Hip Arthroplasty

Archives of Orthopaedic and Trauma Surgery

, Volume 131, Issue 9, pp 1299-1308

First online:

Cobalt, chromium and molybdenum ions kinetics in the human body: data gained from a total hip replacement with massive third body wear of the head and neuropathy by cobalt intoxication

  • U. E. PazzagliaAffiliated withOrthopaedic Clinic, University of Brescia
  • , P. ApostoliAffiliated withDepartment of Experimental and Applied Medicine, Section of Industrial Hygiene, University of Brescia
  • , T. CongiuAffiliated withDepartment of Human Morphology, University of Insubria
  • , S. CatalaniAffiliated withDepartment of Experimental and Applied Medicine, Section of Industrial Hygiene, University of Brescia
  • , M. MarcheseAffiliated withOrthopaedic Clinic, University of Brescia
  • , G. ZarattiniAffiliated withOrthopaedic Clinic, University of Brescia Email author 

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Abstract

Introduction

A patient with a total hip replacement developed optic, acoustic and peripheral neuropathy from metal ions intoxication, due to the wear products released from the prosthesis. Subsequently the kinetics of the metal ions was studied.

Materials and methods

Massive wear and acute intoxication allowed a study of the metal ions kinetics and of EDTA treatment.

Results

Plasma and other organic fluids were saturated by each of the metal ions released from the exposed surface according to the solubility of each ion; a larger fraction of Co ions was bound within red cells, while the plasmatic fraction appeared more movable. In a patient with a prosthesis subjected to wear, the ions released are from the prosthetic and from the debris surface (spread in the body). The latter is a function of the number and size of particles.

Discussion

Revision of the prosthesis from the point of view of the metal ions kinetics corresponded to a reduction of the releasing surface because of debris washed out by irrigation and tissue excision; however, the metal particles spread by lymphatic circulation continued to release ions even though the source of wear had been removed. Early diagnosis of high metal wear can be ascertained with mass spectrometry and after revision high levels of metal ions can only be reduced with repeated chelating treatment. It is preferable not to revise fractured ceramic components with a polyethylene–metal articulation.

Keywords

Total hip replacement Cobalt intoxication Metal ions Foreign body reaction Prosthetic wear