PHACT vs. Fiction

Abstract

Introduction and objective: Prosthetic hip-associated cobalt toxicity (PHACT) is a rare cause of cobalt toxicity from metal-on metal (MoM) total hip prosthesis. There are few reports of PHACT and only one case report from our review that reported tremor as a presenting symptom. Case presentation: This is a report of a 44 year old male with history of hip replacement. He presented to PCP with progressive worsening of muscle weakness, fatigue and tremor of two months duration. After an extensive work up was performed and reviewing current literature, serum cobalt level was eventually performed and was found to be high. Resolution of the symptoms with concomitant decrease in serum cobalt was noted. Discussion: PHACT being a diagnosis which is rare and done by exclusion, it is important to make it a part of the differential diagnosis. As our patient also has the diagnosis of Charcot Marie Tooth, it is important to prevent anchoring heuristic bias and evaluate the patient from fresh eyes especially with a history of MoM device placement. Conclusion: The symptoms did resolve on removing the MoM device which does imply that PHACT can be regarded closer to a fact when compared to a fiction.