Key result
Cobalt toxicity was considered the definite cause of cardiomyopathy in 8 of 23 cases and probably contributory in 13 cases, with most patients recovering after hip revision and cardiac management.
Why the study?
Cobalt toxicity-related cardiomyopathy in hip arthroplasty has recently been reported, prompting a review of available published evidence to derive recommendations for management.
Cobalt toxicity from hip arthroplasty is a rare but serious cause of cardiomyopathy, highlighting the need for timely diagnosis and implant revision to prevent mortality.
BACKGROUND: Cobalt (Co) toxicity-related cardiomyopathy (CMP) in hip arthroplasty has recently been reported in the literature. The purpose of this review was to identify and assess available published evidence of CMP in hip arthroplasty patients and to derive recommendations for management. METHODS: We evaluated 23 cases reported till October 2018 and stratified into three categories, based on pre-existing risk factors for CMP, histological confirmation and evidence of systemic signs of Co toxicity. RESULTS: Co toxicity was considered to be the definite cause of CMP in 8 cases and probably contributory in 13 cases. Two cases were considered to have developed CMP secondary to pre-existing risk factors. Majority of the patients had good recovery of cardiac function after hip revision and cardiac management, but five cases deteriorated and died. CONCLUSION: Although Co-related CMP has been reported in a small number of cases of hip arthroplasty, a delay or missed diagnosis may lead to significant morbidity and mortality. Timely diagnosis, removal of causative implant and avoidance of metal articulations in revision for fractured ceramic implants may help in effective management.
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Umar et al. (2020) conducted a review in Cobalt toxicity-related cardiomyopathy (n=23). Cobalt toxicity from hip arthroplasty was evaluated on Cause of cardiomyopathy and clinical outcome. Cobalt toxicity was considered the definite cause of cardiomyopathy in 8 of 23 cases and probably contributory in 13 cases, with most patients recovering after hip revision and cardiac management.
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