Problems plague metal on metal

[Dannywayoflife]

I echo what Pat has written there. There are numerous MOM THR's still in situ here in the UK after well over 40 years. They were well engineered and well implanted. Thats one of the unique things with the BHR the assosiated clinical data goes way way back its only been recently when lots of surgeons have started using the MOM bearing couple that there have been issues assosiated with it.
I really hope your husband gets his issues sorted though and once again fantastic advice by Pat get the best surgeons opinions.

[cwg]

Hi DONNA

I had my BHR Jan 2007 and my levels are high, higher than your husband, but under 100 which is when I am told to really start worrying.
My blood levels were not tested until last year, so who knows, they may have even been higher before.

Until then, after ultrasounds and cat scan which show excellent postioning, and not huge new pain, I am waiting and doing nothing surgically.

I have top surgeons interested and assisting. Also a toxicologist who monitors my levels every six months.

Good luck. Please keep me posted and I will do the same.
Oh, I have met a couple of others, women, with the same problem, in Connecticut while I visited family, through my Pilates instructor.

Also, does your husband have any cognitive issues?

I keep hoping this will all go away and is just one big mistake
smile

best of luck!

[Tin Soldier]

I agree with everyone here. CWG has a good point about reviewing the data with a toxicologist.  I haven't seen any information supporting long-term effects of elevated Cr and Co in blood from MoM HR.  The main problem is localized toxicity to the tissue around the device due to elevated metals from wear.  It sounds like maybe your husbands device isn't getting enough lubrication from the synovial fluid.  There are certainly lots of reports from folks about temporal short-term squeaking or even "grinding" and that tends to be pointed at dehydration and excessive exercise.  Sadly, there is at least one other poster that I can think of that has posted a similar story about continued squeaking, followed with elevated metals, then followed with revision.  There is a possiblity of revising only the cup also, which is done when the angle is way off.  Not sure about your husband's case.  I'd recommend discussing with an expereinced HR surgeon as others have pointed out.   

BTW - the ASR is the only HR MoM device that had a lawsuit (class action) which is really the main driver for the whole anti-MoM run that we've seen for a couple years.  The ASR has an 80% success rate for it's period of use (6 years?). 

Good luck.

[mccabe66]

I thought I would use this conversation to provide some additional data points on the complicated topic of resurfacing and metal ions.  I got a BHR on the right side from Dr. Jim Pritchett in July of 2008. I won't spend much time on the history, but you will can find more of my story in old posts to this website.  About 1.5 yrs after the procedure, my complaints about pain during running brought the revelation from Dr. Pritchett that my cup angle was very steep at 65 degrees, but that fluid asperated from the hip showed no evidence of metallosis (deterioration of tissue around the Smith & Nephew components).  I backed off my running (could not get more than 4 miles without too much pain) and got my first blood test for metal ions at just about 2 years after the surgery.  These tests and follow-up tests to year 4 showed the following:

Year 2 after:     Cobalt = 1.5       Chromium = 3.0
Year 3 after:     Cobalt = 6.2       Chromium = 2.6
Year 4 after:     Cobalt = 1.1       Chromium = 3.0

The results always arrive with a note that the "normal" ranges are 0.0 to 0.90 for cobalt and 0.10 to 2.1 for chromium.  The first notable thing about these results are that they are not very high, almost in the expected range for MOM resurfacing, despite the fact that my cup angle is near the upper end of the range I have heard of.  Why aren't the metal levels higher ?  I think a big reason is that I am light, weighing only 135 pounds. Also, I have drastically changed my exercise routine to keep running to a minimum (maybe once every other week for a couple miles), although I run up and down a set of 300 steps for about 45 minutes a couple days a week (smaller range of motion and less pounding reduces the discomfort level in my hip) with the remainder consisting of exercise bicycle and elliptical trainer.   
I point out that I frequently experience some discomfort, sometimes to the pain level (not like I experienced before the resurfacing), and that every day I feel something unusual about my hip.  I am told most folks with resurfacing do not have that feeling.  Because I can still do a lot of active things, including skiing the toughest terrain, and my metal ion levels are not that high, I have not elected to do a revision yet (Dr. Pritchett says get it done, other second opinions say leave it alone).   

What can we learn from my experience so far?  That very steep cup angles do not necessarily mean high metal levels, even with some pain and discomfort.  I recall reading about JMS who did a revision beause of high metal levels, but he had no pain or discomfort issues. The general experience still seems to indicate that steep cup angles result in high metal levels.  I have to believe that my lighter weight and reduced levels of activity helped keep the metal levels in check.
I am not sure what the real meaning of this information is, but I hope it helps increase the understanding of the hip resurfacing treatment.

By the way, I would encourage new folks to spend some time looking through some of the old metal ion and revision topics on this website to get a more complete picture of the issue.  The more recent posts here seem to be a bit on the over-simplified side.

McCabe66

[einreb]

I have not elected to do a revision yet (Dr. Pritchett says get it done, other second opinions say leave it alone).   

Would you simply (easy for me to say) have the cup revised?

Best of luck and thank you for posting the details of your situation.

-Bernie

[Pat Walter]

Revision of just the acetabular cup is very difficult.  I only know of a few cases where that was done.  The couple I know were with Dr. Su and I think Dr. De Smet. Most surgeons won't try to just replace the cup.  If the cup is not placed properly, then the femur component might not be optimally placed either.  Both need to work at the proper angles together.

Pat