Fatal Cobalt Cardiomyopathy Following Revision Total Hip Arthroplasty – A Brief Report with Review of Literature

Document Type : CASE REPORT


1 Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), New Delhi, India

2 Department of Orthopedics, Military Hospital, Kirkee, Pune, India


Ceramic bearing surfaces are being increasingly used in young patients undergoing total hip arthroplasty. However,
failures have been reported including fractures even with the newer third generation ceramics. The recommended
treatment for fracture of ceramic bearing surfaces is complete synovectomy and revision total hip arthroplasty.
However, disappointing results have also been reported with this approach. The residual ceramic particles may lead
to complications. We report a fatal case of cobalt toxicity leading to cardiomyopathy secondary to the catastrophic
failure of a Cobalt-Chrome femoral head, which followed the revision of a fractured ceramic-on-ceramic total hip
Level of evidence: IV


Main Subjects

1. Fisher J, Jin Z, Tipper J, Stone M, Ingham E. Tribology
of alternative bearings. Clin Orthop Relat Res. 2006;
2. McLean CR, Dabis H, Mok D. Delayed fracture of the
ceramic femoral head after trauma. J Arthroplasty.
2002; 17(4):503-4.
3. Allain J, Roudot-Thoraval F, Delecrin J, Anract P,
Migaud H, Goutallier D. Revision total hip arthroplasty
performed after fracture of a ceramic femoral head. A
multicenter survivorship study. J Bone Joint Surg Am.
2003; 85-A(5):825-30.
4. Kwon YM, Jacobs JJ, MacDonald SJ, Potter HG, Fehring
TK, Lombardi AV. Evidence-based understanding
of management perils for metal-on-metal hip
arthroplasty patients. J Arthroplasty. 2010; 27(8
5. Kennedy A, Dornan JD, King R. Fatal myocardial
disease associated with industrial exposure to cobalt.
Lancet. 1981; 1(8217):412-4.
6. Mao X, Wong AA, Crawford RW. Cobalt toxicity:
an emerging clinical problem in patients with
metal-on-metal hip prostheses? Med J Aust. 2011;
7. Bradberry SM, Wilkinson JM, Ferner RE. Systemic
toxicity related to metal hip prostheses. Clin Toxicol.
2014; 52(8):837-47
8. Harris A, Johnson J, Mansuripur PK, Limbird R. Cobalt
toxicity after revision to a metal-on-polyethylene total
hip arthroplasty for fracture of ceramic acetabular
component. Arthroplasty Today. 2015; 1(4):89-91.
9. Zywiel MG, Brandt JM, Overgaard CB, Cheung AC,
Turgeon TR, Syed KA. Fatal cardiomyopathy after
revision total hip replacement for fracture of a ceramic
liner. Bone Joint J. 2013; 95-B(1):31-7.
10. Sharma V, Ranawat AS, Rasquinha VJ, Weiskopf J,
Howard H, Ranawat CS. Revision total hip arthroplasty
for ceramic head fracture: a long-term follow-up. J
Arthroplasty. 2010; 25(3):342-7.