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Non-ischaemic cardiomyopathy associated with elevated serum cobalt and accelerated wear of a metal-on-metal hip resurfacing
  1. Tahsin M Rahman1,
  2. Deborah J Hall2,
  3. Brian Darrith1,
  4. Songyun Liu2,
  5. Joshua J Jacobs2,
  6. Robin Pourzal2 and
  7. Craig D Silverton1
  1. 1Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, USA
  2. 2Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
  1. Correspondence to Dr Tahsin M Rahman; trahman1{at}


A man in his late 30s developed non-ischaemic cardiomyopathy due to systemic cobalt toxicity associated with accelerated bearing surface wear from metal-on-metal hip resurfacing implanted in the previous 6 years. Following revision arthroplasty, the patient regained baseline cardiac function. Cobalt-induced cardiomyopathy is a grave condition that deserves early consideration due to potentially irreversible morbidity. We present this case to increase awareness, facilitate early detection and emphasise the need for research into the diagnosis and management of at-risk patients.

  • Hip implants
  • Cobalt toxicity
  • Hip prosthesis implantation

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  • Contributors All authors of the respective work contributed significantly in the patient care, analysis and/or drafting of the report. Involvement of the seven preapproved authors allowed for a comprehensive case presentation. TMR, BD and CDS were involved in direct patient care, were responsible for the conception of the report, involved in manuscript drafting and present for final approval of the draft. DJH, SL, RP and JJJ were all equally involved in the analysis of biospecimens, manuscript drafting and final approval of the draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests JJJ is a board member of the American Board of Orthopaedic Surgery, holds stock options for Hyalex, is on the editorial board for the Journal of Bone and Joint Surgery, receives research support from Medtronic Sofamor Danek, receives research support from Nuvasive, is a board or committee member of Orthopaedic Research and Education Foundation, is a paid consultant for Smith & Nephew and is a paid consultant for Zimmer. CDS receives royalties from Biomet and is a board member of MOAOS. All other authors do not have any conflicts of interest to disclose. All reported competing interests did not have a direct relation to the respective work.

  • Provenance and peer review Not commissioned; externally peer reviewed.