Abstract：
OBJECTIVE: Cobalt metallosis is a rare but dangerous complication of total joint arthroplasty resulting from deterioration of the joint leading to metal-on-metal friction and breakdown. Potential manifestations vary in severity and include dilated cardiomyopathy, thyroid dysfunction, cognitive disturbances, neuropathy, fatigue, and weakness. The therapeutic role of N-acetylcysteine in metallosis has been investigated due to its ability to chelate with heavy metal ions, such as cobalt and chromium.
CONCLUSIONS: Here we report the case of a 71-year-old female who presented with suspected metallosis diagnosed in the outpatient setting due to symptoms of significant weight loss and failure to thrive. This metallosis was secondary to the hardware breakdown of a left knee revision roughly 6 years previously. The patient was not a surgical candidate due to her poor nutrition status and was started on nasojejunal tube feeds along with N-acetylcysteine 600 mg by mouth twice daily for 45 days. The patient\'s serum cobalt levels decreased from 61.7 µg/L on admission to 16.2 µg/L prior to her undergoing proper revision of the left knee roughly 2 months after admission to the hospital. The patient tolerated treatment well and was able to be discharged the day after surgery, with no further complaints or complications.
CONCLUSIONS: This case report contributes to the body of literature suggesting that administration of N-acetylcysteine can reduce serum cobalt concentrations, without notable adverse effects, in the context of prosthetic knee-associated metallosis.
CONCLUSIONS: Here we report the case of a 71-year-old female who presented with suspected metallosis diagnosed in the outpatient setting due to symptoms of significant weight loss and failure to thrive. This metallosis was secondary to the hardware breakdown of a left knee revision roughly 6 years previously. The patient was not a surgical candidate due to her poor nutrition status and was started on nasojejunal tube feeds along with N-acetylcysteine 600 mg by mouth twice daily for 45 days. The patient\'s serum cobalt levels decreased from 61.7 µg/L on admission to 16.2 µg/L prior to her undergoing proper revision of the left knee roughly 2 months after admission to the hospital. The patient tolerated treatment well and was able to be discharged the day after surgery, with no further complaints or complications.
CONCLUSIONS: This case report contributes to the body of literature suggesting that administration of N-acetylcysteine can reduce serum cobalt concentrations, without notable adverse effects, in the context of prosthetic knee-associated metallosis.
摘要：
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目的：钴金属化是一种罕见但危险的全关节置换术并发症，其原因是关节退化导致金属对金属的摩擦和破裂。潜在的表现在严重程度上有所不同，包括扩张型心肌病，甲状腺功能异常,认知障碍，神经病,疲劳,和弱点。由于其与重金属离子螯合的能力，已经研究了N-乙酰半胱氨酸在金属学中的治疗作用，如钴和铬。
结论：在这里，我们报告了一例71岁的女性，因体重明显下降和不能茁壮成长的症状，在门诊诊断为疑似金属病。这种金属是大约6年前左膝翻修的硬件故障的继发原因。由于营养不良，该患者不是手术候选人，因此开始经鼻空肠管喂养，每天两次口服N-乙酰半胱氨酸600mg，共45天。患者的血清钴水平从入院时的61.7µg/L降至入院后大约2个月接受左膝适当翻修之前的16.2µg/L。患者耐受治疗良好，手术后第二天就能出院，没有进一步的投诉或并发症。
结论：该病例报告有助于大量文献表明，服用N-乙酰半胱氨酸可以降低血清钴浓度，无明显不良反应,在假肢膝关节相关金属学的背景下。
目的：钴金属化是一种罕见但危险的全关节置换术并发症，其原因是关节退化导致金属对金属的摩擦和破裂。潜在的表现在严重程度上有所不同，包括扩张型心肌病，甲状腺功能异常,认知障碍，神经病,疲劳,和弱点。由于其与重金属离子螯合的能力，已经研究了N-乙酰半胱氨酸在金属学中的治疗作用，如钴和铬。
结论：在这里，我们报告了一例71岁的女性，因体重明显下降和不能茁壮成长的症状，在门诊诊断为疑似金属病。这种金属是大约6年前左膝翻修的硬件故障的继发原因。由于营养不良，该患者不是手术候选人，因此开始经鼻空肠管喂养，每天两次口服N-乙酰半胱氨酸600mg，共45天。患者的血清钴水平从入院时的61.7µg/L降至入院后大约2个月接受左膝适当翻修之前的16.2µg/L。患者耐受治疗良好，手术后第二天就能出院，没有进一步的投诉或并发症。
结论：该病例报告有助于大量文献表明，服用N-乙酰半胱氨酸可以降低血清钴浓度，无明显不良反应,在假肢膝关节相关金属学的背景下。
