Heavy metals blood test results for Metal on Metal hip joint

I had TKR 2019, I asked Dr about allergies and he said one in a million! Well after a year of stiffness and pain i had tests done thru Orthopedic Analysis in Chicago. I am highly allergic to nickel, mildly allergic to Chromium, Cobalt, Iron and bone cement. This is very little info on metal allergies. Dr.s don't want to go there and they have no interest in finding out for fear of losing a surgery. My other knee is Smith and Nephew zirconium but has bone cement. Now I need a shoulder replacement using Titanium, which I'm not allergic to but worry they s cheaper metals with the Titanium? Anyway, thanks for the info on Dr. Seumour, I an going to contact her to see if I can live with metals or it best to replace. Thanks again, Diana

I was on a business trip last October, with a lot of walking through the airports and convention halls. I was experiencing a lot of pain in both hips ( I had bi-lateral replacements). In December last year, I went to my Orthopedic Surgeon for help. They were alarmed that I had metal on metal implants. They wanted to get the devices out as soon as possible, noting necrosis and tissue damage in both hips. along with suedo tumors. My blood tests came back with Cobalt levels at 8.9 and Chromium levels at 5.0. I had a revision on my left hip in March of this year.

While in the hospital, I had a number of doctors who were not assigned to me, come in to see me because they had never seen anyone with Cobalt and Chromium poisoning. The lack of knowledge was concerning, as I felt I knew more than they did. My Primary care physician has been very supportive and is trying to research the long term effects of heavy metal toxicity.

During the operation, there was evidence of metallosis and staining, with necrosis and a bio mass that was removed and sent for testing. The recovery was challenging, but I am walking every day. I met with my surgeon on Monday, and he wants to schedule a revision on the right hip for this November. My latest blood test was at 3.9 for Cobalt and 3.0 for Chromium. The surgeon stated that this was well over the levels to recommend removal of the old device.

I have had permanent nerve loss/damage to my feet, legs hands and face. My vision is also affected with my optic nerve showing damage as well. My implants have been systemically impacting me with over 17 years of damage.

I know that is a lot of information to consider...

Yikes, 2005 or right around there was exactly when the problems first surfaced and the implants were recalled. Did you not receive notice from your original surgeon or hospital to be tested some time between 20010 and 2012?

Let me say that I had the implants for 7 years, had all the symptoms your are reporting, except the optic nerve damage, and my other nerve damage was minor and has healed. I also had Graves Disease (hyperthyroid), tremors and heartbeat irregularities. Most of the symptoms subsided, and 11 years later, I am followed annually for Graves, tremors and rapid heartbeat.

I am not surprised by the lack of knowledge of chromium/cobalt metallosis - in the grand scheme of things, there are not a lot of us with this issue - especially at this late date. Many of us on Connect regularly experience doctors scratching their heads over our conditions. The complexity of the human body, and the breadth of things that can go wrong is truly mind-boggling.
Can you tell me why you are waiting for the second surgery?
Also, let me assure you that with your issues, and how long t has gone on, you need to be referred to rehab PT - someone who deals with multiple chronic issues, not just typical pot hip surgery exercises. This will be your best chance of regaining all you have lost.
Sue

I am waiting to accommodate the surgeon’s schedule.

I’m so sorry for all you’ve been through. Other than cobalt & chromium, exactly what test should I have done for metal toxicity?

May I ask why you are concerned about metal toxicity?

Your posts indicate that you have a recent total knee replacement. I think you are going through the usual trials and tribulations of healing and therapy to get the knee working and have less pain. For most people, this takes from 3 months to a year, depending on their physical condition before surgery and the complexity of your procedure.

A little about metal toxicity in joint replacements - this typically occurs when two metal components rub on one another over time, causing ions to be shed. This was a problem with a specific class of total hips, known as metal-on-metal, which were used on younger patients in the US between about 2003-2007. The theory was that it would take longer for a metal cup to wear out than the traditional metal head on cross-linked polymer cup that is commonly used. But...the metal wore faster than expected, and the body could not completely absorb and excrete it fast enough, leading to elevated levels of chromium and cobalt in the blood and a variety of symptoms.

Now let's talk about knees. Metal-on-metal knee implants are rare. Your surgeon can tell you if you have one. If you have a "traditional" implant, there is a polymer wear layer between the components, so the metal does not rub together. If metallosis occurs, it is typically many years after implant, when that layer begins to wear. I did some quick research, and someone else who was looking at this issue found reference to fewer than 100 cases, most after many years of wear.

If you are still struggling to recover after 5 or more months, I would recommend that you ask for some intensive rehab physical therapy - not the post-surgery "do this exercise, do this stretch..." I mean an evaluation of your knee, your gait and all other issues you are having, then a comprehensive plan to address it.

I think you can set aside your concerns of metal causing your issues.
Sue

Thank you for your reply. Iit's been 4 months since my TKR, but I have been feeling ill since it was done. (lightheaded, exhausted, occasionally nauseous, etc.) I also have a lot of stiffness & some pain in the knee with walking & standing. I did a cobalt level and it was
0.6, (nl range-0.1-0.4). I was also concerned I might have a metal allergy, (nickel, etc.), that would be apparent immediately, and not require a longer time for the "wear & tear" component to take effect. I do NOT have a "metal on metal" implant, it's a robotic Zimmer with no metal on metal issues, I was told. I don't know how to proceed to see if this is an issue, as my orthopedist dismisses any concerns.

Well, your symptoms are not necessarily consistent with a typical metal allergy, but sensitivities can present in many ways.
I will suggest though, that the stiffness and pain are in the range that most docs and PTs would consider normal for 4 months post-surgery. In other words, recovery is harder than you thought it would be, and more hard work on your part to regain full use than you ever thought possible.
The other symptoms could be a manifestation of another problem, such as an indication of low hemoglobin or a thyroid issue. OR...your body may be one of those which really hates surgery and anesthesia...and this is a normal recovery for you. Also when we hurt, and our life is feeling off-track, sometimes we become highly attuned to every sign and symptom that things are not right.
Have you had a complete physical with bloodwork by your primary since your surgery? This could uncover the source of the fatigue, nausea, etc.
If you want to pursue the testing, you can contact an allergist or immunologist. I am not sure if insurance covers this without specific symptoms.

Good luck - I hope your symptoms lessen as your body adjusts to its new parts.
Sue

FYI-The cobalt level was done on serum, and because it was elevated, (0.6 with a nl range of 0.1-0.4), I am concerned & don't know where to go from here. To answer your question, I have seen many doctors, had many tests & multiple scans, & everything else so far is WNL. I didn't think it was possible to feel this way for 4 monhs from a TKR, particularly because I'm fairly athletic & was in good health before the surgery. (I had a spinal, no other anesthetic, & never took opiates, etc.) Thanks for your help, I'm really at a loss at this point.

Thanks very much for your reply. I do not have “metal on metal”, I had a robotic Zimmer implant with cobalt/chromium 4/3. I wondered about the possibility of other metal toxicities because I have extreme lightheadedness and exhaustion since surgery 4 months ago, & have seen many doctors, done innumerable scans, labs, etc., all of which have been normal, except for cobalt, which was just slightly elevated. I’m really not functioning well due to these medical issues, and am trying to figure out what is causing my symptoms, which no one else seems to experience for this long. My doctors are puzzled by my symptoms & so am I, & I can’t return to a normal lifestyle.