Elevated blood Cr and Co levels, psuedotumor, recommeded revision by Dr. Gross

[sixstring]

I got a right hip resurfacing using the Biomet Magnum Recap by Dr. Gross in SC in June 2006.  The hip functions well other than frequent clunking/shifting when the hip is extended (standing/walking); the clunking causes no pain. I am a very active 59 year old male, 5'-8", 163 lbs.

In February 2011, I had blood levels of chromium and cobalt measured on my own - Dr. Gross did not suggest it.  Cr was 38 mcg/l ("normal" <1.4mcg/l) and Co was 81 mcg/l ("normal" <0.5 mcg/l), both extremely high.  I reported this to Dr. Gross who asked me to have them rechecked with a lab he uses - results there were virtually identical.  (Note: mcg/l means micrograms/liter; one lab measured serum metal levels and one measured plasma levels with very little difference between the two.) 

I talked to Dr. Gross after the elevated blood metal levels were confirmed.  He said my cup inclination angle is ~ 60 degrees (optimum is closer to 40 degrees) which is associated with excessive wear, probably due to edge loading of the cup.  He said steep inclination angles weren't known to be a problem in 2006 when I had the resurfacing, and that he didn't have a way then to set the angle during the operation.  He now uses an intra-operative x-ray to measure the angle at which the cup is placed and now never has cup angles > 50 degrees.  I recommend reading Dr. Gross's article on Acetabular Component Inclination Angle on his website (http://www.grossortho.com/). Given that my hip is functioning well, he didn't feel my blood metal levels were a serious health issue, and said the options were to continue to track metal levels, get an MRI to check surrounding tissues for signs of metallosis, or to revise the cup. 

I opted for a metal-shielding MRI (MARS protocol) (May 2011) to see if there were abnormalities around the implant.  The MRI showed abnormal fluid accumulation around the hip; the radiologist's report concluded it was most likely a "psuedotumor due Particle Disease."   

I met with Dr. Gross in May 2011 right after the radiologist reported the MRI results.  Dr. Gross recommended replacement of the acetabular cup to correct the steep inclination angle.  As a side note, he believes my clunking is due to the temporary loss of "lubricating" fluid in the implant due to the excessive wear on the edge of the cup, causing the hip to catch or stick - he feels this probably accelerating the wear.

Dr. Gross feels that replacing the cup at the correct angle will resolve the excessive wear, metallosis, and psuedotumor. He said that total hip replacement is also an option, but that since the femoral component looks good, he recommends cup replacement.  Even though the femoral component likely also has wear, he feels that when placed in a new cup at the proper angle, it will function well.   He says he has revised 3 HSRs in his patients who had steep cup angles (>60 degrees), one of whom had metallosis.  In one revision he replaced cup only (very recently) and in one case did a THR (about a year ago).  He said the revisions went smoothly and both patients are doing well. I don't recall him mentioning the outcome with the third revision.   

I also posted this story under the clunking and shifting thread to provide some perspective to those who have these symptoms, but want to be clear that the clunking/shifting is not significantly affecting the quality of my life and I would not consider surgery to eliminate it.  I am considering the "revision" surgery to address the metallosis.  I'll also try to post this under "serious post op problems thread."

I'd appreciate any insights from those of you who have had elevated blood metal levels and revision, particularly from any of you who have had a cup-only revision due to metallosis, and especially from any of Dr. Gross's patients who have had these issues.  Thanks.

Brian
Black Mt., NC

[hernanu]

Wow, sorry to hear that, Brian. Sounds like replacing the cup might be the thing, but sorry you have to deal with this. I don't have this issue (AFAIK), but let us know what you decide on.

[newdog]

Brian,
I feel bad that this is happening to you. I agree with hernanu, replacing the cup might be the best decision. It sounds like Dr. Gross is good at doing that procedure. If you do have to go to THR or if that is the way you decide to go, the new THR's work well and people seem happy with them. Just a thought. Keep us posted on what you do. Good luck.

Steve

[Lopsided]

I think you have an excellent attitude, and are handling the situation calmly and well.

Maybe all hippies should be aware and get ion levels checked periodically.

[socross31]

Brian,
My husband is going through a similar issue, only his Dr. wants a THR, Tom is 54 years old and very active and in very good  shape. Also his BHR is only 2 years old. I believe his numbers are MUCH Higher on the ions, i will have to look at home. If anyone reading this has any ideas, please help. We are just devastated by this.

[Lopsided]

Socross31, is the doctor that is suggesting a THR, the same doctor that did the original resurfacing?

If so, and he cannot place a resurfacing correctly, then he would not be skilled enough to place a modern THR correctly either.

What you do is, do not feel devastated, as it will not help. Start by doing lots of research: Who placed the resurfacing? What angle is the cup at? What do the top surgeons suggest now?

D.

[Lori Cee]

I just read a post from Vicky in another thread that Mr McMinn has started implanting ceramic BMHRs.  They are new, so no data, but if you were in the market for a second opinion like lopsided has suggested, McMinn might be an option if you had considered travel (there is a thread about him taking US insurance too).  If you do need revision, can travel and this step before THR is suitable for you, it would be at least worth considering.

(I have the MOM BMHR's installed by an awesome surgeon here in Australia so I am a little partial to a BMHR solution over THR.  Just thought I'd be fair and share my biases!)