Kobaltvergiftiging door metaal-op-metaalheupprothese

Conflict of interest: none declared. Financial support: none declared.

• Since 2011, cobalt and chromium blood levels are measured in patients with a metal-on-metal hip implant (MoM prosthesis).

• In this article we discuss the health risks that are related to chronically elevated blood cobalt concentrations induced by abnormal wear and corrosion of the MoM prosthesis.

• Only a few patients who have systemic symptoms of poisoning, besides local symptoms around the failing MoM prosthesis, have been described in the literature.

• Toxic blood cobalt concentrations may be accompanied by hypothyroidism, polyneuropathy, impairment of cranial nerves II and VIII and cardiomyopathy.

• Treatment consists of removal of the prosthesis. In patients with a normal kidney function, the cobalt blood levels rapidly decrease and symptoms of cobalt intoxication subside.

• Chelation therapy should be restricted to those patients who are unable to undergo removal of the prosthesis immediately due to their medical condition. This can for example be because of a severe cobalt-induced cardiomyopathy.