Our aim is to show the patient's clinical progress, determine the clinical features of cobalt toxicity, discuss the radiological and intraoperative findings, and finally to review the recommendations for the management and prevention of this complication. At the time of the initial revision surgery it was found that the ceramic head was fractured and the acetabular lining was intact. We present the case of a 74-year-old man presenting symptoms of cobalt toxicity after change of a total hip replacement prosthesis with a fractured ceramic-on-ceramic bearing to a polyethylene-metal total hip arthroplasty. 6 These residual particles incorporated in polyethylene rapidly increase the rates of wear on the prosthetic head and expose the patient to the toxic effects of heavy metals. However, it has been demonstrated that reliably removing all ceramic debris without extensive anterior dissection and subsequent synovectomy is extremely difficult. This is one reason, amongst others, that polyethylene metal is often chosen in conjunction with synovectomy to mitigate the amount of residual ceramic particles and thus avoid increased rates of wear. 5 When revision component options are discussed after a catastrophic failure, patients are often reluctant to accept another ceramic device for fear of a further fracture of the component. 5 The fracture rates of third and fourth generation ceramic liners have remained relatively constant at 0.032% and 0.028%, respectively. Recent manufacturer's data (CeramTec GmbH, Plochingen, Germany) show a significant reduction in the rate of fractures of fourth generation Biolox Delta ceramic heads (0.002%) compared to third generation ceramic heads (0.021%). 3 Failure of the ceramic femoral head component is most common after a traumatic event, whereas acetabular inserts commonly fail where there is no history of trauma. 1,2 Unfortunately, ceramic components can fracture due to their fragility and low elasticity coefficient. Recomendamos el uso de pares cerámica-cerámica en las cirugías de revisión de cadera tras rotura de componentes cerámicos para reducir al mínimo el riesgo de toxicidad por cobalto.Ĭeramic-on-ceramic bearings used in total hip replacement were first developed in the seventies in the hope that ceramic's low incidence of wear would reduce the rates of revision surgery. Tras retirada protésica y reimplante, se normalizaron los niveles de cromo y cobalto en sangre y orina, encontrándose el paciente actualmente asintomático. A los 6 meses de la reintervención comenzó con clínica de intoxicación por cobalto, confirmada mediante determinación analítica, presentando niveles pico de cobalto en suero de 651,2 μg/l. Presentamos el caso de un varón de 74 años que tras recambio a par cerámica-cerámica y dos episodios de luxación protésica se decidió nuevo recambio a par polietileno-metal. Los síntomas incluyen: cardiomiopatía, hipotiroidismo, erupciones en la piel, alteraciones visuales, cambios en la audición, policitemia, debilidad, fatiga, deterioro cognitivo y neuropatía. La intoxicación por cobalto después de la revisión de una artroplastia total de cadera es poco común, pero una complicación potencialmente devastadora. The Journal is included in the major databases: MEDLINE/PubMed, IME, EMBASE, Bibliomed, SCOPUS, and IBECS. All works are evaluated blind by at least 3 peer reviewers, whose judgements are finally supervised by the Editor of the particular area of knowledge and by the Journal Editor in Chief. The Editorial Committee consists of 10 independent members, specialists of recognised prestige that are not associated with the governing bodies of the Society. The Updates and Research Works sections are of great interest to specialists, due to the careful selection of the topics. In each issue it also publishes one or two clinical cases that are of great interest to the readers, since they are usually exceptional cases that are difficult to diagnose or treat. In the contents of the Journal, priority is given to original research articles on the specialty, which is also its main aim the publication of the best original research articles in Spanish. The Revista Española de Cirugía Ortopédica y Traumatología (Journal of Orthopaedics Surgery and Traumatology) is the official publication of the Spanish Society of Orthopaedic Surgery and Traumatology that has a combined total of 5,000 members, and is the leading Spanish journal of the specialty.
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