Hip implants and systemic cobalt toxicity: a comprehensive review with case studies

Rarely, patients with metal hip implants present with generalised toxicity symptoms, including cardiomyopathy, peripheral neuropathy, hearing/vision impairment, thyroid dysfunction, increased red blood cell production, dermatitis, cognitive decline, and mood disturbances. The ill effects are attributed to abnormal wear of cobalt-chromium components and high circulating levels of cobalt ions. While certain implant materials or designs are known to predispose to high cobalt release, the risk of developing remote adverse effects is modulated by a complex interplay of implant and patient influences. In this chapter, we discuss systemic cobalt toxicity with a focus on the differential diagnosis, treatment options, and predisposing factors. A comprehensive review of the literature is supplemented by case studies that aim to raise awareness of the variable presentation of arthroprosthetic cobaltism and highlight the importance of timely diagnosis and treatment.