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

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Abstract

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.

About the authors

M. Thomsen

Mittelbaden Clinics Baden-Baden, Trauma and Orthopaedic Surgery Units

Author for correspondence.
Email: marc.thomsen@klinikum-mittelbaden.de
Russian Federation

V. Krenn

Center for Histology, Cytology and Molecular Diagnostics

Email: noemail@neicon.ru
Russian Federation

P. Thomas

Hospital and Outpatients’ Clinic for Dermatology and Allergology, Ludwig Maximilian University

Email: noemail@neicon.ru
Russian Federation

J. P. Kretzer

Laboratory of Biomechanics and Implant Research, University of Heidelberg, Department of Orthopaedics

Email: noemail@neicon.ru
Russian Federation

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