-metal bearing in total hip arthroplasty.
abstract: Pain after hip arthroplasty is less likely to be attributed to dermal sensitivity from orthopedic implants. Unexplained persistent pain after hip arthroplasty typically leads to further investigation, occasionally revealing a metal sensitivity. Our case study presents an unusual finding of a delayed type IV cobalt hypersensitivity in a patient several years after use of cobalt in the contralateral hip. Recognition and a high index of suspicion are needed for timely treatment of metal allergy when it presents as persistent pain after hip arthroplasty.
authors.affiliation: Cincinnati Orthopaedic Research Institute, Cincinnati, Ohio 45249, USA.
authors.forename: Venkatachalapathy
authors.initials: V
authors.lastname: Perumal
authors.forename: Martha
authors.initials: M
authors.lastname: Alkire
authors.forename: Michael L
authors.initials: ML
authors.lastname: Swank
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D003035:Cobalt / Q000009:adverse effects*; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000139:chemically induced* / Q000473:pathology / Q000628:therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D010146:Pain / Q000139:chemically induced / Q000473:pathology; D010328:Patch Tests; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation
chemical_list: D007166:Immunosuppressive Agents; D003035:Cobalt; D016572:Cyclosporine; D008775:Methylprednisolone