Chromium-Cobalt Intoxication with Intense Systemic Complications following Total Hip Revision after Per-Operative Ceramic Fracture

Lecoanet, Paul; Blangis, Mathias; Garcia, Matthieu; Legallois, Yohan; Fabre, Thierry

doi:10.1155/2019/4209796

Cited by 9 publications

(4 citation statements)

References 13 publications

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“…The pathomechanism of chromium-cobalt toxicity is not fully understood, but it is hypothesized that the ions induce oxidative stress within macrophages and inhibit enzymatic reactions along the electron transport chain [16]. Systemic side effects of chromium/cobalt intoxication include neuropathy of peripheral nerves, weight loss, fatigue, and hearing/vision loss in severe cases [17,18]. Many centers have reported success using N-acetyl-cysteine (NAC) as a chelating agent, which works by directly binding ions via the thiol group.…”

Section: Discussionmentioning

confidence: 99%

Reactive Peri-Arthroplasty Pseudotumors: A Rare Cause of Hip Pain and Iatrogenic Sciatica

Ahmed,

Grabie,

Loeffler

et al. 2023

Cureus

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Total hip arthroplasty (THA) is the preferred treatment for patients with hip joint disorders refractory to conservative management. While original implants were designed to articulate a metallic femoral head onto a polyethylene liner, the popularity of "metal-on-metal" (MoM) hip implants surged in the early 21st century due to their perceived superior long-term durability and lower revision rates. However, subsequent followup studies showed high failure rates due to inflammatory responses to periprosthetic metallic debris leading to lymphocytic proliferation, soft tissue necrosis or fibrosis, systemic metal toxicity, and/or the development of cystic pseudotumors. Although these discoveries resulted in a significant decrease in MoM THA and revision procedures, the majority of MoM hip implants persist in the adult population. In this case report and review, we report the presentation, diagnostic work-up, and management of an 84-year-old status-post MoM THA who presented with unilateral leg tenderness and poor ambulation secondary to pseudotumorinduced sciatica.

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Section: Discussionmentioning

confidence: 99%

Reactive Peri-Arthroplasty Pseudotumors: A Rare Cause of Hip Pain and Iatrogenic Sciatica

Ahmed,

Grabie,

Loeffler

et al. 2023

Cureus

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“…1,2 This complication may occur after prosthetic revision with a metal bearing surface following a fracture of the ceramic component. [2][3][4][5] The fracture of the ceramic bearing component may lead to debris (third body), which after revision with a Co-Cr component, can lead to premature wear of the polyethylene, especially of the metal head. This debris releases cobalt ions into the body, leading to systemic manifestations.…”

mentioning

confidence: 99%

“…The patient presented with obvious symptoms of toxicity that have been well-described in the literature. [2][3][4][5] One of the problems encountered in the management of this patient was that all symptoms were treated independently without recognizing the etiology. A multidisciplinary approach and communication between different specialties would have enabled an early diagnosis and avoided the development of complications.…”

mentioning

confidence: 99%

Cobalt-chromium toxicity following revision of total hip replacement

Samargandi,

Le Nail,

Hetaimish

et al. 2024

SMJ

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Systemic cobalt-chromium (Co-Cr) toxicity following a total hip replacement is a rare complication that may sometimes lead to fatal consequences. We report a case of a 64-year-old woman, who presented with Co-Cr toxicity after revision of fractured ceramic components with metal-on-polyethylene. Systemic toxicity occurred a year after surgery and was expressed brutally with mostly central neurological symptoms. Revision surgery allowed rapid regression of all symptoms. Prosthetic revision with a metal bearing surface after a history of fracture of the ceramic bearing component should be avoided. Orthopedic surgeons and the different medical actors should be aware of this rare but serious complication to allow earlier management. Above all, multidisciplinary management is primordial to allow correct diagnosis and appropriate treatment.

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“…PROMS can be both generic and disease-specific [64]. Life and health changes continuously and well-being is influenced by many factors, which means that PROM results are subjective by nature and influenced by socioeconomic and psychological factors [60,65,66]. For many PROMs, the main determinant of outcome seems to be pain, because patients experience difficulties in differentiating between pain and functional disability [67,68].…”

Section: Subjective Outcome Assessmentmentioning

confidence: 99%

Metal-on-metal hip arthroplasty

Jelsma¹

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Chromium-Cobalt Intoxication with Intense Systemic Complications following Total Hip Revision after Per-Operative Ceramic Fracture

Cited by 9 publications

References 13 publications

Reactive Peri-Arthroplasty Pseudotumors: A Rare Cause of Hip Pain and Iatrogenic Sciatica

Reactive Peri-Arthroplasty Pseudotumors: A Rare Cause of Hip Pain and Iatrogenic Sciatica

Cobalt-chromium toxicity following revision of total hip replacement

Metal-on-metal hip arthroplasty

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