Monday, May 14, 2012

How Cobalt Toxicity Affects Patients: Part Two: The Case Studies

The first case study was for a male patient who underwent hip replacement surgery due to osteoarthritis. Initially this patient showed great improvement following the surgery, reporting a reduction in pain during activity. Soon, however, the patient began experiencing a return of hip pain, and approximately three months post-surgery, rashes began to appear on the skin of the hip which had received the metal-on-metal implant. At this time cobalt levels were tested, however no excessive amounts appeared in the patient’s bloodstream.

Some twelve months later the patient was experiencing such progressive levels of pain in the hip area that he returned for further testing and it was determined there was a large pocket of accumulated fluid in the hip implant area. Another test to determine the level of cobalt in the blood was performed and those levels were at 50 µgl—over fifty times the “normal” level. At this time revision surgery was not considered. At eighteen months post-surgery, the patient began noting progressively more severe headaches and an overall feeling of fatigue. He stated he was experiencing some loss of hearing as well as an almost-constant ringing in the ears. He also suffered from irritability and anxiety. His cobalt levels were tested once again, and were actually found to have decreased to 35µgl—still many times the normal level.

Three years following the surgery, the patient was suffering hip pain even when he was not engaging in any type of activity and was also having coordination concerns, visual changes, hand tremors and had noted a decline in cognitive abilities. The patient’s serum cobalt levels reached 122µgl at three and a half years and revision surgery was scheduled. When the metal-on-metal hip implant was removed it was noted that the device showed excessive wear. A year following the revision surgery the male patient noted lessening amounts of hip pain and stated his hearing and cognitive abilities had improved and the tremors occurred less often and were less severe. The wear on the removed implant was noted to be almost a hundred times that of normal metal-on-metal hip implants, believed to be from inadequate bearing clearance.

The second male had undergone revision surgery after a failed resurfacing attempt, yet twelve months after this revision he noted significant groin pain, a gradual decline in mental abilities, a decline in his hearing and rashes in the hip surgery area. Cobalt levels were tested and found to be at 23µgl. Three and a half years later the symptoms had worsened and the cobalt levels had increased. The patient chose to have a second revision surgery at this time and was diagnosed with extreme metallosis when the metal-on-metal implant was removed which had caused a myriad of minor to severe health symptoms. The removed hip implant showed significant levels of scuffing and scratching, indicating the metal parts had been rubbing against one another, releasing dangerous cobalt ions into the blood. The patient was seen seven months following his second revision surgery and while he was still experiencing some effects from cobalt toxicity, he reported a lessening in the more severe symptoms.

Author: Sullo & Sullo Attorneys

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