title: Hip arthroplasty with high chromium and cobalt blood levels--Case report of a patient followed during pregnancy and lactation period.
abstract: Metal-on-metal arthroplasty may lead to elevated blood chromium (Cr) and cobalt (Co) levels (>7 μg/l). Since carcinogenic, mutagenic, and teratogenic effects have been suggested, there is concern of pregnancy hazards for women with this condition. The 34-year-old patient has had a unilateral hip replacement for seven years. Before her pregnancy high Cr (47 μg/l) and Co (103 μg/l) blood concentrations were measured, but she did not develop any symptoms. A male infant was delivered after 41 weeks with first degree hypospadias. His levels were increased at 3 weeks of age: 14 μg/l (Cr) and 20 μg/l (Co), but decreased by 9 weeks to 6.7 μg/l (Cr) and 10.0 μg/l (Co). Maternal levels at delivery were 25 μg/l (Cr) and 51 μg/l (Co). The child was fully breast-fed and developed normally. An association between hypospadias and Cr/Co has to be considered speculative. The otherwise favorable outcome of this case may be reassuring for pregnant and breast-feeding patients with metal-on-metal hip replacements.
authors.affiliation: Institute for Clinical Teratology and Drug Risk Assessment in Pregnancy, Charité - Universitätsmedizin, Berlin, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Oppermann
authors.affiliation: Institute for Clinical Teratology and Drug Risk Assessment in Pregnancy, Charité - Universitätsmedizin, Berlin, Germany.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Borisch
authors.affiliation: Institute for Clinical Teratology and Drug Risk Assessment in Pregnancy, Charité - Universitätsmedizin, Berlin, Germany. Electronic address: christof.schaefer@charite.de.
authors.forename: Christof
authors.initials: C
authors.lastname: Schaefer
mesh_terms: D000328:Adult; D019644:Arthroplasty, Replacement, Hip; D002857:Chromium / Q000097:blood*; D003035:Cobalt / Q000097:blood*; D005260:Female; D005312:Fetal Blood / Q000737:chemistry; D006801:Humans; D007021:Hypospadias / Q000097:blood; D007231:Infant, Newborn; D007774:Lactation; D008297:Male; D008895:Milk, Human / Q000737:chemistry; D011247:Pregnancy / Q000097:blood*
chemical_list: D002857:Chromium; D003035:Cobalt
keywords: Chromium; Cobalt; Lactation; Metal-on-metal arthroplasty; Pregnancy