Missing Elements of the History

The risk of cardiac failure following metal-on-metal hip arthroplasty

“…33 More recently, case reports and small series have reported cardiomyopathy related to failure of MoM implants. 7,[35][36][37][38][39] However, there were < 30 cases in total and these patients had extreme levels of circulating metal ions. Prentice et al 40 performed a cross-sectional observational study of systemic complications and found a 5% lower ejection fraction in 35 patients with MoM resurfacing implants compared with patients with conventional arthroplasties.…”

Biocompatible ultrananocrystalline diamond coatings for implantable medical devices

“…These elevated levels could result in systemic toxicity, as observed for other metallic implants. 40 On exposure to air or liquid, titanium develops a passivating titanium dioxide (TiO 2 ) layer that makes it nonreactive. It is well known that the TiO 2 layer prevents corrosion.…”

Unusual Case of Congestive Heart Failure

“…Histopathology of myocardium showed hypertrophic myocytes with increased interstitial fibrosis and histological features consistent with a dilated cardiomyopathy probably caused by elevated levels of cobalt ( Figure 6). 1 No interstitial inflammatory cell infiltrate, iron deposition, or amyloid was seen. The electron microscopy showed nonspecific increased lipid and degenerated lipid deposits with minimal mitochondrial changes, which is also consistent with a diagnosis of cobalt cardiomyopathy, (Figure 7) though myocardial cobalt levels could not be obtained.…”

“…These cardiomyopathies associated with high circulating level of heavy metals usually tend reverse with removal of the offending prosthesis. 1,3,4 Chelation and phlebotomy in addition to treatment of heart failure has been suggested by some authors, though experience with these therapies is limited.…”

“…The electron microscopy showed nonspecific increased lipid and degenerated lipid deposits with minimal mitochondrial changes, which is also consistent with a diagnosis of cobalt cardiomyopathy, (Figure 7) though myocardial cobalt levels could not be obtained. 1 The patient progressed to cardiogenic shock and was transferred to a tertiary care hospital for advanced heart failure support and prosthetic hip removal with the diagnosis of cobalt cardiomyopathy. The patient was stabilized with extra corporeal membrane oxygenation therapy and then underwent biventricular assist device placement.…”