![]() Challenges in Clinical Electrocardiography.Note extensive corrosive debris on distal male end of neck. D, The explanted left hip plastic socket liner has an alumina ceramic head and a modular cobalt-chrome femoral neck. Focal brain hypometabolism was consistent with toxic encephalopathy noted on fluorodeoxyglucose-positron emission tomography brain scan. Cobalt levels in urine were 21 ppb in blood, 4.1 ppb in joint fluid, greater than 1000 ppb. C, Patient with high-risk bilateral hips (Microport) with modular cobalt-chrome femoral necks and alumina ceramic femoral heads implanted in 2013, presented with complaints of tremor, fatigue, anxiety, and groin pain. B, Metal-suppression magnetic resonance imaging (MRI) of same patient shows abnormal fluid collections around the medial subtrochanteric area of the right femur and in the joint space of the left hip. ![]() Focal brain hypometabolism consistent with toxic encephalopathy was noted on fluorodeoxyglucose-positron emission tomography brain scan. Cobalt levels in urine were 23.5 ppb in blood, 5.1 ppb in joint fluid, 440 ppb. A, The patient with an extreme-risk right metal-on-metal hip replacement implanted in 2007 and a left metal-on-metal hip resurfacing implanted in 2009 presented complaints of tremor, fatigue and forgetfulness, and hip swelling and stiffness.
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