Hip Pelvis.  2016 Dec;28(4):259-263. 10.5371/hp.2016.28.4.259.

Cobalt Intoxication Heart Failure after Revision Total Hip Replacement for Ceramic Head Fracture: A Case Report

• Kim CH
• Choi YH
• Jeong MY
• Chang JS
• Yoon PW

• KMID: 2364705
• DOI: http://doi.org/10.5371/hp.2016.28.4.259

Abstract

In 1960s, toxic heart failure due to cobalt poisoning was firstly reported from Canadian industrial worker. Following development of bearing materials in hip arthroplasties, using cobalt-chrome alloy in bearing surface, there were rarely reported of systemic affect toxic cobaltism include toxic heart failure due to articulation wear in Western countries. It could be happened more easily by third body wear from ceramic particle especially revision total hip replacement (THR) surgery using cobalt-chrome alloy following ceramic articulation breakage which index surgery performed by ceramic on ceramic bearing. In Korea, due to many surgeons prefer ceramic on ceramic bearing in THR compared to Western countries, it might be more important issue within a time. However in our knowledge, there was no previous report about cobalt poisoning heart failure in Korea. It is still very rare and hard to diagnose cobalt intoxication heart failure after THR, so we report a case of fatal heart failure caused by cobalt intoxication after revision THR in 53-year old man who successfully underwent re-revision THR.

Keyword

Hip; Hip replacement arthroplasty; Heart failure; Cobalt; Ceramics

MeSH Terms

Alloys
Arthroplasty
Arthroplasty, Replacement, Hip*
Ceramics*
Cobalt*
Head*
Heart Failure*
Heart*
Hip
Korea
Poisoning
Surgeons
Alloys
Cobalt

Figure

• 

  Fig. 1 Simple radiograph image shows radiodense area around the hip joint extended intrapelvic cavity. Deformed cobalt-chrome alloy metal head shows eccentric wear (asterisk) and ceramic particle is seen near the lessor trochanter (arrow).

• 

  Fig. 2 Contrast computed tomography shows huge cystic mass combined foreign body debris suspected caused by metallosis. Coronal images (A, B) and axial image (C) are obtained.

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  Fig. 3 Intraoperative findings. (A) Thick and blackish fluid gushed out immediately when incision fascia. (B) Soft tissue involvement around greater trochanter (asterisk) was founded. Ant: anterior, Post: posterior, Prox: proximal, Dist: distal.

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  Fig. 4 Severely deformed metal head and defect of head apex. Trunnion was seen through the defect (arrow).

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  Fig. 5 (A) Ceramic particle was found near the lessor trochanter. (B) Blackish fluid was seen in suction bottle.

• 

  Fig. 6 Postoperative X-ray image which using ceramic on ceramic bearing re-revision total hip replacement. Ceramic particle was removed.

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