Acta Scientific Orthopaedics (ISSN: 2581-8635)

Case Report Volume 3 Issue 12

Titanium and Cobalt Neurotoxicity due to Catastrophic Failure of a Metal/Polyethylene Total Hip Arthroplasty (THA)-Case Report and Literature Review

Ioannis C Vossinakis1* and Evangelia Bachlava2

1Head of Orthopaedic Department, “ANASSA” Private Hospital, Volos, Greece
2Private Practice, Volos, Greece

*Corresponding Author: Ioannis C Vossinakis, Head of Orthopaedic Department, “ANASSA” Private Hospital, Volos, Greece.

Received: October 12, 2020; Published: November 27, 2020



  Cobalt metallosis from failed total hip arthroplasty (THA) has been implicated in brain toxicity with, sometimes, severe neurological symptoms. We present a case of a destroyed metal on polyethylene THA, in a male patient that resulted in extreme metallosis from Titanium and Cobalt within 5 years and presented with severe neurological impairment. A literature review revealed that little is known regarding titanium toxicity from orthopaedic implants. We discuss the case and the literature aiming to raise awareness for this rare and potentially serious complication.

Keywords: Failed THA; Metallosis; Neurotoxicity; Titanium; Cobalt; Metal on Polyethylene



  1. Gessner BD., et al. “A Systematic Review of Systemic Cobaltism after wear or corrosion of Chrome-Cobalt Hip Implants”. Journal of Patient Safety 2 (2019): 97-104.
  2. Delaunaya C., et al. “Metal-on-metal bearings total hip arthroplasty: The cobalt and chromium ions release concern”. Orthopaedics and Traumatology: Surgery and Research 96 (2010): 894-904.
  3. Harris A., et al. “Cobalt toxicity after revision to a metal-on-polyethylene total hip arthroplasty for fracture of ceramic acetabular component”. Arthroplasty Today 1 (2015): 89-91.
  4. Silva M., et al. “Bearing surfaces”. In: Callaghan JJ, Rosenberg AG, Rubash HE (editions). The Adult Hip”. 2nd ed. Philadelphia, PA: Lippincott Williams and Wilkins (2007): 251.
  5. Cipriano CA., et al. “Metallosis after metal-on-polyethylene total hip arthroplasty”. American Journal of Orthopedics 2 (2008): E18-E25.
  6. Tower SS. “Arthroprosthetic cobaltism: neurological and cardiac manifestations in two patients with metal-on-metal arthroplasty: a case report”. Journal of Bone and Joint Surgery 17 (2010): 2847-2851.
  7. Cheung AC., et al. “Systemic cobalt toxicity from total hip arthroplasties. Review of a rare condition part 1 - history, mechanism, measurements, and pathophysiology”. The Bone and Joint Journal 98-B (2016): 6-13.
  8. Bridges R and Tower S. “PET/CT Brain Imaging of Arthroplasty Cobalt Encephalopathy (ACE) due to failure of Chromium-cobalt hip protheses - A works in progress”. Journal of Nuclear Medicine1 (2017): 484-484.
  9. Clark MJ., et al. “Brain Structure and Function in Patients after Metal-on-Metal Hip Resurfacing”. American Journal of Neuroradiology 9 (2014): 1753-1758.
  10. Sidaginamale RP., et al. “Blood metal ion testing is an effective screening tool to identify poorly performing metal-on-metal bearing surfaces”. Bone and Joint Research5 (2013): 84-95.
  11. Devlin JJ., et al. “Clinical Features, Testing, and Management of Patients with Suspected Prosthetic Hip-Associated Cobalt Toxicity: a Systematic Review of Cases”. Journal of Medical Toxicology 9 (2013): 405-415.
  12. Huerta-García E., et al. “Titanium dioxide nanoparticles induce strong oxidative stress and mitochondrial damage in glial cells”. Free Radical Biology and Medicine 73 (2014): 84-94.




Citation: Ioannis C Vossinakis and Evangelia Bachlava. “Titanium and Cobalt Neurotoxicity due to Catastrophic Failure of a Metal/Polyethylene Total Hip Arthroplasty (THA)-Case Report and Literature Review".Acta Scientific Orthopaedics 3.12 (2020): 83-86.


Acceptance rate33%
Acceptance to publication20-30 days

Indexed In

News and Events

Contact US