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. Soft tissue, capsule and bone adjacent to the component densely stained with black metal debris. Deterioration of the metal head on radiographic control 3 years after revision surgery. 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. At the time of the authors’ 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.
Legislation in the EU states that surgeons are responsible for quality assurance and product liability if they mix components from different manufacturers. This case is therefore another example of what every surgeon should know: never mix and match.