This case involves a fifty-six-year-old male who underwent a right total hip arthroplasty. The patient subsequently leached cobalt out of the Stryker Trident ceramic replacement device, causing toxic levels to enter the bloodstream. The resultant cobalt poisoning lead to the following complications: fatigue, insomnia, irregular thyroid function, hip pain, peripheral neuropathy and numbness, hair loss, skin discoloration, rash, blotching, broken and cracked teeth, weakened gums, sexual dysfunction, infection (debris), tumor (interior to hip), tumor (on hand), aggravation of asthma, eyes (miosis, vision disturbance, dryness), chest pain, headache, urinary problems, multi-organ failure, and irregular bowel movements. The serum cobalt levels continue to be high in the patient despite medical management, and the patient’s severe dental complications in particular have dramatically decreased his standard of living; he has had to undergo numerous reconstructive surgeries, and now must wear special dentures with adhesives in order to accommodate his complications.
Question(s) For Expert Witness
1. What are the dangers of heavy metal poisoning from a joint replacement device?
Expert Witness Response
Though joint replacement devices have been safe for many years, companies are beginning to use new materials to engineer them differently. The primary issue with the metal-on-metal (MoM) are the small particles of chromium and cobalt that are released into the body from the hip replacement as the components on the hips begin to wear. These particles have already been shown to cause tissue damage and can develop into what are being termed “pseudotumors” at the site of the hip replacement. These particles then make their way into the blood stream and cause heavy metal poisoning in the recipients of MoM hip replacements. Both chromium and cobalt can be toxic in the human body at certain levels. There have already been patients with MoM hip replacements that have been diagnosed with heavy metal poisoning. Some of the possible side effects from toxic levels of chromium or cobalt are cancer, renal tubular damage, liver and kidney problems including failure, cardiovascular collapse and failure, visual impairment including blindness, auditory problems including deafness, neurological damage, and death. The main problem is it takes time for the device to deteriorate and release these particles into the blood stream. Hence, the companies had already allowed thousands of these devices to be implanted before the toxicities appeared.
About the author
Dr. Faiza Jibril
Dr. Faiza Jibril has extensive clinical experience ranging from primary care in the United Kingdom, to pediatrics and child abuse prevention at Mount Sinai Hospital, to obstetrics in Cape Town, South Africa. Her post-graduate education centered on clinical research and medical ethics. Dr. Jibril is currently Head of Sales in the US and Canada for Chambers and Partners - a world leading legal ranking and insights intelligence company.
