Ms. X had a right sided ASR total hip replacement - acetabular implant, taper sleeve adaptor and unipolar femoral implant when she was 58 and required revision surgery four years later. She had pre-revision chrome levels of 213 nmol/l and cobalt levels of 249 nmol/l. She was left with persistent anxieties about the need for future surgery and a feeling she must always be cautious about protecting her hip, tearfulness, lability of mood, lowered self esteem – “I used to be very active and now I feel a mess”, guilt about being a burden on her husband, a fear about the effects of ions on her body and poor concentration. She had no cognitive abnormalities and a MMSE score of 30, but had a significantly elevated Beck Depression Inventory Score of 33, after treatment with fluoxetine.
Mr. Y had a left sided ASR total hip replacement - acetabular implant, taper sleeve adaptor and unipolar femoral implant when he was 52 and required revision surgery six years later. He had pre-revision chrome levels of 152 nmol/l and cobalt levels of 262 nmol/l. He complained of chronic pain, loss of his occupation, low mood, social withdrawal, poor sleep, poor concentration, short term memory loss noted by relatives, misplacing items round the house, increased irritability, and absent libido. At age 58 he had cognitive abnormalities and a MMSE score of 26, and a significantly elevated Beck Depression Inventory Score of 30 after treatment with dosulepin.
Mrs. Z had a right sided ASR total hip replacement - acetabular implant, taper sleeve adaptor and unipolar femoral implant when she was 51 and had revision surgery seven years later. She had pre-revision chrome levels of 326 nmol/l and cobalt levels of 544 nmol/l. She complained of poor sleep with early morning wakening, low mood and emotional lability, social withdrawal, poor appetite, forgetfulness and a tendency to repeat herself reported by relatives, her frustration at being unable to do day to day activities such as cleaning, she felt she was a burden to relatives, and complained of anhedonia. She was disorientated in person, was unable to perform serial sevens and was able to register, but not able to retain any elements of a new name and address on cognitive testing. At age 62 she had cognitive abnormalities and a MMSE score of 17, and a significantly elevated Beck Depression Inventory Score of 38 after treatment with escitalopram.
Mrs. A had a right sided ASR total hip replacement - acetabular implant, taper sleeve adaptor and unipolar femoral implant when she was 50 and had revision surgery five years later. She had pre-revision chrome levels of 664 nmol/l and cobalt levels of 2470 nmol/l. She complained of missing her previous occupation, chronic pain, low mood, low self confidence, poor sleep with early morning wakening, poor appetite, forgetfulness with difficulty recalling words, difficulty recalling conversations, social withdrawal, anhedonia, and worry about the need for any further surgery. Her concentration was poor, she was unable to subtract serial sevens or spell the word ‘world’ backwards. At age 57 she had cognitive abnormalities and a MMSE score of 18, and a significantly elevated Beck Depression Inventory Score of 33.