pain and high metal count in blood - I would appreciate advice

[Catalina]

I had my R hip resurfaced in June of 2007.  The recovery was good and so was my first year post-op.  About a year ago I started having pain in my right hip and also in my leg.  It is definitely worse when I put weight on my leg and it has gotten so bad that I can't walk any distance or play any sports.  I am even going to work half-time because of this.  I went back to my surgeon six months ago and he took an x-ray.  He said everything looked great and I had bursitis and I should go exercise and do PT.    He also did a blood test and ruled out infection.  So, six months later with my hip getting progressively worse, I went back to the surgeon.  This time he took an x-ray and said, my hip is at a 56 degree angle, and let's do a CT scan and check blood for metals.  The results of the Ct scan do not apparently offer new info. Doctor said the same thing he told me after x-ray.  The blood test showed heavy metals of 33 which I guess is parts per million and I'm not sure if it's the cobalt or chromium that is that number.  First the surgeon said he could replace the socket implant with a ceramic inplant.  But then yesterday his assistant called me and said he want to do a THR.  I was shocked at the metal ion info she gave me and then also that she was saying I need a THR.  I am wondering if I do have to have a THR, then can I have a local surgeon do it instead of traveling to my Hip replacement surgeon?  Can a non hip resurfacing surgeon do the THR? Does anyone know about ceramic socket inplant as a way to fix this problem?  Can they just leave the femur alone as my surgeon first suggested?  I am so freaked out about the metals, I am not doing any activity at all now.  Don't want to mke it worse. 

[fedup]

I am a bit unclear regarding your underlying problem. Is the femoral prosthesis moving or is the acetabular cup? The other question is then why is it moving. Getting a second opinion on your xray by someone very experienced with hip resurfacing will help. Your metal levels are high because of the change in mechanics of your prosthesis, which causes increased wear and increased metal levels. In the short term don't worry too much about the metal levels (as long as your kidneys are normal they will keep mostly filtering out of your system). It is more important to get your revision options sorted out and without knowing the underlying cause  it is hard to comment. Did you ever get your metal levels checked before? I had to get a revision because of a loose Durom cup and I had high metal ions. They came down after the revision and my pain went away. I happen to have a metal on highly cross-linked polyethylene prosthesis. Not sure what to do with the other hip though...

[Catalina]

Thank you for your comments.  The problem, I was told, is that the cup has moved.  According to my surgeon, in 4000 surgeries he has had this happen about 4 times.  I have a copy of the x-ray right after surgery and I want to look at the recent x-rays and see what the difference is.

My question to you is, did you have to have a THR to fix the problem with your cup, or did they just put in a different cup and you kept your femur as it was?

Thanks.

[kb134]

Hi Catalina,
Which manufactured device did you have implanted?  BHR? Zimmer's Durom? ...
I am not medically trained so take this with a grain of salt ...
Your Ion levels may have elevated because of the migrating Acetabular cup. Look up the term "Edge Loading." When an Ac. Cup shifts out of its "ideal" position, more pressure is directly placed where the femoral component contacts the Ac. Cup. Instead of the whole Ac. Cup displacing the load of a peson's body weight and forces of movement over the whole inner surface area of the Ac. Cup, when the Ac. Cup shifts, load is focused more acutely, and a higher wear rate occurs. 
If this is your case, you may be able to have the Acetabular Cup replaced - as long as the Femoral Component and your bone are all OK.
I agree with Fedup - GET A SECOND OPINION!  From an experienced surgeon.
You may not need a THR.
Who is/was your surgeon?  What is his experience?  If you do not know, ask.  From what I have read, seek out information and ask questions.  We don't care if it makes you uncomfortable.  This is very important for you right now.  So while you have the time, google and look up all the info you can on Pat's Surface-Hippy site and Vicky Marlow's http://www.surfacehippyinfo.com/.   

[fedup]

If the acetabular cup is loose it depends on what caused it (infection, metal sensitivity, a cement problem or a prosthesis problem?) It also depends on the state of the bone in your acetabulum. Only a surgeon would know how to revise this based on the type & state of prosthesis in the femoral head, and the state of your acetabulum. Hope it gets sorted out soon. Take care while it is being sorted out.

[kristiiirn]

Hi
I am 5-6 yrs out from bilat biomet Dr. Gross and am having similar problems I would be interested in hearing what you have decided to do to resolve your pain and ion levels.  I'm going to Dr.Barack in St.Louis now.  I wish there was a crystal ball that could have told me this would be a problem and what the solution would be......
Any thoughts?
K

[woodway2]

Hello K. and hello again Pat!
Saw your query about your pain and high metal levels. Did you get tested because of your pain, or was your doctor concerned about your xrays and acetabular positioning? What were your levels?  I ask you these questions because I have a high acetabular cup angle with high levels as well, in the 55ppm range for both chromium and cobalt. I have no pain, although I did for a couple of months in the summer after very vigorous work moving a hot water heater. My doc has been following my levels for a while, and after I developed the pain and lost my range of motion we decided to put me on the list for revision. Since then the pain has really improved and I have back my range of motion. So very confusing for me but the levels are no doubt still high. I think I will still follow through with the revision, especially after reading the new report here on Pat's web site home page. But it's really weird considering losing my resurfacing and facing serious surgery when I am not in daily pain. I wish there were a definitive answer, but I guess that's just not going to come!
Nancy

[stevel]

Hi Nancy,

Could your Dr. do a biopsy where a probe can determine if black metal debris has accumulated around your hip joint?  I know they do biopsies for verifying cancer on livers and other organs.
It is quite a quandary for people with steep cup angles, such as you and Bill, that are not experiencing pain and whether or not you should revise now or wait until problems develop.

[B.I.L.L.]

Hi Nancy,

Could your Dr. do a biopsy where a probe can determine if black metal debris has accumulated around your hip joint?  I know they do biopsies for verifying cancer on livers and other organs.
It is quite a quandary for people with steep cup angles, such as you and Bill, that are not experiencing pain and whether or not you should revise now or wait until problems develop.

Yeah aint being in limbo awesome ?   I'm just happy mines working good enough to move on with my life now, and I am not really eager to go through this again unless it absolutely has to be done.  Seems like lots of unanswered questions and gray areas surround this subject too. Please post any updates and let us know who's telling you what.
Thanks Nancy and best of luck to you.