RT Journal
A1 Tower, Stephen S.
T1 Arthroprosthetic Cobaltism: Neurological and Cardiac Manifestations in Two Patients with Metal-on-Metal ArthroplastyA Case Report
JF The Journal of Bone & Joint Surgery
JO The Journal of Bone & Joint Surgery
YR 2010
FD December 1
VO 92
IS 17
SP 2847
OP 2851
DO 10.2106/JBJS.J.00125
UL http://dx.doi.org/10.2106/JBJS.J.00125
AB 
Early failure of metal-on-metal hip arthroplasties is a current concern because tissue damage resulting from periprosthetic metallosis can compromise subsequent revision arthroplasty1,2. The United Kingdom's Medicines and Healthcare products Regulatory Agency has advised that patients with metal-on-metal implants who have pain, prosthetic malposition, or implants that are known to have excessive failure rates should be evaluated with the measurement of serum cobalt. A serum cobalt level of >7 µg/L indicates possible periprosthetic metallosis3,4. A normal serum cobalt level is 0.19 µg/L, and 95% of those who are unexposed to cobalt have a value of <0.41 µg/L5. A serum cobalt level of >1 µg/L indicates excessive cobalt exposure, and levels of >5 µg/L are considered toxic6.