Document Detail

Case report: High chromium and cobalt levels in a pregnant patient with bilateral metal-on-metal hip arthroplasties.
MedLine Citation:
PMID:  22692823     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Metal-on-metal bearings frequently are used in young patients leading to the concern that disseminated metals such as chromium (Cr) and cobalt (Co) as the main constituents could affect pregnancies.
CASE DESCRIPTION: We describe a 41-year-old patient with bilateral metal-on-metal hip arthroplasties, a recurrent pseudotumor, and extremely high blood levels (Cr 39 μg/L, Co 138 μg/L) at 12 gestational weeks. At different gestational weeks, maternal blood, aspirate of the pseudotumor, and amniotic fluid were analyzed for Cr and Co. Therapy with chelating agents was not recommended because the mother showed no symptoms of toxicity and the safety of chelating therapy during pregnancy is not established. At 38 weeks of gestation, a healthy male infant was delivered with elevated Cr and Co cord blood levels. At the age of 8 weeks, the infant's Cr was comparable to the cord blood level, whereas the Co decreased considerably without treatment. At the age of 14 weeks, the infant's development was seemingly uneventful and no signs of toxicity were obvious.
LITERATURE REVIEW: Carcinogenic, mutagenic, and teratogenic potentials of these metals have been suggested. However, we found no published clinical observations in context with pregnancies of women with hip arthroplasties using metal-on-metal implants. To our knowledge, this is the first report of such high levels of Cr and Co in a human pregnancy.
PURPOSES AND CLINICAL RELEVANCE: Although we cannot generalize from one case, the seemingly uneventful outcome of this pregnancy may reassure colleagues when counseling patients with high ion levels whether to carry a pregnancy to term.
Juliane Fritzsche; Cornelia Borisch; Christof Schaefer
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Publication Detail:
Type:  Case Reports; Journal Article; Review     Date:  2012-06-13
Journal Detail:
Title:  Clinical orthopaedics and related research     Volume:  470     ISSN:  1528-1132     ISO Abbreviation:  Clin. Orthop. Relat. Res.     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-07-10     Completed Date:  2012-09-20     Revised Date:  2013-08-13    
Medline Journal Info:
Nlm Unique ID:  0075674     Medline TA:  Clin Orthop Relat Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2325-31     Citation Subset:  AIM; IM    
Pharmakovigilanz- und Beratungszentrum für Embryonaltoxikologie (Institute for Clinical Teratology and Drug Risk Assessment in Pregnancy), Institut für Klinische Pharmakologie und Toxikologie, Charité Universitätsmedizin Berlin, Berlin, Germany.
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MeSH Terms
Arthroplasty, Replacement, Hip*
Chromium / blood*
Cobalt / blood*
Fetal Blood / chemistry
Gestational Age
Hip Prosthesis / adverse effects*
Infant, Newborn
Live Birth
Maternal Exposure*
Maternal-Fetal Exchange
Pregnancy Complications, Hematologic / blood*
Pregnancy Trimester, First
Prosthesis Design
Reg. No./Substance:
7440-47-3/Chromium; 7440-48-4/Cobalt
Erratum In:
Clin Orthop Relat Res. 2012 Sep;470(9):2626

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