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Cobalt Cardiomyopathy Secondary to Hip Arthroplasty: An Increasingly Prevalent Problem

Russel Tilney1, Melanie Roberta Burg2, Mark Adrian Sammut2

  • 1Department of Medicine, Mater Dei Hospital, Msida, Malta.

Case Reports in Cardiology
|August 29, 2017
PubMed

Insights

Metal-on-metal hip implants can release cobalt, causing heart failure. Revision surgery to replace the implant resolved the patient's symptoms and improved heart function.

Area of Science:

  • Biomaterials Science
  • Cardiology
  • Toxicology

Background:

  • Total hip replacement with metal-on-metal components can lead to adverse local tissue reactions and systemic toxicity.
  • Cobalt-chromium alloys are commonly used in hip arthroplasty, raising concerns about ion release and systemic effects.

Observation:

  • A patient presented with worsening heart failure four years after bilateral complicated total hip replacement.
  • Elevated cobalt blood levels and clinical presentation suggested implant-related toxicity.
  • Intraoperative findings revealed biotribocorrosion on the hip arthroplasty components.

Findings:

  • Revision surgery of the affected hip led to significant symptomatic improvement in heart failure (NYHA class III to I).
  • Echocardiography demonstrated recovery of ejection fraction post-revision.
  • Cobalt ions, similar to nanoparticles, exhibit cytotoxicity affecting neurological, thyroid, and cardiac systems.

Implications:

  • Cobalt-induced cardiomyopathy is a potential complication of metal-on-metal hip arthroplasty.
  • Arthroplasty revision is the definitive treatment for cobalt toxicity, as other therapies are unproven.
  • Monitoring cobalt blood levels requires careful interpretation due to independent erythrocyte and serum dynamics.

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