Ceramic hip wear sparks rapid cobalt poisoning and surgical salvage
A 56-year-old woman with a long-ago titanium‑ceramic hip developed rapid cobalt poisoning after a previously fractured ceramic liner and a revision left ceramic debris that accelerated wear on a cobalt–chromium head. She presented with numbness, cognitive changes, tachycardia, and thyroid issues; imaging showed the implant remained in place, but surgical debris caused systemic cobalt exposure. A second hip revision removed debris and replaced the cobalt head with a ceramic one while a polyethylene liner was refreshed, followed by chelation therapy. Blood cobalt was extremely elevated (592 ng/mL) and chromium also high; recovery was slow and incomplete, with persistent nerve symptoms and tinnitus. The case highlights cobalt toxicity risks linked to certain hip implants and notes a decline in cobalt–chromium use.