Intracranial hypertension associated with arthroprosthetic cobaltism?

Area of Science:

• Orthopedic Surgery
• Toxicology
• Neurology

Background:

• Metal-on-metal hip prosthetics, specifically cobalt-chromium implants, have been associated with systemic metal ion release.
• Systemic cobaltism can manifest with various symptoms, but neurological complications are less commonly reported.

Observation:

• A 59-year-old male with a history of hip osteoarthritis presented with clinical and radiographic evidence of increased intracranial hypertension.
• The patient had a prior total hip arthroplasty utilizing a cobalt-chromium metal-on-metal implant, and subsequent serum cobalt levels were significantly elevated (0.9 microg/L).

Findings:

• Revision arthroplasty with removal of the cobalt-chromium implant led to the resolution of the patient's increased intracranial pressure.
• The patient became asymptomatic and neurologically stable one year post-explantation, managed with acetazolamide.

Implications:

• This case is the first to report a direct association between systemic cobaltism secondary to metal-on-metal hip prosthetics and increased intracranial hypertension.
• Clinicians should be aware of potential neurologic and neuro-ophthalmic presentations in patients with metal-on-metal orthopedic implants, prompting investigation for metal toxicity.