Case Report: High Chromium and Cobalt Levels in a Pregnant Patient with Bilateral Metal-on-Metal Hip Arthroplasties

Abstract

Background Metal-on-metal bearings frequently are used in young patients leading to the concern that disseminated metals such as chromium (Cr) and cobalt (Co) as the main constituents could affect pregnancies. Case Description We describe a 41-year-old patient with bilateral metal-on-metal hip arthroplasties, a recurrent pseudotumor, and extremely high blood levels (Cr 39 lg/L, Co 138 lg/L) at 12 gestational weeks. At different gestational weeks, maternal blood, aspirate of the pseudotumor, and amniotic fluid were analyzed for Cr and Co. Therapy with chelating agents was not recommended because the mother showed no symptoms of toxicity and the safety of chelating therapy during pregnancy is not established.

A Prospective Study of Serum Trace Elements in Healthy Korean Pregnant Women

“…The demands for trace elements in a normal pregnancy, especially during the third trimester and at parturition, impose considerable systemic oxidative, metabolic, and inflammatory stresses that play an important role in many diseases and adverse pregnancy outcomes such as miscarriages, preeclampsia, gestational diabetes mellitus (GDM), and intra-uterine growth restriction [10,11,12,13,14,15,16]. There is insufficient evidence regarding the potential adverse effects of excess Co on pregnancy outcomes, although mouse models have suggested that metal-induced chromosomal changes and DNA damage could have carcinogenic effects in females and mutagenic and teratogenic effects in their offspring [17]. …”

A Miniaturized Therapeutic Chromophore for Multiple Metal Pollutant Sensing, Pathological Metal Diagnosis and Logical Computing

“…For example, for the simultaneous detection of chromium and cobalt metal ions in human urine during post-surgery recovery of metal-on-metal hip resurfacing of young patients8384, there is a need of simpler and high-throughput diagnostic methods than the commonly used complicated method of detection85868788. Urine is such a biological continuum that has a strong background noise below 450 nm.…”

“…Apart from the identification of metals, the ability of our analytical system was demonstrated by the detection of various pathologically important metal ions 83 84 and its mixtures. For example, for the simultaneous detection of chromium and cobalt metal ions in human urine during post-surgery recovery of metal-on-metal hip resurfacing of young patients 83 84 , there is a need of simpler and high-throughput diagnostic methods than the commonly used complicated method of detection 85 86 87 88 . Urine is such a biological continuum that has a strong background noise below 450 nm.…”

Congenital anomalies in the offspring of women with total hip replacement: a nationwide register study in Finland

“…Another study reported three healthy newborns without malformations when the mother had a MoM hip replacement and also elevated Co and Cr ion levels (36). In a recent case report, the authors described one healthy newborn with increased umbilical cord Cr and Co levels at birth that normalised during the first three months, and no harm to the newborn was detected (37).…”

“…Indeed, the incidence of primary THR in younger patients aged 30 to 59 years old increased from 9.5 per 100 000 person years in 1980 to 61 per 100 000 person years in 2007. The increase in incidence was smaller in the youngest age group (30)(31)(32)(33)(34)(35)(36)(37)(38)(39) compared with the older age groups (40-49 and 50-59) (6). During the same period, the total annual number of primary THRs performed on women aged less than 55 years increased from 238 to 468 (7).…”