Does metallosis get better? What helped you?

Good morning @srwolfe and welcome to Mayo Connect. I'm sure you have a lot of people here scratching their heads and thinking "What's metallosis, and what does it have to do with hip replacement?" - But that's the beauty of having 100,000 plus members to ask - some member on here is likely to have had experience with just about any issue you can name.

For those not familiar, there was a period when, instead of the traditional metal/ceramic/polymer hip implants, which typically wear out in about 20 years, it was believed that implants made entirely of metal would prove longer lasting, especially for younger or very active people. Sadly, for about half of the implant recipients, the rubbing of the two surfaces wore off an extraordinary amount of metal, which deposited in the tissues around the hip and eventually made it into the bloodstream. This resulted in metallosis, often referred to as chromium/cobalt poisoning, and resulted in pain, hip instability, implant failure, and many other unpleasant symptoms. The only cure is to remove and replace the implants with more traditional materials.

Eleven years ago, I had my metal-on-metal hip implants replaced for this very reason. Instead of pseudo-tumors, my muscle & fat tissue had just degenerated into something the surgeon described as "lumpy gray oatmeal." And yes, there was quite a bit of discomfort as the tissue healed. It gradually subsided until at 6 months it was completely gone. As I recall, the things that helped were temporarily replacing one walk a day with some simple stretches, gentle massage of the sore area and ice 3 times a day. After the second replacement, I got quite a bit of PT, including in the pool, and "gait training" to correct the imbalances the bad implants had caused, and I had to replace my shoes - especially the walking shoes. At my check in May I was told the new replacements look great, and they feel fine too.

Which implants did they remove for you? How long did you have them, and what brought you to the surgeon? Did you treat yourself to new walking shoes for your rehab?
Sue

OH that is great news. I was worried that my hip was failing. My right hip revision was to clean up all the metal and remove that tumor. Which was six x two inches. Replaced cup and cup liner and replaced metal head with ceramic. My right hip eleven years old and the left hip is ten years old. Surgery on the left by December.

As a former runner, pain in the groin usually occurs because of changes in gait. If I was favoring some part of my leg, I'd keep running and inevitable get pain in the groin. It may be more serious than that, especially if it hurts at night. Seems there should be a better answer than "time".

Wow, I didn't realize that metal on metal implants were done. That sounds awful. I think today with hips and knees, the metal is moving against a plastic, polyethylene that has been irradiated to make it last.

And I think now with THR, the ball on top of the femur is metal, but the socket lining is polyethylene, so no metal on metal.

I'm lucky I didn't have these done 10 years ago. I hope you are better.

I know of a case where an individual was found to have an allergy to titanium after 2 years of pain. Five years ago a Smith & Nephew "alloy" joint was put in in rescission surgery. There was an improvement but there were still lingering metal allergy issues.

People might also be interested in these related discussions:
- Hip revision due to metal on metal ions.: https://connect.mayoclinic.org/discussion/hip-revision-due-to-metal-on-metal-ions/
- Severe metal allergy to titanium, nickel need joint replacement: https://connect.mayoclinic.org/discussion/severe-allergy-to-titanium-nickel-need-tkr-in-severe-pain/

Colleen,

Are metal on metal replacements still being done? I'm surprised they were ever done because, yeah, the metal rubbing on metal will shed particles. My knees are metal on polyethylene so they will be no degradation of the metal.

Knee replacements started in 1968. I'm sure the medical community has learned a lot since then. But thanks for this info!

Joe

Hi Joe, Not Colleen here, but a recipient of metal-on-metal (MOM) implants 17 years ago, who had them replaced 11 years ago.

MOM hip implants were developed and approved in Europe around 2000, designed especially for use in younger & more active patients on the theory that the very hard (chromium & cobalt) metals would provide longer wear then the traditional metal or ceramic ball/poly cup liner models in common use. They were approved for use in the US around 2004-5 based on the European approvals, which has been a pretty common practice.

In 2006-2007, surgeons in Europe and the UK began seeing a much higher than predicted rate of failures of these implants, but continued using them and they were slow to share their experience in the ortho world. As a result, surgeons around the world continued to use them, and after a short time the US began to see excess failures as well.

Lawsuits ensued. In 2010 the manufacturers and distributors issued a caution to all surgeons that anyone with MOM implants who was having issues of pain, instability or failure needed to be screened for metallosis and implant failure.

Around 2010 the FDA stepped in to study the issue, and by 2011 the MOM implants stopped being used. As of 2012 FDA requires additional PMA (Pre Market Authorization) of any MOM devices being used or proposed.

As of today, there are no MOM total hip replacement devices approved, or requesting approval. There are just two MOM hip resurfacing devices (a much less invasive surgery) that went through approval and are on the market.

So, there are many people (in the thousands) who still have MOM hips, many without issue. There are also some who are now experiencing issues & getting them replaced. The reasons for why some work fine & others fail are probably varied, but one that is known is that they are much more "picky" about placement - with the polymer liner, there is some tolerance in acetabular cup positioning, with the harder metals, perfect placement was crucial.

My surgeon really thought he was doing the "right thing" to give me a longer-lasting joint, but as time proved, newer is not always better!

Fortunately, it did lead to a valuable policy change in the approval of devices by the FDA.
Sue

Since I had my hip revision 2020, it seems my whole body is deteriorating. My teeth are crumbling, my mind comes & goes, the depression is debilitating , my other hip is going out…I can’t sleep on either side & now my heart has been POUNDING, not constantly (yet). So now I need an implant on the other side…the 1st was my left, I’m pretty sure they won’t do it until I see a cardiologist…not sure what that Dr would say. Could he say I’m not fit for surgery? Not that I really want 1, but this is ridiculous. I’m ready to just let it go & see what happens. It’s not like I have a lot of great things going on anyway. 🤷‍♀️

@srwolfe
I too am experiencing a pulling in the groin after this last surgery in July 2023 to treat a pseudotumor that became evident after an MRI 2 years prior.
At this point in the recovery I am not yet able to walk unaided.
At this point I am concerned that this will not change.
And I'm concerned about the long term effects of this metal on metal erosion.
Thank you for posting.
Have things improved for you?