Help ! Elevated cobalt & chromium levels

[Claire B]

Hi

I'm just new to this forum as research has brought me here.  I had a left birmingham hip resurface done by Ronan Treacy in June 2006.  I have had no problems, no complications and very little pain/discomfort.  I lead a fairly active life, hiking the moors and fields with my working gundogs as well as running around a show ring with them, again no problems.

Although I had my op done privately, I was previously seeing an NHS surgeon and Mr Treacy felt it would good to keep seeing this surgeon on an annual basis, just to keep a check on things because I am in Scotland and he is 5hrs away in Birmingham.  Mr Treacy checked my hip 18mths ago and an xray was taken and all was good.  I saw my NHS surgeon a couple of months ago at my usual annual appointment.  I informed him that at some point I may want to try for a family and so for that reason he didn't give me another xray but I did submit a 24hr urine sample to check the metal ions because of it being known that they pass over the placenta.

I have just received a letter from my NHS surgeon saying I have elevated levels (he doesn't say what the levels are) and I am to see him on Monday for further investigation which I presume will be an xray to start with.  I am devastated and really worried.  I'm sure he has fit me in on Monday, probably due to a cancellation but I'm worried as to why the short notice in seeing me.  I am also concerned that he is a little sceptical of the resurfacing procedure and I don't think he was 100% happy that I went private but the fact remains I had to do what was best for me and as he doesn't do resurfacing I went to a more than reputable private surgeon instead.

I've been doing a lot of reading up on this, some of it gives me relief and some of it gives me cause for concern.  I just wondered what experiences you guys had of this?  My main concern is that I will have to undergo another operation to revise my BHR.  But I'm really mistified as to why I would need to do that when I am suffering no problems with my hip and if I hadn't mentioned starting a family I would never have had the levels tested in the first place.

Advice please!  I'm really worried.

Claire

Left BHR, 3 June 2006, Ronan Treacy

[obxpelican]

Claire,

The things I am aware of are just things I've learned along the way.

To date, I've never read anywhere where anybody has ever come out with a table that shows what is an elevated level.  When you take vitamins certain types contain the same kinds of metals that you might have in your blood right now. 

I've read plenty of stories that discuss elevated ion levels that yielded perfect babies and I've never read a single case that has ever blamed ions on a deformity.

Sometimes if the contact between the 2 devices is not nominal it can yield more ions, I've also read where early on where many people present with elevated ion levels at first, then, the levels go down a few years later.

I think the big issue is, what is too high a level? 

I am not a doctor so listen to the true experts, YOUR DOCTORS.

Just MHO based on what I've read.

Chuck

[stevel]

Claire,

A study examining metal ion levels in pregnant women with a BHR is available at www.jbjs.org.uk/cgi/content/abstract/89-B/3/301.  The concentration of metal in the blood was 1.39 ug/l (cobalt) and 1.28 ug/l (chromium) for the BHR group and 0.341 ug/l (cobalt) and 0.199 ug/l (chromium) for the control group, e.g. no implants.  This shows an elevated level of metal ions although the concentrations are still low, e.g. ug/l = micrograms/liter = parts per billion.  The study also examined the metal ion concentrations on the umbilical cord and showed that the placenta filtered the ions and reduced the concentrations for the study group but not much for the control group.

Chromium is listed as a Toxic waste (as well as lead) by EPA at concentrations over 5 mg/l (milligrams/liter = ppm = parts per million) in solid waste using the TCLP procedure but cobalt is not listed.  I know the blood of workers exposed to lead or chromium is tested for concentrations of these metals as required by OSHA.

[Claire B]

Thanks Guys, I'm really grateful for your replies.  I have been doing a lot of research on this subject and read the various factsheets on this website which have been a great help.

My plan is to phone Mr Treacy first thing tomorrow and hopefully speak to either him or his surgical assistant to get some advice on how to deal with my NHS surgeon.  I'll report back here tomorrow night once I know more.

Thanks again for your support, its much appreciated!

[woodway2]

Hi Claire
I have high levels of metal ions without pain. Pregancy is not an issue as my kids are grown.  I am an outlier with blood serum levels way above the average. Last test around 26 ug/l/ for both. It is normal for a resurfaced hip to have elevated metal ions and that norm will put you high by about 10 times. But that is considered normal and not an issue.  It is when one's levels are above that that there is concern. I have read that Dr. De Smet, the leading resurfacing surgeon, thinks that levels above 20 ug/l are too high.
I wouldn't freak from just your urine levels. Your metal levels may be only the normal resurfacing levels.  As you are only 5 hours from Birmingham I would call the McMinn Centre and see if they will take your blood. That way you know you are being tested by a facility that really knows what they are doing. It is very controversial and there is little consistency among labs in how they do the tests.
Good Luck,
Nancy

[Claire B]

Well, where do I start!

Yesterday morning I spoke with Mr Treacy's surgical assistant who is excellent and very knowledgeable.  She told me that as I have had absolutely no problems with my hip then likely there is nothing to worry about.  She confirmed that I have a 97% chance of my Birmingham Hip lasting a minimum of 10 years    Mr Treacy has now performed 5000 BHRs and has done the most in the whole world!  So he really knows what he is doing and what he is talking about.  She explained about the metal ions and how research has shown that during pregnancy the ions are filtered through the placenta before reaching the unborn child and that so far no health problems have been documented relating to metal ions.  Her concern was that my NHS surgeon was scaremongering me because he doesn't do this surgery himself, nor does he know enough about it or the research and he may well be comparing my Birmingham hip to other makes/models that are not quite so good.  She mentioned the Duron resurfacing made by zimmer, apparently this is failing quite a bit.

So I saw my NHS surgeon.  Politely chastised him for giving me heart failure on a Friday night which subsequently led to a difficult weekend and he did apologise.  My metal ions are approx 10 times increased (just as you mentioned Nancy    He looked at my xrays again and said there is no denying Mr Treacy has done an excellent job.  I argued the fact that surely because I have a metal implant then it is expected to have increased metal ions, he did not disagree with this, but felt it should still be checked out    He wants to send me for an MRI scan to have a look at the hip and this will avoid unnecessary radiation.

When I got home I phoned Mr Treacy's assistant again and she discussed all of this with him and telephoned me back.  Mr Treacy feels there is absolutely nothing to worry about, he himself has no concerns especially as my hip is doing great.  He feels my NHS surgeon is perhaps looking for problems that do not exist!  He doesn't see the need for an MRI scan and feels this is wasted NHS expenditure.  He says the MRI scan won't show anything up other than a good hip.  He has said, however, that it would be useful for me to get a blood test done, either through my own GP or by going to one of his hospitals in Birmingham, to have the levels checked again and this will be recorded on my files.  He doesn't need to see me, but from a research point of view it would be good to get this done.  Also, although urine samples are good, there is a chance of it being contaminated and it also only shows what my body is excreting whereas they prefer a blood test which is more accurate and shows what is actually circulating my body.

So I've arranged to see my GP to see if she is able to organise this sort of blood test for me, if not then I will travel to Birmingham for it.  I'm still undecided about the MRI scan.  My NHS surgeon is writing a letter to Mr Treacy but goodness knows what he is planning on telling him and if Mr Treacy does reply I'm sure it will be an interesting one 

[Pat Walter]

Hi Claire

I am not a doctor or have medical training, but I sure would put a lot of faith into what Mr. Treacy told me.  Especially after he looked at your x-rays.  He is one of the best hip resurfacing surgeons in the world.

It does sound like your surgeon is being a bit of a worry wart here.  I would guess he he is concerned about your resurfacing, but is really making you worry.  Hopefully he will listen to what Mr. Treacy is saying.

Good Luck.

Pat