To the best of our knowledge psychiatric symptoms following MoM implants have never previously been described. Neurological problems including changes in brain structure and function have been reported following MoM hip resurfacing and higher chromium/cobalt levels. Cobalt toxicity has been known to follow some arthroplasties since the 1970s. There are reports of metallosis following MoM hip implant failure, but little is known about the specific impacts of chromium and cobalt metallosis from these implants. We looked at the psychiatric impact of these failures in a case series.Īfter MoM hip resurfacing, higher cobalt and chromium concentrations in blood have been associated with structural changes in visual neurological pathways ( study of 29 patients, mean age 59 years). Regulators including the US Food and Drug Administration, Health Canada and the Therapeutic Goods Administration of Australia have raised concerns about the safety of MoM implants. There have been high failure rates associated with these hip implants: 5-year revision rates in women aged 55 were 8.3%. The National Registry for Hip Implants in England and Wales recorded 402,051 primary hip implants between 20, of which 31,171 were stemmed metal-on-metal (MoM) hip implants. These implants have both the ball and socket components made of metal. Metal-on-metal (MoM) hip implants are used in total hip replacement surgeries and hip resurfacing procedures. There may be implications for public health. Larger studies of neurocognitive effects are indicated in this group. We found neurocognitive and depressive deficits after cobalt and chromium metallosis following MoM implant failure. The normal population mean MMSE for this group would be expected to be 28 with <25 indicating possible dementia. 7 of 9 patients showing short term memory deficit with mean mini mental state examination score of 24.2. Depression assessment showed 9 of 9 respondents fulfilled the BDI criteria for depression and 3 of these were being treated. Pre-revision surgery, nine patients had toxic levels of chromium and cobalt (mean level chromium 338 nmol/l, mean cobalt 669.4 nmol/l).
#HIP REPLACEMENT METALLOSIS SERIES#
This case series describes, for the first time, neuropsychiatric complications after revision where there has been cobalt and chromium toxicity.
Implants were ASR total hip replacement (acetabular implant, taper sleeve adaptor and unipolar femoral implants) performed between 20.
This is a presentation of ten cases (mean age 60 years) where we evaluated neuropsychiatric morbidity following metal-on-metal hip implant failure and revision. Some of these were subject to failure and widescale recalls and revisions followed. There were at least 31,171 metal-on-metal (MoM) hip implants in the UK between 20.
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