Hip revision due to metal on metal ions.

Hi Stephanie - I know that you have said you are trying to avoid another surgery. But chelation therapy is used to remove heavy metals from the body once the source material is removed. For example, it may be used on children with lead poisoning once the source of lead paint is gone.
Since you still have the metal-on-metal hip implant, the rising chromium & cobalt levels are going to be a constant problem are going to continue until is is removed. Here is a partial list of the damage these metals can cause: soft tissue destruction, osteolysis (bone damage), neurological issues (such as tremor), endocrine issues, heart damage (cobalt).

This is what the CDC has to say about chromium poisoning:
"No proven antidote is available for chromium poisoning.
Treatment in cases of acute high-level chromium exposure is usually supportive and symptomatic.
Treatment consists of removal of the patient from further chromium exposure, reliance on the body’s naturally rapid clearance of the metal and symptomatic management.
The physician can provide advice and patient education regarding smoking cessation, how to avoid or minimize exposure to other known pulmonary carcinogens, and general preventive health measures."
(https://www.atsdr.cdc.gov/csem/chromium/treating_and_managing_chromium_exposure.html)

Here is more information about the source (the MOM implant) needing to be removed. https://www.drugwatch.com/hip-replacement/metallosis/

I don't think you are going to find a proven chelation method that will eliminate your issues unless you also remove the implant.
What have the doctors told you? Have you consulted a toxicology specialist?
Sue

Thank you for this valuable information. I have read some research articles and there is just a couple articles about chelation in relation to removing the cobalt and chromium coming from the MOM implants. I am having trouble finding a toxicology specialist. Does Mayo clinic have one that is familiar with this.? Today I saw my orthopedist and he said it is a more difficult decision to know when to have the revision surgery when you have no symptoms of damage and the only thing to go by are the labs. Am thinking of getting a second opinion which should be fairly easy on zoom. Does Mayo have a specialist in hip replacements/revisions ? Thank you again

As to whether there are toxicology & hip revision specialists at Mayo, here is the place to initiate contact with Mayo Clinics, where they will ask you a lot of questions to determine where to best refer you within the system: https://www.mayoclinic.org/appointments?mc_id=us&utm_source=connect&utm_medium=l&utm_content=discussion&utm_campaign=mayoclinic&geo=national&placementsite=enterprise&cauid=101653

I can tell you from experience that "wait and see" when your metal levels are already rising didn't work for me. By the time I agreed to the removal, I had numerous medical issues now known to be the result of the high metal levels.

My second ortho was also not convinced of the need to remove and replace - until he opened up my hip and found extensive tissue damage - he likened it to "cleaning out old oatmeal" from around the implant. After the initial replacements of the MoM implants, I needed a third revision on one leg due to dislocation/instability issues - 10 years later I am wondering if "dithering" and waiting that extra year for surgery caused more muscle/ligament weakness & damage that wasn't readily apparent.

What did your ortho suggest as a treatment plan, knowing that the levels are rising and the toxicity of cobalt in particular?
Sue

Dear Sue,
I so appreciate your support and comments. I saw my orthopedist last week and he said it was a hard decision call to do a revision. I don't have any other symptoms warranting a hip revision and he said he did not like just chasing the labs. But he also said every single revision he has done (35) when he did it it showed some damage. My orthopedist ordered a MARS MRI to see if there is any damage but apparently that test is not that reliable unless there is already "gross" damage occuring. My problem is that this is my left hip that needs a revision and my right knee needs a knee replacement. I am currently having a lot of pain when I walk due to the rt knee issue, I wonder how I will be able to walk at all after having a hip revision and current pain on my right knee causing me to limp. Also I can't take NSAID's (Advil, etc) due to having coronary bypass surgery last year. I wonder how I can manage the pain. This is a lot of major surgeries to undergo . I currently take CBD and tylenol (which does not do much) and the doctors won't prescribe any real pain meds like tylenol with codeine due to all the concern over opioids I am going to call Mayo tomorrow and see if they have a toxicologist to give advice on chelation. . Just wondering, how long did you wait and see before you decided to replace it? I know I shouldn't wait too long because I know these metals can be carcinogenic , cause cardio myopathy and a host of other bad things. . Your thoughts, comments greatly appreciated.

First, I will address the "how long" - my initial surgeon told me "waiting is no big deal" when it is "just elevated metal ions" so I waited a year, until it fit into my life. By then it had affected my heart, thyroid and nervous system - so it WAS and IS a big deal. I had a horrendous experience with that surgeon on the first revision, accusing me of being dramatic about my symptoms and ignoring the nurses' pages after surgery about my condition. Were it not for the hospitalist on duty that night, it may have been very bad.

Needless to say, I found a different surgeon for the second revision. Since he had never used the MoM implants, he was wary also, of replacing the implant based on metallosis. But then in his exam, he could also feel the tissue breakdown along the bone and decided to proceed. Afterward he told my husband he was appalled at the "invisible" damage - the muscle was deteriorated to the consistency of old oatmeal.

Second, as to the opiates, I have had 4 surgeries in the past 2 years. After each procedure, a small amount (10-20)of these meds were prescribed. In each case, by using ice, LOTS of ice, plus transition to Tylenol taken faithfully at the prescribed dose and interval, I didn't use up even the small amount I was given.

Going with my gut, and listening to your surgeon say "But he also said every single revision he has done (35) when he did it it showed some damage" in your place, I personally would opt for revision. Before knee surgery. If you are concerned about the stress on your bad knee, plan on using a walker after the hip surgery for several weeks, and working with and excellent PT before and after surgery on exercises and body mechanics to minimize the effects.

Have you considered getting a second opinion from an ortho who specializes in revisions?
Sue

Not so much a reply as a realization….I DO have mettallosis. Now I just wonder…”What Now”?
My mental state is declining rapidly…I guess it doesn’t just stop or go away with the rev. I guess I thought that would be the case…I guess I’ve had it too long so the “damage” is permanent. I guess at this point, I just hope it doesn’t progress….unless there are Dr.s that can help heal the damage done…I don’t know any…Any suggestions welcome.

I had my metal on metal hip resurfacing done in 2006. It allowed me to be super active- ski, competitive tennis etc. my metal levels stayed in the low range and had it monitored every year. This year they discovered a huge cyst and the metal on metal destroyed my bone.
My “new hip” was put in two weeks ago. I am walking without a cane indoors, and feeling pretty good. I was mad, and so disappointed I had to go through it again because of failure. That hip served me well for many years. I don’t think I will be able to do the activities I have done in the past but coming to terms with that.
I had a “great” surgeon and very thankful for that. I have yet to take a pain pill and laughed when he told me I would not have much pain.
I know what you are going through.

My surgeon does over 100 revisions a year. I think you need to find a surgeon that is a expert on revision surgery.

You had low cobalt / chromium when you had your revision, then your levels tripled? What did they use as revision? That is concerning to me…I just had my m.o.m. revised with ceramic on metal. I can’t afford any more metallic ions in my body. I can’t find anyone who deals with mettallosis. I read earlier that there was tissue like “old oatmeal”… that’s how my Ortho described crap around my old M.O.M. “Plus copious amounts of brown fluid…” get it out NOW.

who is your surgeon? I'd like to see him