Cobalt related cardiomyopathy in hip arthroplasty is a complication of concern. A review of published evidence

Abstract

Cobalt toxicity related cardiomyopathy in hip arthroplasty has recently been reported in the literature. Purpose of this review was to identify and assess available published evidence of cardio- myopathy in hip arthroplasty patients and to derive recommendations for management.

We evaluated 23 cases reported till October 2018 and stratified into three categories, based upon pre- existing risk factors for cardiomyopathy, histological confirmation and evidence of systemic signs of cobalt toxicity.

Cobalt toxicity was considered to be the definite cause of cardiomyopathy in 8 cases, and probably contributory in 13 cases. 2 cases were considered to have developed cardiomyopathy secondary to pre- existing risk factors. Majority of the patients had a good recovery of cardiac function after hip revision and cardiac management, but 5 cases deteriorated and died.

Although cobalt related cardiomyopathy has been reported in a small number of cases of hip arthro- plasty, a delay or missed diagnosis may lead to significant morbidity and mortality. Timely diagnosis, removal of causative implant and avoidance of metal articulations in revision for fractured ceramic implants may help in an effective management.