Cardiac cobaltism: a rare complication after bilateral metal-on-metal total hip arthroplasty

Martin, John R.; Spencer-Gardner, Luke; Camp, Christopher L.; Stulak, John M.; Sierra, Rafael J.

doi:10.1016/j.artd.2015.10.002

Cited by 30 publications

(42 citation statements)

References 19 publications

(27 reference statements)

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“…Increased serum cobalt and chromium metal ions, ALTR, osteolysis, and failure rates 2 to 3 times that associated with metal-on-ultra-high-molecular-weight polyethylene have been well described [13] , [15] . In extreme cases, cobalt poisoning can result in neurologic injury, such as permanent hearing and vision loss, and even in death from cardiac cobalt toxicity [14] , [16] . The potential for increased local and systemic cobalt and chromium metal ions and ALTR exists whenever there is corrosion of a CoCr implant [16] .…”

Section: Discussionmentioning

confidence: 99%

“…In extreme cases, cobalt poisoning can result in neurologic injury, such as permanent hearing and vision loss, and even in death from cardiac cobalt toxicity [14] , [16] . The potential for increased local and systemic cobalt and chromium metal ions and ALTR exists whenever there is corrosion of a CoCr implant [16] . Sources include the head-neck junction (trunnionosis) with a CoCr head, modular necks, and backside wear of modular metal cup liners, including CoM [3] , [17] , [18] , [19] , [20] , [21] , [22] .…”

Section: Discussionmentioning

confidence: 99%

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Pseudotumor in ceramic-on-metal total hip arthroplasty

et al. 2017

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The increasing demand for total hip arthroplasty (THA) in relatively young, high-demand patients has led to the use of hard-on-hard bearing surfaces. Adverse local tissue reaction/pseudotumor and elevated serum metal ion levels are commonly reported complications encountered in metal-on-metal THA, while audible articulation and rim fracture are reported in ceramic-on-ceramic THA. For this reason, ceramic-on-metal THA was implemented as an ideal hard-on-hard bearing combination. In this report, we describe a case of bilateral simultaneous ceramic-on-metal THA in a 69-year-old woman who presented 7 years postoperatively with unilateral hip pain associated with underlying pseudotumor and elevated serum cobalt and chromium ion levels. Pre-revision workup, intraoperative findings, and postoperative evaluation are included and suggest acetabular malposition as a potential source for complication.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pseudotumor in ceramic-on-metal total hip arthroplasty

et al. 2017

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“… 2013 , Martin et al. 2015 ). Analysis of Australian Veterans data reported an association between ASR XL MoM THAs and hospital admission for heart failure in elderly male patients (Gillam et al.…”

Section: Threshold For Armd Revision Surgerymentioning

confidence: 99%

Revision surgery of metal-on-metal hip arthroplasties for adverse reactions to metal debris

et al. 2018

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Background and purposeThe initial outcomes following metal-on-metal hip arthroplasty (MoMHA) revision surgery performed for adverse reactions to metal debris (ARMD) were poor. Furthermore, robust thresholds for performing ARMD revision are lacking. This article is the second of 2. The first article considered the various investigative modalities used during MoMHA patient surveillance (Matharu et al. 2018a). The present article aims to provide a clinical update regarding ARMD revision surgery in MoMHA patients (hip resurfacing and large-diameter MoM total hip arthroplasty), with specific focus on the threshold for performing ARMD revision, the surgical strategy, and the outcomes following revision.Results and interpretationThe outcomes following ARMD revision surgery appear to have improved with time for several reasons, among them the introduction of regular patient surveillance and lowering of the threshold for performing revision. Furthermore, registry data suggest that outcomes following ARMD revision are influenced by modifiable factors (type of revision procedure and bearing surface implanted), meaning surgeons could potentially reduce failure rates. However, additional large multi-center studies are needed to develop robust thresholds for performing ARMD revision surgery, which will guide surgeons’ treatment of MoMHA patients. The long-term systemic effects of metal ion exposure in patients with these implants must also be investigated, which will help establish whether there are any systemic reasons to recommend revision of MoMHAs

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“…Although causation is suspected, our patient's cardiac biopsy was improperly processed for presence of cobalt. Positive biopsy is not a requirement for diagnosis, although other case reports of cardiomyopathy associated with occupational [ 15 ] and prosthetic cobalt exposure [ 16 ] have shown positive cobalt deposition in the myocardium. In our patient's case, the patient had a precipitous decline in serum cobalt levels and significant improvement in cardiac function following his revision operations, supporting the hypothesis that his cardiomyopathy was associated with elevated serum ion levels.…”

Section: Discussionmentioning

confidence: 99%

Arthroprosthetic cobaltism associated with cardiomyopathy

2017

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Systemic cobaltism related to metal-on-metal total hip arthroplasty has been published in case reports and series with effects on the cardiac, neurologic, endocrine, and immunologic systems. This case report presents a 46-year-old male who underwent bilateral metal-on-metal total hip arthroplasty and subsequently developed cardiomyopathy requiring left ventricular assist device implantation. Intervention with bilateral revision to non-cobalt-containing implants resulted in improved cardiac function. This case report will alert clinicians to the presentation of this rare but devastating complication while also displaying improvement following revision total hip arthroplasty. It is our hope this case will aid in early recognition and intervention of this condition.

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Cardiac cobaltism: a rare complication after bilateral metal-on-metal total hip arthroplasty

Cited by 30 publications

References 19 publications

Pseudotumor in ceramic-on-metal total hip arthroplasty

Pseudotumor in ceramic-on-metal total hip arthroplasty

Revision surgery of metal-on-metal hip arthroplasties for adverse reactions to metal debris

Arthroprosthetic cobaltism associated with cardiomyopathy

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