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    Total Hip Replacement-metal ion issues
    An_206577 posted:
    In 2007 I had a hip replacement with a metal on metal implant(not a Depuy) and early in 2009 I had a Depuy ASR put in the other hip. The blood test I just had done now shows abnormally high cobalt and chromium. I am not having any other symptoms. I am concerned however, because some studies have indicated that more data is needed and we do not know the long term effects. These ions are known carcinogens. If a person has 2 metal on metal implants, do we know what the acceptable range / values of chromium and cobalt should be? It has been documented that these metal ions can cause tissue destruction around the implant. Has anyone tried chelation and has it been effective, to remove the ions before the destruction gets any worse? Short of having the implants removed, is there any way to prevent metallosis and get rid of these potentially quite harmful ions? I have asked the surgeon but he said let's wait and see and we will continue to follow up. Is there anything that can be done to prevent an increase in the metal ions in the surrounding tissue and in the blood? Even if one does not need a revision, can something be done to prevent potential damage to neural tissue and the potential long term negative effects of these ions?
    Bal M Rajagopalan, MD responded:
    Hi Anon_122411,

    Very good question. First of all, the metal ions is an unknown. The levels in earlier studies showed it is in the first year where the ion levels peak, and after that it settles down significantly. Chelation would not really address the local issue, as the debris from the wear settles adjacent to the implant which can cause wear. This topic is still really an unknown and that is why you have the "lets wait and see" answers. Any recommendations to prevent metallosis would not be supported with literature. Five years ago this metal on metal big head was definitely very popular but the ion issues changed my practice towards ceramic on high grade polyethylene. Unfortunately we still don't have the answers, but there is a lot of active discussion regarding this topic. I can guarantee that if there is any proven remedy, that our patients will be the first to know about it.

    - Dr. Raj
    Michael P Bolognesi, MD responded:
    Dr. Raj is indeed right on on this in that we are still learning a lot about this issue. I suspect you are aware the the ASR socket has been recalled. The American Association of Hip and Knee Surgeons is continuously working on recommendations about how to best manage patients with metal on metal devices. If your serum cobalt and chromium levels are indeed elevated there are several options at this point. Cross sectional imaging like an MRI can be used to look for any abnormal fluid collections or abnomamlities to the soft tissues. If you are asymptomatic your surgeon may elect to repeat the levels in 3-6 months to see if the are continuing to trend up. We have an extensive experience with metal on metal total hips at our institition and while most patients have done well we have identified some patients that have had trouble. You need to make sure that your surgeon follows you closely going forward to make sure that any sins of failure are not missed and caught early.
    ohiggin replied to Michael P Bolognesi, MD's response:
    I had an original hip replacement 10 years ago. The stryker device squeaked terribly. I had revision and made it a plastic cub and metal ball, three years ago. All was well for 2 years, even exercising again and controlling weight. Over past 6-8 months, I have had gradual pain increasing and spreading down my leg, with groin pain and hypersensitivity of the hip area (can't sleep on that side anymore). Surgeon Xray shows arthritis in back, so he wrote it off initially to that, but did a chromium/cobalt blood test to double check. My levels are elevated, but he says borderline. Pain continues to grow, I am having outbreaks of rashes, especially if I break my skin. An almost immediate rash that is VERY low to heal occurs with high itching levels. I will have a MARS MRI soon, but seems obvious that Metalosis is the issue. Would appreciate feedback and information about how to treat this and what are options to correct the cause.


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