ArticleCase reports in orthopedics2017
Fatal Cobalt Toxicity after a Non-Metal-on-Metal Total Hip Arthroplasty.
Article in Case reports in orthopedics, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
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Who cites it
17 citing papers in PubMed.
- Cardiac Tamponade and Pneumonitis as Indicators of Systemic Cobaltosis in Metal-on-Polyethylene Hip Implants.The American journal of case reports · 2025Article
- Cobalt Toxicity Presenting as Bilateral Optic Neuropathy.Ochsner journal · 2025Article
- Cobalt Toxicity Induces Retinopathy and Optic Neuropathy in Mice.Investigative ophthalmology & visual science · 2024Article
- Cobalt-chromium toxicity following revision of total hip replacement.Saudi medical journal · 2024Article
- Poly (Ether-Ether-Ketone) for Biomedical Applications: From Enhancing Bioactivity to Reinforced-Bioactive Composites-An Overview.Polymers · 2023Review
- [Postoperative imaging of the hip].Radiologie (Heidelberg, Germany) · 2022Review
- Prosthetic hip-associated cobalt toxicity: a systematic review of case series and case reports.EFORT open reviews · 2022Review
- Current understanding of hexavalent chromium [Cr(VI)] neurotoxicity and new perspectives.Environment international · 2022Review
- Metals and Metal-Nanoparticles in Human Pathologies: From Exposure to Therapy.Molecules (Basel, Switzerland) · 2021Review
- The role of Vitamin E in hip implant-related corrosion and toxicity: Initial outcome.Journal of the mechanical behavior of biomedical materials · 2021Article
- No association between blood count levels and whole-blood cobalt and chromium levels in 1,900 patients with metal-on-metal hip arthroplasty.Acta orthopaedica · 2020Article
- Nanotechnology for angiogenesis: opportunities and challenges.Chemical Society reviews · 2020Review
- Cobalt toxic optic neuropathy and retinopathy: Case report and review of the literature.American journal of ophthalmology case reports · 2020Article
- Total hip replacement failure due to adverse local tissue reaction from both ceramic abrasive wear and trunnion corrosion.Arthroplasty today · 2019Article
- Cobalt cardiomyopathy in hip arthroplasty.Arthroplasty today · 2019Article
- Analysis of Cellular Activity Short-Term Exposure to Cobalt and Chromium Ions in Mature Human Osteoblasts.Materials (Basel, Switzerland) · 2019Article
- Chromium-Cobalt Intoxication with Intense Systemic Complications following Total Hip Revision after Per-Operative Ceramic Fracture.Case reports in orthopedics · 2019Article
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
This case illustrates the potential for systemic cobalt toxicity in non-metal-on-metal bearings and its potentially devastating consequences. We present a 71-year-old male with grinding sensations in his right hip following ceramic-on-ceramic total hip arthroplasty (THA). After diagnosing a fractured ceramic liner, the hip prosthesis was revised into a metal-on-polyethylene bearing. At one year postoperatively, X-rays and MARS-MRI showed a fixed reversed hybrid THA, with periarticular densities, flattening of the femoral head component, and a pattern of periarticular metal wear debris and pseudotumor formation. Before revision could take place, the patient was admitted with the clinical picture of systemic cobalt toxicity, supported by excessively high serum cobalt and chromium levels, and ultimately died. At autopsy dilated cardiomyopathy as cause of death was hypothesized. A third body wear reaction between ceramic remnants and the metal femoral head very likely led to excessive metal wear, which contributed systemic cobalt toxicity leading to neurotoxicity and heart failure. This case emphasizes that fractured ceramic-on-ceramic bearings should be revised to ceramic-on-ceramic or ceramic-on-polyethylene bearings, but not to metal-on-polyethylene bearings. We aim to increase awareness among orthopedic surgeons for clinical clues for systemic cobalt intoxication, even when there is no metal-on-metal bearing surface.
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Registered trials
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