In May 2012, a 55-year-old man arrived at a clinic at the University of Marburg in Germany with severe heart failure and a disturbing mix of ailments that had grown progressively worse.
His doctors were stumped.
Gina Kolata describes his symptoms in the New York Times:
He had low thyroid hormone levels, inflammation of his esophagus and fever of unknown origin. His loss of vision was so profound he was almost blind, and his loss of hearing so severe he was almost deaf. Most perilous of all, his heart had weakened so much it could not pump hard enough to supply blood to his body.
In a paper just published in the journal The Lancet, the Marburg doctors note that “his medical history was mostly uneventful, apart from the fact that he had had both hips replaced.”
This observation would prove crucial, as would the doctors’ media consumption.
The medical team was familiar with the TV show House, in which Hugh Laurie plays a Sherlock-type title character — a master of solving medical mysteries. (They have even used the show for teaching, they said.)
In unravelling the patient’s strange web of symptoms, the German doctors remembered one episode in which the fake patient (played by Candice Bergen) had been poisoned by cobalt used in her hip replacement.
On a House-related hunch, the real-life doctors measured their patient’s cobalt level. “It was a thousand times the level considered normal,” Kolata reports.
What had happened? The man had had a ceramic hip before his metal one, and a doctor had left behind bits of ceramic that rubbed against the new metal joint.
Here you can see a visible hole in the metal prosthetic they removed from the man:
After the patient received a new ceramic hip and an implanted defibrillator, the poisoning subsided, his fever and esophageal problems went away, and his heart improved. Sadly, he did not significantly regain his vision or hearing.
Cobalt poisoning from hip replacements is not common, even with metal-on-metal artificial hips.
“The stability of cobalt” — when combined with other components used in artificial hips — “made this metal an excellent and stable compound in hip prosthetics,” The Lancet doctors write.
“Literally tens of thousands of people had these hips without [such] problems,” Larry A. Allen of the University of Colorado told The Times.
But when metal hips are placed incorrectly by surgeons or combined with ceramic hips, cobalt poisoning is a small risk. It’s “an increasingly recognised and life-threatening problem,” the Lancet paper concludes.
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