1. Heart transplant secondary to cobalt toxicity after hip arthroplasty revision
- Author
-
Alberto M Rico Villoras, Marta I Sanz Pérez, Jesús Campo Loarte, Sergio Bartolomé García, and Aurelio Moreno Velasco
- Subjects
Chromium ,Male ,Reoperation ,inorganic chemicals ,Ceramics ,medicine.medical_specialty ,Arthroplasty, Replacement, Hip ,Artificial Limbs ,COBALT TOXICITY ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,In patient ,030212 general & internal medicine ,030222 orthopedics ,business.industry ,Cobalt ,Middle Aged ,Prosthesis Failure ,Surgery ,Heavy Metal Poisoning ,Hip arthroplasty ,Polyethylene ,Heart Transplantation ,Female ,Chromium Alloys ,Hip Prosthesis ,business ,Complication ,Total hip arthroplasty - Abstract
Cobalt toxicity in patients with hip arthroplasty is a rare complication, but it should be considered in those patients who, after a ceramic fracture, were implanted with a metal-on-polyethylene prosthesis. The complete removal of ceramic particles during revision surgery can be complicated. If the bearing surface is replaced with a metal-on-polyethylene prosthesis, these residual ceramic particles may wear down the chrome-cobalt head, producing localised metallosis. This can trigger blood metal ion levels to rise, causing systemic toxicity. Visual and auditory alterations, cognitive deterioration, hypothyroidism, neuropathy, cardiomyopathy, anorexia, fatigue, diabetes, polycythemia, and respiratory and cutaneous symptoms are some of the clinical manifestations of prosthetic cobaltism.A young patient presented with multiorgan failure secondary to cobalt toxicity after a ceramic fracture and revision with a metal-on-polyethylene prosthesis; his serum cobalt and chromium levels were 652 μg/L and 270 μg/L, respectively. The patient needed a heart transplant after presenting with cobalt-induced cardiogenic shock.In a patient with a ceramic fracture who is subjected to revision surgery with a metal-on-polyethylene bearing, it is necessary to rule out the possibility of cobalt intoxication. Serum cobalt levels20 μg/L are inadmissible; in these cases, surgical treatment should be considered in the short term. A wide synovectomy and replacement of components should be performed with hard friction options, preferably with a ceramic-on-ceramic prosthesis.
- Published
- 2019