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Corrosion of Polished Cobalt-Chrome Stems Presenting as Cobalt Encephalopathy.


ABSTRACT: Adverse reactions to metallic debris from corrosion of polished cobalt-chromium-cemented femoral stems are reported. Cobaltism (systemic cobalt poisoning) has not been reported from this phenomenon. Three patients presented to their surgeon for ongoing care 10-20 years after primary metal-on-plastic hip arthroplasty with the same polished cobalt-chromium-cemented femoral stems (Heritage, Zimmer). Urine cobalt was elevated, and the patients had symptoms consistent with cobaltism. Quantitative-F16DG-PET-CT brain imaging was performed showing generalized and focal brain hypometabolism consistent with cobalt encephalopathy. At revision, all stems were well fixed and grossly corroded. At 1 year after revision, cobalturia and cognitive symptoms were resolved or improved. Mechanically assisted crevice corrosion at the polymethylmethacrylate interface is a complication of polished cobalt-chromium-cemented stems that can result in systemic cobalt exposure and toxic encephalopathy. Our cases had only minor periprosthetic symptoms. Patients implanted with polished cobalt-chromium-cemented stems warrant monitoring with urine cobalt. Patients with cobaltemia warrant an evaluation for toxic encephalopathy.

SUBMITTER: Tower SS 

PROVIDER: S-EPMC7772456 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Corrosion of Polished Cobalt-Chrome Stems Presenting as Cobalt Encephalopathy.

Tower Stephen S SS   Medlin Dana J DJ   Bridges Robert L RL   Cho Christina S CS  

Arthroplasty today 20201202 4


Adverse reactions to metallic debris from corrosion of polished cobalt-chromium-cemented femoral stems are reported. Cobaltism (systemic cobalt poisoning) has not been reported from this phenomenon. Three patients presented to their surgeon for ongoing care 10-20 years after primary metal-on-plastic hip arthroplasty with the same polished cobalt-chromium-cemented femoral stems (Heritage, Zimmer). Urine cobalt was elevated, and the patients had symptoms consistent with cobaltism. Quantitative-F<s  ...[more]

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