title: Neuropsychiatric symptoms following metal-on-metal implant failure with cobalt and chromium toxicity.
abstract: There were at least 31,171 metal-on-metal (MoM) hip implants in the UK between 2003 and 2011. Some of these were subject to failure and widescale recalls and revisions followed.
  
  
  
  This is a presentation of ten cases (mean age 60 years) where we evaluated neuropsychiatric morbidity following metal-on-metal hip implant failure and revision. Implants were ASR total hip replacement (acetabular implant, taper sleeve adaptor and unipolar femoral implants) performed between 2005 and 2009. This case series describes, for the first time, neuropsychiatric complications after revision where there has been cobalt and chromium toxicity.
  
  
  
  Pre-revision surgery, nine patients had toxic levels of chromium and cobalt (mean level chromium 338 nmol/l, mean cobalt 669.4 nmol/l). Depression assessment showed 9 of 9 respondents fulfilled the BDI criteria for depression and 3 of these were being treated. 7 of 9 patients showing short term memory deficit with mean mini mental state examination score of 24.2. The normal population mean MMSE for this group would be expected to be 28 with <25 indicating possible dementia.
  
  
  
  We found neurocognitive and depressive deficits after cobalt and chromium metallosis following MoM implant failure. Larger studies of neurocognitive effects are indicated in this group. There may be implications for public health.
authors.affiliation: The Institute of Medicine, University of Chester and University Centre Shrewsbury, Bache Hall, Countess Way, Chester, Cheshire, CH2 1JR, UK. bgreen@chester.ac.uk.
authors.forename: Ben
authors.identifier: 0000-0002-3934-3065
authors.initials: B
authors.lastname: Green
authors.affiliation: Public Health England, 5 Old Fulwood Road, Sheffield, S10 3TG, UK.
authors.forename: Emily
authors.initials: E
authors.lastname: Griffiths
authors.affiliation: The Institute of Medicine, University of Chester and University Centre Shrewsbury, Bache Hall, Countess Way, Chester, Cheshire, CH2 1JR, UK.
authors.forename: Solomon
authors.initials: S
authors.lastname: Almond
mesh_terms: D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D002857:Chromium / Q000097:blood / Q000633:toxicity*; D003035:Cobalt / Q000097:blood / Q000633:toxicity*; D003863:Depression / Q000139:chemically induced*; D005260:Female; D006801:Humans; D008297:Male; D008569:Memory Disorders / Q000139:chemically induced*; D061825:Metal-on-Metal Joint Prostheses / Q000009:adverse effects*; D008875:Middle Aged; D011475:Prosthesis Failure / Q000009:adverse effects*
chemical_list: D002857:Chromium; D003035:Cobalt
keywords: Chromium; Cobalt; Cognitive; Depression; Hip implant; Metal-on-metal; Neuropsychiatric