Good blood serum ion test

[John C]

With all of the concern recently about high metal ion levels, and their potential for causing both soft tissue and bone destruction, I thought that it would be prudent to ask for a blood serum chromium test to see where I stood. I was also interested because I had read studies showing varying chromium levels with the BHR, Conserve+, and ASR implants, but I had not come across any ion studies with Biomet.
Though it is still somewhat controversial, I have the impression that levels over 10 are cause for concern, and levels in the 30-50 range are often associated with serious bone and tissue problems. The lab that did my test considered 1.4 or less to be the "Reference Range" for people who did not have any implants. I was delighted when my test came back at 1.3. 
It is relevant to mention that my cup angle is at 39 degrees, and I have a fairly high activity level (skiing 8 hours every day for five months at the time of the test). The test was done at 22 months after surgery with Dr. Gross, at the end of what is often considered the wear in period. I should mention that because of my well positioned cup, my doctor did not think that the test was necessary, since he was confident that the ion levels would be low. I am happy that he allowed me to do the test, but in retrospect I can see that his advice to not bother with the test was well founded.
I am sharing my results because I think that it is very encouraging for people involved with, or considering, resurfacing to know that, with good surgical placement of a well designed prosthesis, there is the potential for the serum ion levels to remain within the reference range for those without metal implants.

[Pat Walter]

HI John

Glad to hear your test is normal.  Enjoy that hip.

I asked Dr. De Smet at one of the courses if I should have a blood test and he laughed and said " Pat, I placed your cup properly - don't worry!"  Guess that's what you want to hear!

Thank You for sharing your information.  Again, I agree that it is very important to choose a very experinced hip resurfacing surgeon that will place your device components properly.

Pat

[stevel]

John,

Great to hear you metal ion levels are normal.  I also ski a lot and I hunt in the alpine.
I had a well placed BHR by Dr. Su about 1 yr 8 months ago, who is one of the best hip resurfacing surgeons in the US.
A newbie will also have excellent results with the "big" names such as Dr. Su, Dr. Gross, Dr. Bose, Dr. DeSmet, etc. but it's with the lesser known Drs. where a newbie is taking a chance.
I suppose the only item you and I need to be concerned about now considering our similar age and activity level, is how long will the device last and whether we should modify our activity level to make our device last longer?
Pat was going to find some posts where past hippies that received revisions, wished they hadn't done so much.

Have you heard from Pat?

Or Pat, have you found any data correlating high impact athletic or occupational activity with premature failure (after a two year break-in period) of a well placed, well designed hip resurfacing device?

[Lopsided]

Is a blood serum chromium test a standard hospital test? Do you have to specially ask for it? Is it only available at certain hospitals?

[Pat Walter]

Hi Stevel

I haven't found any specific information correlating people with high activity levels and revisions of hip resurfacing. I just don't think anything has been done about that yet.  If there has, I don't remember reading it.

Many surgeons would prefer their patients not do extreme sports - but know many do. 

Sorry I can't help more.

Pat

[John C]

Hi lopsided,
I am not an expert, but here is what I learned in my process. Firstly, doctors will not encourage nor prescribe this test, unless there is some indication that there might be a problem, such as a high cup angle, unusual symptoms, or a prosthesis that has been shown to generate higher wear rates. It is my understanding that in England, it has recently been recommended that all patients showing risk factors be tested for ion levels. In my case, my doctor was kind enough to indulge my insistent need to know. The test is not cheap, it cost me over $300 just for that one test. I believe that any hospital or lab can do the appropriate blood draw, but it takes a specialized facility to do the test. My blood sample was sent all the way from our hospital lab in Idaho, to Quest Diagnostics Nichols Institute in California. There is also some concern about results of these technically demanding test being consistent from one lab to another.
Once again, in my case my doctor was very correct in assuring me that the test was unnecessary, but I am glad that I had it done. Since I am at the end of the wear in period, I doubt that I will ever have it done again, since the level should remain consistent, or possibly drop slightly from this point.
John

[JeanM]

Hi John,
This is great news!  Thanks for sharing the outcome of your test!

Jean

[Lopsided]

...In my case, my doctor was kind enough to indulge my insistent need to know...

I understand that. Even if it is not totally necessary, in a couple of years I am sure I will like to know too.

Dan

[ginnie]

I too participated in the ion study my surgeon was conducting. My ions were also low. Its up to your surgeon if he is studying this or not .. you can contact them and tell them you would like to be included. its usually just a blood draw.

[KayakDeb]

Pat was going to find some posts where past hippies that received revisions, wished they hadn't done so much.

I'm not at that point yet... but a bunch of frantic research (because I've ignored the whole "hip" scene for 7 bliss-filled years) is showing that there ARE some criteria for people who *might* have more wear-and-tear on their prothsesis:

Females (presumably because of smaller-diameter heads create more PSI of force)
Dysplasia (higher angle of installation)
High level of activity

Unfortunately, those describe me to a "T"

*IF* I have to have a revision (still a HUGE unknown) and armed with hindsight, there are a few things I might have done  differently:
To he!! with "treadmill time" and would throw away the pedometer - I should have kayaked/bicycled more
Wouldn't have volunteered to lead horses at a Therapeutic Riding Center - maybe should have taught sailing instead.
Would have hired someone to tote umpteen tons of rock and topsoil, instead of wheelbarrowing it :-(
Would have climbed a few less ladders

I don't mean to be dour - because my resurf gave me 8 incredible years that I wouldn't have dreamed of before the surgery.  And back then, too-high levels of ions was a "concept" that was generally pooh-poohed; and the angle of a cup was never mentioned.  I only offer these insights so that the younger, female, dysplastic Hippies might reassess what they do for fun?  And if their heart sings because they can run a Marathon - then go for it.  It's still years of pain-free active life that would have been impossible any other way.

[John C]

Hi KayakDeb.
I understand what you are saying and feeling, but I am not so sure about the activity correlation. I have read some studies showing that high levels of activity have very little, if any, affect on ion levels if everything else is good. You are right about component size and positioning as being the main factors in ion levels, along with the brand of prosthesis. I would not regret any of the wonderful activities that you described, since it is likely that they may have had little effect on whatever is happening. Keep those as happy memories with no regrets.

John

[KayakDeb]

Oh - a million good memories - like offroading in Utah!  Or the trip to Alaska.  Or Nova Scotia.  Yellowstone/Grand Tetons.  Climbing the grandstands to watch my husband dragrace.  Learning to kitesurf.

Those were all impossible 8 1/2 years ago.