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This cohort study analyzed redacted data from 1 orthopedic clinic. Shared Decision Making and Communication.

Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.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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