Corrosion of Polished Cobalt-Chrome Stems Presenting as Cobalt Encephalopathy

Adverse reactions to metallic debris from corrosion of polished cobalt-chromium–cemented femoral stems are reported. Cobaltism (systemic cobalt poisoning) has not been reported from this phenomenon. Three patients presented to their surgeon for ongoing care 10-20 years after primary metal-on-plastic hip arthroplasty with the same polished cobalt-chromium–cemented femoral stems (Heritage, Zimmer). Urine cobalt was elevated, and the patients had symptoms consistent with cobaltism. Quantitative-F(16)DG-PET-CT brain imaging was performed showing generalized and focal brain hypometabolism consistent with cobalt encephalopathy. At revision, all stems were well fixed and grossly corroded. At 1 year after revision, cobalturia and cognitive symptoms were resolved or improved. Mechanically assisted crevice corrosion at the polymethylmethacrylate interface is a complication of polished cobalt-chromium–cemented stems that can result in systemic cobalt exposure and toxic encephalopathy. Our cases had only minor periprosthetic symptoms. Patients implanted with polished cobalt-chromium–cemented stems warrant monitoring with urine cobalt. Patients with cobaltemia warrant an evaluation for toxic encephalopathy.