Systemic Disease After Hip Replacement: Aeromedical Implications of Arthroprosthetic Cobaltism

Abstract

A multisystem illness recently reported in recipients of the newest generation of metal-on-metal hip prostheses has been ascribed to toxic effects of cobalt and possibly chromium. We present a case of insidiously developing neurologic illness that occurred in a physically active professional. This case illustrates the potential for a hip prosthesis to occultly impair safe functioning of aviators. Based on this case and others, we suggest modifications to aeromedical policy relating to waiver requests after hip replacement, including routine monitoring of serum cobalt and chromium levels in recipients of metal-on-metal hip prostheses. The evaluation of aviators having an elevated cobalt level is also discussed.