University of Toronto, Banting Institute, Division of Orthopaedic Surgery, 100 College Street Room 302, Toronto, Ontario M5G 1L5, Canada.
Bone Joint J. 2013 Jan;95-B(1):31-7. doi: 10.1302/0301-620X.95B1.30060.
Symptomatic cobalt toxicity from a failed total hip replacement is a rare but devastating complication. It has been reported following revision of fractured ceramic components, as well as in patients with failed metal-on-metal articulations. Potential clinical findings include fatigue, weakness, hypothyroidism, cardiomyopathy, polycythaemia, visual and hearing impairment, cognitive dysfunction, and neuropathy. We report a case of an otherwise healthy 46-year-old patient, who developed progressively worsening symptoms of cobalt toxicity beginning approximately six months following synovectomy and revision of a fractured ceramic-on-ceramic total hip replacement to a metal-on-polyethylene bearing. The whole blood cobalt levels peaked at 6521 µg/l. The patient died from cobalt-induced cardiomyopathy. Implant retrieval analysis confirmed a loss of 28.3 g mass of the cobalt-chromium femoral head as a result of severe abrasive wear by ceramic particles embedded in the revision polyethylene liner. Autopsy findings were consistent with heavy metal-induced cardiomyopathy.We recommend using new ceramics at revision to minimise the risk of wear-related cobalt toxicity following breakage of ceramic components.
因全髋关节置换失败而导致的症状性钴中毒是一种罕见但严重的并发症。钴中毒已有报道发生于陶瓷部件骨折后的翻修，以及金属对金属关节出现故障的患者中。潜在的临床发现包括疲劳、乏力、甲状腺功能减退、心肌病、红细胞增多症、视力和听力障碍、认知功能障碍和神经病变。我们报告了一例 46 岁健康状况良好的患者，该患者在滑膜切除和陶瓷对陶瓷全髋关节置换翻修为金属对聚乙烯承窝后，大约六个月开始出现逐渐加重的钴中毒症状。全血钴水平峰值为 6521μg/l。患者死于钴诱导性心肌病。植入物回收分析证实，由于修复聚乙烯衬垫中嵌入的陶瓷颗粒的严重磨损，钴铬股骨头的质量损失了 28.3 克。尸检结果与重金属诱导的心肌病一致。我们建议在翻修时使用新型陶瓷，以尽量降低陶瓷部件断裂后因磨损相关的钴中毒的风险。
