title: Cobalt toxicity after revision total hip replacement due to fracture of a ceramic head.
abstract: Symptomatic cobalt toxicity from a failed total hip replacement is a rare, but devastating complication. Potential clinical findings include cardiomyopathy, hypothyroidism, skin rash, visual and hearing impairment, polycythaemia, weakness, fatigue, cognitive impairment, and neuropathy. The case is presented of a 74year-old man in whom, after a ceramic-ceramic replacement and two episodes of prosthetic dislocation, it was decided to replace it with a polyethylene-metal total hip arthroplasty (THA). At 6months after the revision he developed symptoms of cobalt toxicity, confirmed by analytical determination (serum cobalt level=651.2μg/L). After removal of the prosthesis, the levels of chromium and cobalt in blood and urine returned to normal, with the patient currently being asymptomatic. It is recommended to use a new ceramic on ceramic bearing at revision, in order to minimise the risk of wear-related cobalt toxicity following breakage of ceramic components.
authors.affiliation: Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Dr. Peset, Valencia, España.
authors.forename: J M
authors.initials: JM
authors.lastname: Pelayo-de Tomás
authors.affiliation: Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Dr. Peset, Valencia, España. Electronic address: le_male2002@hotmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Novoa-Parra
authors.affiliation: Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Dr. Peset, Valencia, España.
authors.forename: P
authors.initials: P
authors.lastname: Gómez-Barbero
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation*; D002516:Ceramics; D003035:Cobalt / Q000506:poisoning*; D000075322:Heavy Metal Poisoning / Q000175:diagnosis / Q000209:etiology*; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D011475:Prosthesis Failure / Q000009:adverse effects*
chemical_list: D003035:Cobalt
keywords: Ceramic; Ceramic fracture; Cerámica; Cobalt poisoning; Fractura de cerámica; Hip prostheses; Hip replacement; Intoxicación con cobalto; Prótesis de cadera; Reemplazo de cadera