Fatal cardiomyopathy after revision total hip replacement for fracture of a ceramic liner

Bone Joint J. 2013 Jan;95-B(1):31-7. doi: 10.1302/0301-620X.95B1.30060.


Symptomatic cobalt toxicity from a failed total hip replacement is a rare but devastating complication. It has been reported following revision of fractured ceramic components, as well as in patients with failed metal-on-metal articulations. Potential clinical findings include fatigue, weakness, hypothyroidism, cardiomyopathy, polycythaemia, visual and hearing impairment, cognitive dysfunction, and neuropathy. We report a case of an otherwise healthy 46-year-old patient, who developed progressively worsening symptoms of cobalt toxicity beginning approximately six months following synovectomy and revision of a fractured ceramic-on-ceramic total hip replacement to a metal-on-polyethylene bearing. The whole blood cobalt levels peaked at 6521 µg/l. The patient died from cobalt-induced cardiomyopathy. Implant retrieval analysis confirmed a loss of 28.3 g mass of the cobalt-chromium femoral head as a result of severe abrasive wear by ceramic particles embedded in the revision polyethylene liner. Autopsy findings were consistent with heavy metal-induced cardiomyopathy.We recommend using new ceramics at revision to minimise the risk of wear-related cobalt toxicity following breakage of ceramic components.

Publication types

  • Case Reports

MeSH terms

  • Arthroplasty, Replacement, Hip*
  • Cardiomyopathies / chemically induced*
  • Cardiomyopathies / diagnosis
  • Cobalt / poisoning*
  • Fatal Outcome
  • Hip Prosthesis / adverse effects*
  • Humans
  • Male
  • Middle Aged
  • Postoperative Complications / chemically induced*
  • Postoperative Complications / diagnosis
  • Prosthesis Failure / adverse effects*
  • Reoperation


  • Cobalt