Metal ions

[bri]

I went to my doctor to see about getting both my hips resurfaced.My left hip is the worst. The bone in the socket is wearing away. My left hip ball actually sits up in the joint about a half inch or so. I also had a large cist on the top of my femur. Because of this he said he may have to do a THP. I also mentioned to him that my uncle went to his doctor in wisconsin. He told him that the metal ions are becoming a problem and he did not advise MOM. My doctor said that he knows a doctor in wisconsin that used to do 250 a year.He has cut that in half. My doctor cut the number he does in half.If you google THP on the internet and you look at some of the metal ion articles, there is some scary stuff there. My doctor said there are a lot of unknowns with MOM.He said if you do become one of the stastics. The problems can be very serious. My doctor wrote several articles on the benafits of hip ressurfacing and used to greatly promote it. He went to school in england for it and 2 scools in the us.Any way I am having second thoughts of resurfacing?.

[Lopsided]

If there are unknowns about metal on metal, there are far more unknowns about all other materials. In fact there is a lot known about metal on metal. And all the surface materials produce debris to some degree, and only metal can be removed naturally by the body (kidneys).

I was also bone on bone, with a cyst. I got a bone graft and resurfacing. My metal ion levels post op are equivalent for someone without implants.

I would say that a THR would be a great result for your surgeon, but not for you. Is that the statistic you want to be?

[Boomer]

Bri,

Who is your doctor?

Where are you located?

[Dannywayoflife]

Bri i aggree with what lop has said. I believe that the alloy used in HR has been in orthopedic use for about 70 years so theres more known about it than any other material im aware of. Its only realy been with the asr and poor surgeon placement of componants that ions have come to the fore and become an issue. If i were you i would seek a second opinion about your own case.
I think it speaks volumes that Derrick Mcminns patients arnt routeenly tested for ion levels.
All the best Danny

[Luanna]

Hi Bri,
If you are a small boned female as I am then metal on metal is not the best option according to my surgeon. We went with polyethelene cup and metal femoral component. He would prefer a ceramic femoral component but one is not on the market that would suit his criteria and he'd have to  have on go through an extensive testing program before he'd be able to use it and then monitor outcomes. He's worked with lots of people with small bone and I trust his judgement completely. He does not hesitate using metal on metal with men and large boned females.

My friend was over yesterday and she has metal on metal and her implant has been recalled. Luckily, she is very large boned and so far at 2 years her ion levels are within acceptable levels. 

For us small gals (not saying you are small boned) finding a viable alternative to metal on metal is very important.

Best of luck to you. Keep us posted.
Luann

[hernanu]

I went to my doctor to see about getting both my hips resurfaced.My left hip is the worst. The bone in the socket is wearing away. My left hip ball actually sits up in the joint about a half inch or so. I also had a large cist on the top of my femur. Because of this he said he may have to do a THP. I also mentioned to him that my uncle went to his doctor in wisconsin. He told him that the metal ions are becoming a problem and he did not advise MOM. My doctor said that he knows a doctor in wisconsin that used to do 250 a year.He has cut that in half. My doctor cut the number he does in half.If you google THP on the internet and you look at some of the metal ion articles, there is some scary stuff there. My doctor said there are a lot of unknowns with MOM.He said if you do become one of the stastics. The problems can be very serious. My doctor wrote several articles on the benafits of hip ressurfacing and used to greatly promote it. He went to school in england for it and 2 scools in the us.Any way I am having second thoughts of resurfacing?.

Hi bri, the metal ion issues are real, but as with many real things you need some information on it so you can put it in the right perspective. There is a lot of information on this site and others that speaks to this much better than I could, so there my only advice is to research this site and then use that to make up your mind.

In my opinion, the issues, while serious and a consideration should not deter you from looking more fully into hip resurfacing. I was told by two respected surgeons not to pursue HR due to metal ion issues.
In my research, I found that the metal ion issues in HR are caused by bad device placement, that those of us with proper cup placement are much less apt to have any problems with it. All devices have wear issues, some of the earlier non-metal devices had bad issues with wear generating fragmentation. I am not downplaying the impact of the metal ion problem on those who have it, but it seems that the incidence is very low when cup placement is done correctly.

The more information that I got, the more it seemed that was a symptom of something that we as patients can avoid:

• Bad device placement, which is overcome if you select a good, experienced doctor, and be willing to travel to him / her.
  
• Bad devices. There is enough information now to select a device that has the least problems.

In my opinion only - The benefits of resurfacing outweigh the possible detriments. I think we all have to consider the possibility of a revision at some later time for any number of reasons, not just metal ion issues, so that is one outcome that I have mentally prepared myself for if it eventually happens. I remain optimistic that it won't, since I think HR is a superior technological approach to the problem, being as minimally invasive as it is. As an engineer, I believe in leaving as much of the original structure that your body has as is possible. If THR is indicated and you've gotten several opinions, well, that is it, but this is a big step, and I would not turn my back on something as promising as HR without fully checking it out.

Pat has put contacts in here with very prominent HR practitioners who have excellent results and some accept copies of your X-Rays to give you their (free) opinion - please take advantage of that to let some serious knowledge and brainpower into your decision. In the end, the decision is your own and everyone here respects that, but my advice is to get as much information as is possible. Good luck.

[Anniee]

Bri, you can google almost any medical issue on the internet and find all kinds of scary stuff!  To get GOOD information, you need to make sure the sites you look at are reputable, and not just people with no real knowledge stating their own opinions and fears.  Get the best information you can, and consult some of the top resurfacing surgeons.  As Hernan says, several of them will provide you with their opinion free of charge if you send them your information, including the advantages and disadvantages of resurfacing versus total hip replacement.  All these surgeons also perform THR, so they have nothing particular to gain by steering you towards resurfacing if you are not a good candidate for it.

I would be very interested to know who your doctor is.

[Tin Soldier]

Bri - not sure how much research you've done, but there is a lot of really good info on this forum regarding the metals issue.  Most experienced surgeons believe the problem (as Lop and Hern and others point out) is placement of the components not the alloy.  The alloy (CoCr,...otherwise known as Vitallium) has been around since 1932 (according to Wiki).  I think it was used in artificial joints in the 50s or so.  There was a population from England in the early 70s (Mckee  Farrerr?) that had MoM HRs.  I believe they had pretty good results.  Anyway, McMinn, Gross, Pritchett, and a number of other well known surgeons could explain in detail the history of the MoM HR hip.  None of them are running away from MoM HR and they expect it to be around for quite some time and continue to expect to see excellent results from it.

Take a look at metals info provided by Pat on this website, read up on the McMinn Centre website, review Pritchett's paper on metallosis, and take a look at the interviews of doctors like Gross and others, and there is a lot more on the sibject out there also.  Stay away from lawyer's websites that like to present feable arguments on thin data.  Good luck. 

[Dannywayoflife]

Bri have you watched the video interview Vicky marlow did with Derrick mcminn? It's on her site I think it's on you tube also. Worth a watch.

[Aerial]

I echo what others have said.  A good surgeon should be able to get the placement right and thus avoid an issue with metal ions.  I was very concerned with this but got an excellent explanation from my surgeon.  I was on the fence with metal on metal until I really looked into it.  They can take x-rays inter-operatively to assure good placement.  Choose a doctor with a lot of experience.

[Lopsided]

For us small gals (not saying you are small boned) finding a viable alternative to metal on metal is very important.

Cannot disagree with you more Luann (even though I am a boy, and I believe Bri is too). The best surgeons manage to resurface small boned women with equal success.

It is not size of bones and gender that matters. It is the correct placement of the device.

D.

[MattBrunner]

Bri,

I think the majority of the people here all looked at the risk including the metal ion reaction and were first directed to THR I know I was. 

After all the risks I came to the conclusion that I wanted to play volleyball and be as active as I was before being only 43 and resurfacing would give me the strongest joint with the most natural movement and the choice was clear. 

Also when you read all the problems that can come up with either THR or HR the one that did if for me was that I could always cut my femur and get a THR later, but when the bone its gone its gone.  I'm at 8 weeks and already starting training to get back to the activities I love.

Just ones athletes view.

Matt

[Luanna]

Response to lopsided: I agree with you that placement is critical. However, I do have one of the top surgeons in the world and agree with him on his assessment derived from his research results. Time will tell. McMinn is using this combination on some patients now and outcomes will be shared when enough data is available.

Maybe should change my surface hippy name to Controversial Hybrid Hip. 

Luanna.

[Lopsided]

Hybrid Hippy is hip.

Controversy is essential.

[MattBrunner]

Luanna,

Dr Pritchett told me about the Hybrid hip but that it wasn't available in all the sizes and wouldn't be for at least 8 more years in the US because of the approval process. 

Do you have any links you could send me on the Hybrid version, I am very interested.  It sounds like it could be the future.

Matt

[Luanna]

Hi Matt,
Here is a link to a few research articles written by Dr. Pritchett: www.pritchettorthopedics.com/articles.php

When I discussed my options with him he said that he would not use metal on metal with me (I'll have to ask him if there were other reasons besides my small bone size) when I see him at my 8 week check-in. His preference would have been to use ceramic ball with the Striker X3 polyethelene acetabular component but an appropropriate ceramic ball was not available. Perhaps that is what he is referring to when he told you that it is still 8 years out. He used a Birmingham metal femoral component with the Stryker X3.

When we talked about a ceramic and polyethelene combo he was not very optimistic that other surgeon's would initially jump on board. It sounds like the old polyethelene of years back failed quite a bit and gave it a very bad reputation. He's had good luck with the newer cross linked poly. He also did a study on heat generation and found that during activity the implants generated a significant amount of heat - enough to cause damage in some cases. The combo that generated the least amount of heat was ceramic and poly. I think you'll find the heat study at the link listed above too.

I'm optimistic and trust that his years and years of surgical experience and research will help ensure that I get a lot of wear out of this new hip. Toes and fingers crossed!!!!!

Luanna
 

[23109VC]

When I talked to Dr. Gross about the metal ion issue he said problems associated with metal ions are very rare. 

The local orthopedic dr. I was seeing who initially recommended hip resurfacing (he knew I needed it but told me he was not trained to do it), said metal ions are a current topic of concern, but he implied that many doctors are shifting to other materials for THR more as a precaution.  Not because they know for sure metal ions are actually a problem.

I also have noticed that the orthopedic field seems to be one evolving experiment to some degree.  It sounds like the field has used various materials at different points in the past decades, with varying degree of success...metal on metal, metal on ceramic, ceramic on ceramic, plastic on ceramic... Etc.

For long term durability I don't think anything is as good as metal on metal.

I think any substance has a potential for problems.  I recall my local orthopedic doctor ,mentioning that there have been issues with plastic debris causing psuedo tumors in patients who had the plastic implants..I believe he called it polyethylene....or something like that.

Bottom line..any time you put a foreign object into tour body, there are risks that something could go wrong....you just want to minimize the risks and maximize the benefits.

I'm 38.  I wanted an IMO,ant that might last my whole life...I as also in major 24/7 pain....

I asked about metal ions to a couple doctors, none of them felt it was a problem to be overly concerned about.  My locoal doctor summed it up this way....he said if you were 75 years old, I'd recommend a non metal on metal option to totally avoid the possible issue....but at your age, the only implant that can last long enough is MOM..... He said if he were me, he'd do metal oh metal and not worry about it, as the incidence of problems is so low.  Yes, if you get the problem, then it will suck...but what else do you do? Put in an implant that has a high chance of failing or don't fix it?

Find a good doctor, and your chance of problems is a lot lower.

Im at 7 months post op and feel like a million bucks!  Friday I was in the gym, and did leg exercises (light weight!) and did 30 minutes  on the elliptical..... zero pain ....andi was cooking on that thing!  Yesterday went apple picking with the family, and pulled my 5 year old up and down hills in a wagon...no pain.  I'm glad I fixed it.....my life is no longer ruled by hip pain...and my fingers are crossed the metal ion issue is never a problem.

good luck!

[Anniee]

Sean, I heard the same thing from Dr. Gross.  It is wonderful to hear that you are feeling so great!

[Vicky]

OK, there are a lot of HALF truths being spread out there by the media as well as the attorneys that are in these class action suits. 

I for one am an extremely small boned female, my implant size is a 42/48.  I wear a size 6 shoe, I am 5'3", my Mom who is only about 4'11" tall, full blooded Chinese, has larger fingers than I do, in other words, my bones are smaller than even hers, so my ring size is smaller, wrist is smaller, I can't wear her watches because they flop around on my tiny wrists and if she borrows a pair of my shoes, she stretches them out.  So I am VERY small boned.  You can place your middle finger and thumb around my wrist and they will easily touch, mine do and they overlap, that is how tiny my wrists are. 

I ALSO have mild dysplasia AND I am a woman entering menopause AND I am extremely allergic to metal earrings.   Oh AND I had a femoral head cyst this last time with my right hip!  But I do have bones as strong as an Ox.  :-)  I got my left BHR implanted CORRECTLY and positioned right by Dr. Bose in India almost 6 years ago and even with all of the scare tactics out there today, I went back almost 10 months ago and got my other right side done, yes I went BACK to India, with all that I know today, I CHOSE to go back to him this time because I truly believe he is one of the best in the world, he sews back every single muscle and reattaches every tendon, etc. and he is one of the only docs I have ever heard of that the majority of his patients never get ANY bruising or swelling after their surgery.  I had no bruising and no swelling at all with either of my hip surgeries, so you have to imagine the care he must take to accomplish that.  This recovery has been nothing short of amazing, down to one crutch at 6 days, no walking aids by 3 weeks, practically running up and down my stairs by 4 weeks and had my full range of motion back by 3 months. 

I knew practically nothing 6 years ago and was lucky enough to have picked one of the best surgeons in the world.  Today, I have been told by multiple orthopedic surgeons that I am the most well educated patient in the world today.  I have attended 4 cadaver labs, even one where I got to place my hand inside the cadaver, (it was SO cool!) watched quite a few surgeons in training plus the top surgeons teaching them during these labs and I have scrubbed in and observed a live surgery, standing only 5 feet away from the real patient having surgery. 

I have attended more orthopedic surgeon conferences than any other patient in the world and I know all of the top hip resurfacing surgeons on a first named basis now, plus I have helped thousands of patients get their x-rays reviewed for free from a variety of surgeons worldwide, so I get to see and read the responses and opinions and look at all the x-rays and have learned a TON in the past six years. 

Do you think with ALL of this knowledge that I have, that I would be stupid and go back 10 months ago and get another BHR if I thought for one second that it would be a danger to ME?  Absolutely not.  I would not have considered anything other than a BHR.  Watch these six video interviews that specifically address the metal on metal and metal ion issues that I did last year with six of the world's top hip surgeons.  At that time just between the six of them, they had done over 27,000 total hip surgeries, out of that, over 13,000 hip resurfacings.  That is a LOT of experience between only six surgeons.  And it is really cool because these interviews were filmed in Broadcast HD quality video.

And here is an entire section on metal ions, now if you have a recalled device like the Zimmer Durom or the ASR, that is a different story, and there is info on that here as well from the world expert on ASR's and revising them, Tony Nargol from the UK

Choose a SKILLED and experienced surgeon, remember NUMBERS ALONE do NOT tell the whole story, AND choose a PROVEN device.  To me, think about it, it took 7 years before they recalled the ASR.  I would not personally want a device with less than 7 years history and data behind it, but, that's just me. 

A well placed implant like the BHR (which is the most proven resurfacing device out there today, has been around for over 14 years, and if you count the first prototypes, over 20 years with a great track record) and a skilled and experienced surgeon that does them on a REGULAR basis, to me, at least 500 total and at least a couple a week to keep up with it and attends these ortho conferences regularly to stay up on the latest news like cup angle placements.   A well placed proven component could last a patient the rest of their lives.  I plan on my BHR's lasting me the rest of my life and now I have two of them.  :-)

Unfortunately even though I recently attended the same conference this year in May, I was unable to write an overview due to all the limitations and forms they made me sign stating that I would not and could not use any info from any of the slide presentations, anything I heard, etc.  I mean, what CAN I write about?  How nice my room was while I stayed there?  LOL  So i didn't bother wasting weeks of my time to write up another detailed overview just to have them say I can't publish it on my site.  But the knowledge is still all in my head.

I do not check these boards that often, just randomly since I have my own support group, so if you want to contact me, you can either find me there, the link is on the upper right of my website or email me at vicky@ vmarlow.com  just delete the space. 

And all these NYT articles have one thing in common, the Author, Barry Meier, do NOT believe what you read that he writes, he ONLY writes HALF truths and leaves out extremely important facts.  I have PROOF because he interviewed me and left out over 80% of what we talked about and only wrote about the negative.


Vicky Marlow

[Luanna]

Hi Vicky,
Thanks for all the great info. You've done tons of research on this. We sound about the same size and oddly enough I have a weird reaction to some metal earings too.

There may be extenuating circumstances for the implant hybrid I received. I'll ask at my next checkup. I'm confident that Dr. Pritchett made the best choice for me at this time in my life. I wouldn't allow a less experienced or less successful doc mix and match parts!!!

Time will tell.

Luanna