Chronic Systemic Metal Ion Toxicity from Wear on a Revised Cobalt-chromium Trunnion

Metal toxicity secondary to corrosion and wear has been reviewed in the arthroplasty literature with evidence supporting dermatologic, neurologic, and cardiac involvement. This is the first report of a novel case with the occurrence of systemic pathology with only mildly elevated serum cobalt (Co) and chromium (Cr) levels due to trunnion wear in a metal-on-polyethylene articulation.

A 45-year-old female who had undergone a revision total hip arthroplasty developed concerning dermatologic, neurologic, and cardiac symptoms. Symptoms were initially attributed to an unknown autoimmune etiology. She had mildly elevated cobalt and chromium levels and subsequently underwent a second revision, this time with complete exchange of the cobalt/chromium components. By her 2-month follow-up, she reported partial resolution of symptoms. She continues to improve more than a year postoperatively.

Consideration should be given to metal ion toxicity due to trunnion wear in patients with cobalt/chromium femoral components, even with relatively low ion levels.