Severe cobalt poisoning with loss of sight after ceramic-metal pairing in a hip—a case report

A healthy 53-year-old man who had been treated with a cemented total hip arthroplasty including a ceramic-on-ceramic pairing 6 years previously underwent revision surgery 3 years later because of chronic pain in the operated hip. The firmly incorporated stem and socket were left in place, the ceramic head was changed to a long metal head for a better offset, and a soft tissue revision was performed.

2 years after revision, the patient noted increasing impairment of his hearing and sight and eventually he could just recognize outlines and colors but could not read. Also, he needed a hearing aid and headphones. In addition, there was numbness in his feet, and his head and neck were affected by dermatitis.

No attention had been paid by the medical staff involved to a hair analysis that had shown an increased amount of cobalt following revision surgery (Table). At the time of our first contact—and months after the reduction of hearing and sight had started—he again also had pain in the hip and radiographs showed deterioration of the metal head (Figure 1).