Edited by Patricia Walter for correct information.
On Febuary 11, 2012 USA Today published an article "Ills plague metal on metal hip implants" after research was presented at the annual meeting of the American Academy of Orthopaedic surgeons of San Francisco. Please note that MOM implants are THRs unless specifically stated as hip resurfacing devices.
My doctor said he had one patient with the Birmingham resurfacing develop this metal ion problem, have any of you out there had metal ion problems?
I am only three weeks three days post-op so I don't have that problem and hope I never do. The release of the metal debris has to do with improper implant of the device and the resulting "edge loading" that occurs. When implanted properly, the two parts of the device will not rub together. So, picking a surgeon with as much experience, thousands of resurfacings under his belt as opposed to a few hundred, is key. That and look at his success/failure rate.
Note by Patricia - I have information on the Surface Hippy Website about the incorrect, negative press information here:
http://www.surfacehippy.info/hipresurfacinginfo.php (http://www.surfacehippy.info/hipresurfacinginfo.php)
I haven't read the article but you are repeating the misconception that we are talking about pieces of metal breaking off. It is actually metal molecules created usually by edge loading. The majority of problems have come from implants with poor design or improperly placed devices.
The Birmingham Hip Resurfacing prosthesis is actually designed to pull synovial fluid in the space between the femoral cap and the acetabular cup. This provides a lubricant so that the pieces don't rub together.
Edit by Patricia Walter
There are many cases of metallosis that you describe in MOM THRs, but few in MOM hip resurfacing. And the pain and revision that these people endure is heart wrenching.
Still the overwhelming majority of hip resurfacing patients enjoy a return to very active and healthy lifestyles.
Dan
Quote by Barbara removed by Patricia Walter - The information below is excellent.
Hi Barbara, welcome to the site - I'm glad you found us to get more information about this. We have several people here who have had problems with this and been revised to a total hip replacement. Their stories, like Dan says are heart wrenching, and affect us all since it is a possibility for us all.
As Dan mentions, it's not shards of metal, but metal ions that are liberated due to friction from edge loading as far as is known. There may be other sources, but the overwhelming cases that have been seen is from edge loading.
As I've heard it described, edge loading happens when the implanted device is positioned incorrectly, at an angle that makes it impossible for the two parts to slide without impacting the edge. Over time, this generates the metal ions that then may cause muscle and bone problems.
This is why many people have their blood levels measured now, to make sure that is not happening within their bodies and if it is, to deal with the issue at an early point, when hopefully not too much damage has been done. The usual remedy is to replace the component, predominantly with a total hip replacement or when possible to replace the offending cup at the proper angle and keep the HR.
After the remedy, blood metal ion levels drop to normal fairly quickly, eliminating the problem. The result is hopefully a fully functional replacement hip.
The failure rate of hip resurfacing, for all hips done by all surgeons, for all devices is 3.6%. That is a 96.4 % success rate.
Surgeons who do a lot of resurfacings, who have gotten a lot of experience, or just are more skilled have higher success rates than that, and obviously those who are less skilled or experienced have a lower success rate. The best prevention for problems is to select your surgeon as well as you can, and to select a device that has a good record.
There have been some devices that have been failures, and have been 'recalled'. They had design flaws and were implanted in many patients. Even within the community of people who have those implants, the majority are still without problems, but a larger percentage than was seen in other devices had problems, so they were withdrawn. The articles written featured these devices and de-emphasized the more successful devices.
Even when a failure happened, it was seen in the Australian registries, which did a study of hip resurfacing over a period of ten years, the large majority of failures were caused by other reasons than metal ion problems. This does not denigrate the suffering that those of us who have these issues experience, but it speaks to the frequency of the problem.
The study found that 8% of all problems were caused by metallosis. That means that 0.08 X 3.6% = 0.288 % of hip resurfacing failures are caused by metallosis in Australia. Again - does not downplay the problem when it rears its ugly head, but it is not the predominant cause of failure.
To attempt to avoid it, the best approach is to have a skilled surgeon who preferably does many and is committed to its practice, a good recuperation regimen, and established and good devices, in my opinion.
I'm glad you're trying to find out good information. This site is invaluable for both discussion and research, roam around it and you'll find a lot of information both about the successes and unfortunately, some failures. We are open to both.
Please note that I have edited the above posts. I don't mind us talking about MOM problems and metal ions, but I want to make sure new people to the discussion group understand what we are talking about. Most of the incorrect negative press is about Metal on Metal THRs and high metal ion problems. There are not hunks of metal floating around the hip joint in improperly placed THRs or even hip resurfacings. Edge wear between the acetabular cup and the femur cap not placed at proper angles causes high metal ions. Some devices like the ASR had problems and caused high metal ions when the acetabular cups were not working properly. The BHR is an excellent hip resurfacing device and has a very high retention rate which is currently 94% overall and much high for the very experienced hip resurfacing surgeons.
I am sorry to remove and change parts of people's replies, but I feel it is necessary. I could remove the whole topic, but I think it is worth a re-visit again and again and again. The incorrect, half truths of the media just never stops!
Pat
Hi Barbara
Sorry to edit your post, but we need to be careful how we state problems.
When did you get your BHR?
Who was your surgeon? How many BHRs has your surgeon done to date.
Interested since you are worried about high metal ions.
Pat
No apology needed. Please correct us as needed! It is appreciated.
:)
Most of the articles I have read in the mainstream media do not paint a good light on any medical device, but this one was one of the most misleading and not worth the ink it took to print it. When you read the article online it gets ads for lawyers offering "free" consultations surrounding it.
I don't believe that Barbara has said she had a BHR, just her doctor talking about it.
Curt
Barbara wants to get resurfacing, and is looking for information. She is just starting to get info on resurfacing and was confronted with this article.
I can understand her hesitance given the slanted reporting, but do like the attempt to get the straight scoop by coming here .
I can always understand perspective patients want accurate information. The only problem I am confronted with is that some people that sign up are not here to learn, but to cause confusion and make statements against resurfacing. I am not saying that is true of Barbara, but there have been others banned with posts removed. I don't believe they are real perspective patients, but plants against resurfacing. All of us involved with hip resurfacing discussion groups are having the same problem. Some are almost making their discussion groups closed to most except people that can prove they are patients.
I am not taking that position. I will let almost anyone join and just watch the posts. If they seem to be real, that is great and if not, they are removed. I just don't want the discussion group to become a battlefield of THRs vs hip resurfacing. This site is about hip resufracing, both the good and bad. Fortunately, there is much more good than bad.
Pat
What everyone must understand is the work that it takes to keep this forum going without turning into a zoo.
We've had thousands of spammers attempt access on this forum, we've probably had a few dozen people claim they are patients then start in on how bad hip resurfacing is.
The money available to ambulance chasers is almost unlimited if enough class action suits get rolling, soon the sounds of the lies will make our truth into whispers.
Some of you may be at times upset when you see certain people disappear in every case those users have been removed for a good cause, it's too keep some modicum of saneness on this forum.
We need you good posters, we need to remove the bad ones, it's just the way it is.
Chuck
Quote from: hernanu on February 16, 2012, 11:01:27 AM
Barbara wants to get resurfacing, and is looking for information. She is just starting to get info on resurfacing and was confronted with this article.
I can understand her hesitance given the slanted reporting, but do like the attempt to get the straight scoop by coming here .
I understand the goals and I think it was just an unfortunate title and introduction.
I've had some messages from her and she is strictly looking for information on the hip resurfacing options for herself. She has talked to one resurfacing doctor and is looking at one that is more experienced based on the information on this site.
I understand that you need to keep the forum in good shape, every forum wants to keep the right focus and decorum; it is your site and it serves a vital purpose, IMO.
This website certainly does serve a vital service, Hern. I don't know how --- or even if --- I would have been able to learn enough about resurfacing to make an informed decision, without the resources provided on SurfaceHippy. I am almost a year and a half out from my LBHR. Every day I marvel at how good my hip feels and the activity level to which I have been able to return.
I am booked in for a LBHR next Tuesday and have come across the negative press about MoM. Barbara's post has been useful for me as it asks the question that I think a lot of prospective patients are pondering. It also gives people who have done their research to present an informed response.
I have found this thread really useful (and the forum in general!)
wrigga
Glad the thread was helpful. I work hard to try to keep the forum balanced and fair about the positive and negative about hip resurfacing. We know there are a few problems, but they are less than 6% of the total number of hip resurfacings. They are even less than that when you go to the top, experienced hip resurfacing surgeons. So hip resurfacing still remains an excellent solution to hip problems.
I want to wish you good luck with your upcoming surgery. Be sure to start a new story thread under Hip Stories when you are able to let us know how you are doing after surgery.
Pat
My husband had a Birmingham resurfacing done November 2009 (he was 47 at the time). I have posted on another topic about "noisy hips" to see if others had the same experience. Beginning almost immediately, the hip squeaked. The surgeon said that was normal and would go away in time. We are now 2 1/2 years out, and during an orthopaedic visit with a local dr. (not the original surgeon) he noticed the squeaking-which now occassionally has a grinding sound to it-and immediately ordered blood work. Sure enough, his metal ions are high-cobalt and chromium, 58 and 49. This dr. does NOT do resurfacings, but does specialize in complex hip and knee replacements. So he does keep up on all of the research, industry news, etc. He says that MoM has proven to be problematic and is no longer recommended. He is advising total replacement to get rid of the metal ion problem. All xrays and scans show the Birmingham is positioned correctly. The thought of going through another surgery-this time more invasive and complex with longer recovery time-so soon is depressing. We're not sure who to trust or believe at this point, and the original surgeon isn't answering any of our questions about "are you still doing resurfacing", "do you still use the Birmingham device", etc. I'm sure he fears a lawsuit. But no one can seem to give us concrete answers about the device, the levels of metal that cause damage, how much damage might be permanent, etc. I'm wondering if those people that have had resurfacing with no problems may have high metal but have not had a reason to get checked? Is it possible that the high ion level is a much bigger problem than we know? Sorry to be so long-winded, but I've read everything I can get my hands on, and still don't have answers.
Hi Donna, welcome to the site, we'll try to help as much as possible. Pat has put together some great information here, and we are definitely interested in the metal ion issues.
There is a lot of agitation right now about MoM devices. A couple have been recalled for not being as effective as most of the devices out there. The overall success rate for resurfacing with MoM devices as far as I know is 96.4%. That is a great success rate, it seems to be ignored in the current frenzy. I have confidence in my implants, will have a metal ions test in due time, but have not had any of the expected effects from metal ion issues.
There's a lot of information out there about the reasons for revision, the most reliable are based on the national registries, in which several countries have gathered 10 years of information about resurfacing and total hip replacement. The information we have from the Australian registry effort (you can look at them in the area that Pat has devoted to this), 3.4% of resurfacings needed to be revised. of those, 8% of the revisions were attributed to metal ion issues. So revisions caused by metal ion issues in the research done in Australia are in the order of 0.3% of all hip resurfacings. The bulk of the problems were from device slippage and lysis, not from metal ion issues.
Having said that, none of it minimizes in the least the hippys that have these issues. There are several folks here who have had measurements done, and have had 'normal' levels. Some have had elevated levels, and some have had revisions due to very high levels. One step you can take is to send your husband's XRays to some of the doctors listed on this site who provide consultation free of charge. They are some of the best in the world, and can let you know where you stand as far as placement, causes for elevated metal issues, and what is liveable and what would cause a revision.
Good luck, we'll be glad to help if we can.
Once again a wonderful and thoughtful reply from Hernanu. All I could think of was to reinforce his advice to take advantage of the free consultations from the top resurfacing surgeons like Drs Gross and DeSmet. Hopefully that will leave you with some clearer answers.
I certainly understand your question about whether or not there are is a problem with unreported high ion numbers. Personally I don't think that we will find that, and I am happy to see more testing being done so that we can come up with some statistical evidence on whether or not there is a problem. I had mine tested twice; once during the break in period (1.6 chromium) and once more recently (which came in at .5 chromium and .6 cobalt). It is my hope that most people will test in this "normal" range, which will give confidence to others as the statistics build.
I hope that you find some clear answers that will allow you to move forward with confidence towards a normal life without hip issues.
Hi
I am sorry to hear your husband is having problems with his hip resurfacing. I will say that unless you have had the top surgeons look at his x-rays, you really can't depend on less experienced surgeons or those that don't do resurfacing to tell if the acetabular cup is properly placed. Many less experienced surgeons just can't tell like the top surgeons. If the blood test indicate high metal ions, then by all means he will need a revision.
Just to have a doctor bad mouth MOM THRs or resurfacing is not really justified. There are national registries that show the BHR has an excellent record of retention rate at 10 years and studies that show the cormet also has a good retention record. All of the devices will normally work well, when well placed. That again, depends on the surgeon. I don't know any of the top surgeons that won't work with you if you have problems. They are interested in the best welfare of their patients. I certainly would not use the original surgeon if he isn't willing to work with you.
There are no class action law suits against the BHR. Many surgeons now routinely have blood tests done on the hip resurfacing patients and very few patients have problems. In general, the high metal ions are the result of edge wear of mis placed acetabular cups.
I would suggest getting a second opinion if possible from someone like Dr. Gross of SC who will do it free via email if you send a copy of the x-rays in a digital format. Dr. Su of NY is excellent. I am not sure where you live.
I would make sure what the problem is before taking action and then choose a really experienced surgeon that does a lot of hip resurfacing or a lot of THRs to do a revision. You don't want to use local orthos who do a little of this and a little of that.
Again, I am sorry for your husbands probelms. The people here are very understanding and we will all give you moral support. Revisions are difficult both physical and emotional.
Good Luck.
Pat
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.
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!
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.
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
Quote from: mccabe66 on June 21, 2012, 08:22:59 PM
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
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