Chronic intoxication with cobalt following revision total hip arthroplasty
Chronic intoxication with cobalt in a male implanted with an uncemented total hip arthroplasty (THA) with a ceramic-on-ceramic bearing.
Three years postoperatively the acetabular ceramic liner fractured necessitating revision. The bearing couple was revised to a metal-on-polyethylene articulation. 20 months postoperatively, the patient represented with a dislocated THA.
The patient presented with symptoms and signs of chronic intoxication with heavy metals, including quadriparesis, hypothyreosis, cardiomyopathy and perceptive amblyacousia. Severe metallosis was discovered at revision.
High concentrations of cobalt, chromium and titanium were found in the serum, blood, pericardial exudate, urine and hair.
On the basis of this experience the authors recommend always using a ceramic-on-ceramic pairing when revising fractured ceramic bearings.
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