Clinical cases of patients with arthroplasty and heightened blood concentration of metal ions

• Main Authors: M. Thomsen, V. Krenn, P. Thomas, J. P. Kretzer
• Format: Article
• Language: Russian
• Published: Vreden Russian Research Institute of Traumatology and Orthopedics 2016-09-01
• Series: Travmatologiâ i Ortopediâ Rossii
• Subjects: эндопротезирование; металл-металлические пары трения; гиперчувствительность к металлам; интоксикация кобальтом; arthroplasty; metal-on-metal couplings; cobalt intoxication
• Online Access: https://journal.rniito.org/jour/article/view/102
• ISSN: 2311-2905; 2542-0933

We report on several clinical cases of different appearance and complications of patients after THR with metal-on-metal (MoM) couplings or a revision knee system. There may be skin irritation mainly due to chromium hypersensitivity or systemic effects and even cobalt intoxication can appear. We recommend clinical control to patients with MoM and a head size of 36 mm or larger or with knee revision systems. Patients who have problems such as pain or mal positioning should have measured the metall ion levels of cobalt. A serum cobalt level of >7 µg /L indicates possible periprosthetic metallosis and may cause trouble. A normal serum cobalt level is below 1 µg /L. We also need an MRI with Metal-Artifact-Reduced-Sequences or if not possible an ultrasound investigation to detect pseudotumors around the hip joint. For the clinical investigation you should look and ask for general hypersensitivity reaction (skin rash), cardiomyopathy, neurological changes including sensory changes, renal function impairment or thyroid dysfunction which may occur in cobalt intoxication. To optimize the diagnostic histological investigations using the Krenn classification are extremely helpful.