title: Systemic effects of cobalt toxicity after revision hip replacement can manifest in intermediate to long term follow-up.
abstract: BACKGROUND
  Metal toxicity from metal-on-metal hip replacements is now well documented and several large series have reported local reactions. Although less common, there are reports of similar reactions from failed ceramic liners. Systemic effects documented in literature have been grouped into cardiac, neuro-ocular and thyroid signs.
  
  
  RESULTS
  We report a case of a patient who had revision for fractured ceramic liner to metal on polyethylene. Third body effect of the ceramic particles led to wear through of the poly liner and the head directly articulating with metal shell. He developed cardiac and neurological features of cobalt toxicity in addition to extensive soft tissue destruction. Revision of the bearing surfaces and synovectomy led to clinical improvement and fall in metal ion levels.
  
  
  CONCLUSIONS
  We recommend 2-stage revision in such situations and close monitoring of all these patients.
authors.affiliation: Clinical Fellow, University Hospitals, Southampton - UK.
authors.forename: Nijil L
authors.initials: NL
authors.lastname: Vasukutty
authors.affiliation: Consultant Orthopaedic Surgeon, Pilgrim Hospital, Boston - UK.
authors.forename: Tahawwar Hasnat Ahmad
authors.initials: TH
authors.lastname: Minhas
mesh_terms: D000328:Adult; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000295:instrumentation*; D002516:Ceramics; D003035:Cobalt / Q000506:poisoning*; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D010020:Osteonecrosis / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology*; D011474:Prosthesis Design / Q000009:adverse effects; D012086:Reoperation; D013997:Time Factors
chemical_list: D003035:Cobalt