Patients undergoing total hip arthroplasty represent a growing portion of the population. More than 330,000 hip replacements are performed annually1, and more than 2.5 million Americans are living with a hip prosthesis2. Many hardware configurations utilize metal alloys for the femoral head and/or acetabulum. Although their use is decreasing due to safety concerns, cobalt-chromium femoral heads were still used in 51% of total hip arthroplasties in 20143. There is rising concern about the adverse effects of metal ions released from these joint replacements. However, little published evidence is available supporting specific interventions for the management of cobalt toxicity.

Given the increasing incidence and prevalence of total hip arthroplasty in the United States, patients with total hip replacements will become more commonplace in the internist’s practice. With the risk of adverse effects related to these prostheses, it is important to be familiar with the presentation of cobalt toxicity in order to spare patients from excessive or irreversible damage.