Hip revision due to metal on metal ions.

Posted by sailaway @sailaway, Dec 10, 2019

My husband has two great Metal on Metal (MoM) hips from 2008 and 2010. He and surgeon chose these types of replacements as being appropriate for an athletic person, and he has been able to downhill ski with them. Now he has rising levels of chromium and cobalt, released from friction between the metal surfaces, and many aches and pains throughout body. There is an "impressive" pocket of inflammatory fluid around one hip joint (where metal ions are being released) and we are being advised to have a revision where one of the metal parts is replaced with ceramic. This is pending another blood test and a MARS MRI in 5 months. Appreciate hearing from any others with this experience. Thank you.

Hello @sailaway. I would like to invite @popolopo, @stephanieann, @axels, @sro50 @jonpaulcobaltpo, and @janneg who have either done some research on metal on metal replacements or had them themselves and may be able to share some of their experiences as well.

@sailaway, you mentioned your husband got this type of replacement because he was told it would be good for staying active. Up until he started experiencing pain, was he able to stay active? If he gets the revision with one part being ceramic, have you discussed staying athletic and active?

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@JustinMcClanahan

Hello @sailaway. I would like to invite @popolopo, @stephanieann, @axels, @sro50 @jonpaulcobaltpo, and @janneg who have either done some research on metal on metal replacements or had them themselves and may be able to share some of their experiences as well.

@sailaway, you mentioned your husband got this type of replacement because he was told it would be good for staying active. Up until he started experiencing pain, was he able to stay active? If he gets the revision with one part being ceramic, have you discussed staying athletic and active?

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Thank you for referring others to share knowledge and experience. We no longer go downhill skiing or other "sports", but he exercises on elliptical regularly, does yardwork and shoveling. And thanks for the question regarding how revision may impact his activities.

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Anyone out there who has had a hip revision where one of the components was replaced with a different material? Recovery time and quality of movement post OP?

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I also suffer from METAL ON METAL hip implants. May I ask what your Cobalt numbers are. Mine are 8 parts per Billion. My doctor told me not to worry unless it gets to 80-100 parts per Billion. Mayo Clinic Suggest that there is a problem with the device if your cobalt levels are 5 parts per billion or grater .
I also have systemic issues: cloudy headedness & depression; a pet scan showed metal ions in my brain, I struggle with Balancing , I have developed hypo thyroid, and of course I have a lot of pain and swelling at the surgical site.
God bless you & hang in there,
Jon paul

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Hi, thanks for sharing your information. Currently my husband's cobalt is 20 and chromium 14. He has generalized joint pains and is taking a holiday from statins which has not made much difference. He has two bad knees which contribute to overall discomfort. His hips are really not symptomatic, but Dr. Is considering a revision due to huge pocket of inflammatory fluid around one hip. How long have you had your MoM hips? Have you seen any other specialists to eliminate other factors- such as a rheumatoid Dr?

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@sailaway Hello, I can tell you a little about this. I had hips done at age 55, and got the metal on metal ones because I was young and very active, and the ortho recommended them as long-lasting. I began complaining about noises from the implants, mushy tissue along the femur and pain at 2 years. My metal on metal hip implants failed at 5 years in 2011, and my chromium and cobalt levels were well above the "replacement" level. At the time, however, the surgeon just told me they needed replacement "at some time". I elected to wait from November until Spring to avoid going out to appointments using crutches in winter. By then the metallosis had progressed a great deal, ultimately causing significant tissue breakdown around the implants and far beyond. In addition, it is suspected the metal caused hyperthyroid (Graves Disease), hair loss, skin problems, mental fogginess…
In 2012 both were replaced with ceramic & plastic. As the metal left my body all of the other issues resolved, but left me with chronic suspicion of the entire medical industry. I later learned that DePuy already knew when my implants were put in that they had a much higher than normal failure rate, especially in smaller people. They were banned in Europe and the UK and still neither patients nor physicians were notified until a lawsuit was filed.
It has been almost 8 years for me, so I don't remember my chromium and cobalt numbers, but I know they climbed rapidly. Also, I still remember the apprehension.
If it was my husband, I would say since he is symptomatic it's time to replace.
My replacements are ceramic and plastic, they function just fine. My doc thinks they should last me at least 20 more years, and he assures me that the plasic cup can be replaced if needed. Caveat – I'm pretty small, so I probably put less pressure on them than a much larger person, but on the other hand they are the smallest ones made. I'm able to dance, walk, bicycle, play with two active grandsons, garden…just about everything I want. My doc even says I can jump "within reason" – like water volleyball or shagging an occasional fly ball, but to keep aerobic exercise low-impact.
Sue

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Have you had a hip revision? Occurs when the hip replacement is faulty and cobalt and chromium levels are elevated. My husband is a candidate… just wondering if others can weigh in. Thanks

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@ltsally

Have you had a hip revision? Occurs when the hip replacement is faulty and cobalt and chromium levels are elevated. My husband is a candidate… just wondering if others can weigh in. Thanks

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Hi @ltsally, I moved your message to this existing discussion about hip revision so you can connect with @sueinmn @sailaway and @jonpaulcobaltpo. Click VIEW & REPLY in the email notification to see the discussion and past posts.

Does your husband have an appointment for the revision already or is this something he's considering?

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He has been putting off the revision surgery for about 2 years now as the surgeon can't be sure he will get back on the tennis court after the surgery. He has his blood tested and he gets an X-ray every 6 months to see if he can continue to wait.

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@ltsally

He has been putting off the revision surgery for about 2 years now as the surgeon can't be sure he will get back on the tennis court after the surgery. He has his blood tested and he gets an X-ray every 6 months to see if he can continue to wait.

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@ltsally At 8 years post-revision, on both hips, I have better function and less pain than I ever had with the original implants. My running & volleyball days are over due to arthritis, but I still walk, hike, bike, dance, garden, exercise and chase grandchildren…

Beginning within 1 year of my implants, I began complaining about "squeaks" when I walked, a feeling of instability, and at 3 years I started noticing a groove or divot in the flesh along my femur. The surgeon kept telling me it was all "normal" – until at 5 years he informed of the recall notice & tested me. I had high metal ions, which ultimately caused other medical issues, as well as significant soft-tissue breakdown near the original implants. At 5 1/2 years, both implants were removed & replaced.

What I have learned over time is that everyone has a different situation – there is some evidence that the smaller implants tend to fail sooner and cause more issues, possibly because the metal was thinner and more subject to distortion, which caused more metal ions to be shed, or possibly because it took less metal to cause severe symptoms in a smaller body. I am only 5'1" tall and less than 110#…

How long has he had the implants? Does he have symptoms, or is he being checked only because he has "recalled" joints? Is he seeing the original surgeon, or one who specializes in revisions? Why does the surgeon think there may be a problem with the revision, and has he sought a second opinion?

Lots of things to ponder – but if the metal is potentially affecting his health, younger is better when contemplating surgery and rehab
Sue

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I had a left hip done in 2017 and was successful. A year later I had the right one done and have had issues since. No recall for me though. Did find out they tore a muscle which can't be repaired and the surgeon tat did it refuses to admit it.

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@ltsally

He has been putting off the revision surgery for about 2 years now as the surgeon can't be sure he will get back on the tennis court after the surgery. He has his blood tested and he gets an X-ray every 6 months to see if he can continue to wait.

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Hi Itsally, my husband had his 2nd MARS MRI which showed that the large area of inflammation, with debris in it, around his right hip was unchanged from 8 months ago. Dr. says this will not resolve on its own and will perform "minimally invasive" surgery to replace the metal ball with ceramic. The hip itself only gives pain when doing heavy lifting; both parts seem to be solidly implanted and have never given him trouble. Husband is concerned about generalized joint pain and aches throughout rest of his body- usually level 4-5 daily. Wondering if this is related to ion levels: cobalt is trending upward at 21.1 and chromium in 12-14 range. Dr says it is up to husband how long he is willing to put up with this situation. And now there is Covid and continuing to age- 79 in March. Good luck with making our decisions!

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@sailaway

Hi Itsally, my husband had his 2nd MARS MRI which showed that the large area of inflammation, with debris in it, around his right hip was unchanged from 8 months ago. Dr. says this will not resolve on its own and will perform "minimally invasive" surgery to replace the metal ball with ceramic. The hip itself only gives pain when doing heavy lifting; both parts seem to be solidly implanted and have never given him trouble. Husband is concerned about generalized joint pain and aches throughout rest of his body- usually level 4-5 daily. Wondering if this is related to ion levels: cobalt is trending upward at 21.1 and chromium in 12-14 range. Dr says it is up to husband how long he is willing to put up with this situation. And now there is Covid and continuing to age- 79 in March. Good luck with making our decisions!

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@sailaway – The constant joint pain and aches got better for me when the metal ion levels began to go down after surgery, and were gone within less than a year. The inflammation & "debris field" improved within the first 3 months.
Sue

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