title: Fatal cardiomyopathy after revision total hip replacement for fracture of a ceramic liner.
abstract: Symptomatic cobalt toxicity from a failed total hip replacement is a rare but devastating complication. It has been reported following revision of fractured ceramic components, as well as in patients with failed metal-on-metal articulations. Potential clinical findings include fatigue, weakness, hypothyroidism, cardiomyopathy, polycythaemia, visual and hearing impairment, cognitive dysfunction, and neuropathy. We report a case of an otherwise healthy 46-year-old patient, who developed progressively worsening symptoms of cobalt toxicity beginning approximately six months following synovectomy and revision of a fractured ceramic-on-ceramic total hip replacement to a metal-on-polyethylene bearing. The whole blood cobalt levels peaked at 6521 µg/l. The patient died from cobalt-induced cardiomyopathy. Implant retrieval analysis confirmed a loss of 28.3 g mass of the cobalt-chromium femoral head as a result of severe abrasive wear by ceramic particles embedded in the revision polyethylene liner. Autopsy findings were consistent with heavy metal-induced cardiomyopathy.We recommend using new ceramics at revision to minimise the risk of wear-related cobalt toxicity following breakage of ceramic components.
authors: University of Toronto, Banting Institute, Division of Orthopaedic Surgery, 100 College Street Room 302, Toronto, Ontario M5G 1L5, Canada. mike@zywiel.com
authors: M G
authors: MG
authors: Zywiel
authors: J-M
authors: JM
authors: Brandt
authors: C B
authors: CB
authors: Overgaard
authors: A C
authors: AC
authors: Cheung
authors: T R
authors: TR
authors: Turgeon
authors: K A
authors: KA
authors: Syed
mesh_terms: D019644:Arthroplasty, Replacement, Hip; D009202:Cardiomyopathies / Q000139:chemically induced* / Q000175:diagnosis; D003035:Cobalt / Q000506:poisoning*; D017809:Fatal Outcome; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000139:chemically induced* / Q000175:diagnosis; D011475:Prosthesis Failure / Q000009:adverse effects*; D012086:Reoperation
chemical_list: D003035:Cobalt