{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:55:05Z","timestamp":1790297705182,"version":"4.1.0"},"reference-count":22,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,8,27]],"date-time":"2017-08-27T00:00:00Z","timestamp":1503792000000},"content-version":"vor","delay-in-days":238,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Orthopedics"],"published-print":{"date-parts":[[2017,1]]},"abstract":"<jats:p>This case illustrates the potential for systemic cobalt toxicity in non\u2010metal\u2010on\u2010metal bearings and its potentially devastating consequences. We present a 71\u2010year\u2010old male with grinding sensations in his right hip following ceramic\u2010on\u2010ceramic total hip arthroplasty (THA). After diagnosing a fractured ceramic liner, the hip prosthesis was revised into a metal\u2010on\u2010polyethylene bearing. At one year postoperatively, X\u2010rays and MARS\u2010MRI showed a fixed reversed hybrid THA, with periarticular densities, flattening of the femoral head component, and a pattern of periarticular metal wear debris and pseudotumor formation. Before revision could take place, the patient was admitted with the clinical picture of systemic cobalt toxicity, supported by excessively high serum cobalt and chromium levels, and ultimately died. At autopsy dilated cardiomyopathy as cause of death was hypothesized. A third body wear reaction between ceramic remnants and the metal femoral head very likely led to excessive metal wear, which contributed systemic cobalt toxicity leading to neurotoxicity and heart failure. This case emphasizes that fractured ceramic\u2010on\u2010ceramic bearings should be revised to ceramic\u2010on\u2010ceramic or ceramic\u2010on\u2010polyethylene bearings, but not to metal\u2010on\u2010polyethylene bearings. We aim to increase awareness among orthopedic surgeons for clinical clues for systemic cobalt intoxication, even when there is no metal\u2010on\u2010metal bearing surface.<\/jats:p>","DOI":"10.1155\/2017\/9123684","type":"journal-article","created":{"date-parts":[[2017,8,27]],"date-time":"2017-08-27T17:02:33Z","timestamp":1503853353000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Fatal Cobalt Toxicity after a Non\u2010Metal\u2010on\u2010Metal Total Hip Arthroplasty"],"prefix":"10.1155","volume":"2017","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1484-4226","authenticated-orcid":false,"given":"Rinne M.","family":"Peters","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pax","family":"Willemse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul 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