Cobalt-related cardiomyopathy: A real concern! A review of published evidence

Background: Cobalt (Co) toxicity-related cardiomyopathy (CMP) in hip arthroplasty has recently been reported in the literature. The purpose of this review was to identify and assess available published evidence of CMP in hip arthroplasty patients and to derive recommendations for management. Methods: We evaluated 23 cases reported till October 2018 and stratified into three categories, based on pre-existing risk factors for CMP, histological confirmation and evidence of systemic signs of Co toxicity. Results: Co toxicity was considered to be the definite cause of CMP in 8 cases and probably contributory in 13 cases. Two cases were considered to have developed CMP secondary to pre-existing risk factors. Majority of the patients had good recovery of cardiac function after hip revision and cardiac management, but five cases deteriorated and died. Conclusion: Although Co-related CMP has been reported in a small number of cases of hip arthroplasty, a delay or missed diagnosis may lead to significant morbidity and mortality. Timely diagnosis, removal of causative implant and avoidance of metal articulations in revision for fractured ceramic implants may help in effective management.