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Tuesday, July 10, 2012
Case Report: High Chromium and Cobalt Levels in a Pregnant Patient with Bilateral Metal-on-Metal Hip Arthroplasties.
und Beratungszentrum für Embryonaltoxikologie (Institute for Clinical
Teratology and Drug Risk Assessment in Pregnancy), Institut für
Klinische Pharmakologie und Toxikologie, Charité Universitätsmedizin
Berlin, Spandauer Damm 130, Haus 10, D-14050, Berlin, Germany.
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.
We describe a 41-year-old patient with bilateral metal-on-metalhip
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.
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.
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.