Terhune E Bailey, Sutter E Grant, Balkissoon Rishi, Pallante Graham, Specht Lawrence M, Leikin Jerrold, Kwon Young-Min, Lewallen David G, Gerlinger Tad L, Jacobs Joshua J
Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
Department of Orthopedic Surgery, Northwestern University Medical Center, Naperville, Illinois, USA.
Bone Joint J. 2025 Jun 1;107-B(6 Supple B):92-100. doi: 10.1302/0301-620X.107B6.BJJ-2024-1114.R1.
Ceramic-on-ceramic (CoC) articulations in total hip arthroplasty (THA) have the advantage of low wear but the unique risk of fracture. After revision for CoC-bearing fracture, third-body ceramic particles can lead to massive wear of cobalt-chrome (CoCr) bearings, causing extremely elevated blood cobalt. We present a multicentre series of five cases where patients sustained fractures of ceramic liners, were revised using a CoCr articulation, and rapidly developed severe cobalt toxicity.
We identified five cases of cobalt toxicity after fractured CoC THA treated with revision to CoCr on polyethylene bearings. Mean follow-up was three years (5 to 72 months) after re-revision to remove the CoCr bearing.
Symptoms of cobalt toxicity occurred at a mean ten months (6 to 12) after revision for ceramic fracture. All patients developed vision and hearing loss, balance difficulties, and peripheral neuropathy. Several had cardiomyopathy, endocrine abnormalities, and local skin discolouration. Only two reported hip pain. Repeat revision for recognized cobalt toxicity occurred at a mean 22 months after revision for ceramic fracture. Mean serum cobalt level at re-revision was 991 ng/ml (normal value < 1 ng/ml; 734 to 1,302). All CoCr femoral heads exhibited massive wear, and deep tissues showed prominent metal staining. Treatment consisted of debridement and revision to a ceramic femoral head with highly cross-linked polyethylene (HXLPE) liner. Serum cobalt improved to a mean 25 μg/l (1 to 76) at final follow-up. All patients reported partial improvement in vision and hearing, however their peripheral neuropathy and balance difficulties did not recover.
Systemic cobalt toxicity is a devastating complication of ceramic-bearing fracture in THA treated with CoCr bearings, which may not present with hip symptoms. The diagnosis of this syndrome of systemic cobalt toxicity was significantly delayed following systemic symptoms in this series. Debridement and re-revision to a ceramic-on-HXLPE bearing leads to improvement, but not full resolution, of cobalt toxicity complications.
全髋关节置换术（THA）中陶瓷对陶瓷（CoC）关节具有低磨损的优势，但存在独特的骨折风险。在因CoC轴承骨折进行翻修后，第三体陶瓷颗粒可导致钴铬（CoCr）轴承大量磨损，致使血液钴含量极度升高。我们呈现了一个多中心系列的5例病例，这些患者陶瓷衬垫发生骨折，采用CoCr关节进行翻修，并迅速出现严重的钴中毒。
我们确定了5例CoC THA骨折后用聚乙烯轴承上的CoCr进行翻修治疗后发生钴中毒的病例。再次翻修以移除CoCr轴承后，平均随访时间为3年（5至72个月）。
钴中毒症状在陶瓷骨折翻修后平均10个月（6至12个月）出现。所有患者均出现视力和听力丧失、平衡困难以及周围神经病变。数例患者有心肌病、内分泌异常和局部皮肤变色。仅有2例报告有髋部疼痛。因已确认的钴中毒进行再次翻修平均发生在陶瓷骨折翻修后22个月。再次翻修时血清钴平均水平为991 ng/ml（正常值<1 ng/ml；734至1302）。所有CoCr股骨头均出现大量磨损，深部组织显示出明显的金属染色。治疗包括清创以及翻修为带有高交联聚乙烯（HXLPE）衬垫的陶瓷股骨头。最终随访时血清钴平均改善至25 μg/l（1至76）。所有患者报告视力和听力有部分改善，然而他们的周围神经病变和平衡困难并未恢复。
全身钴中毒是THA中采用CoCr轴承治疗陶瓷轴承骨折的一种毁灭性并发症，可能不会出现髋部症状。在本系列中，该全身钴中毒综合征的诊断在出现全身症状后显著延迟。清创并翻修为陶瓷对HXLPE轴承可使钴中毒并发症得到改善，但不能完全解决。
