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Author Topic: Confusion about metal ion levels - advice appreciated please  (Read 7904 times)

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chimera191

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Confusion about metal ion levels - advice appreciated please
« on: March 27, 2012, 04:15:30 PM »
I'm very new to the site (today), I wish I'd found it months ago, as had to deal with issues pretty much alone.

I'm one of the unfortunates that has to have a THR following a De Puy resurfacing 5-6 years ago.  Both cup and cap have moved, the cup was placed at 45 degrees (computer guided procedure) but now sits at 52degrees (still not extreme but is on the move).  The head has collapsed onto the femur and still sits in the moved cup.  I understand the surgeon believes bone has died as a consequence of the prothesis.

I had metal ion blood test in 2010 with cobalt being the highest value at only 4ppb.  Had another blood test recently and its now less than 2 ppb.  I had MRI last Sept which showed a fluid filled area, had another MRI 6 weeks ago, which showed a second fluid area has now developed in less than 5 months.

Much of the advice on the site suggests to expect a correlation between high metal ions and damage.  However I appear to have suffered damage despite rather low levels. 

I'm due to have a THR this week, my surgeon's preference is a ceramic on poly replacement (wants to use DePuy's ceramic product), I understand that the poly cup insert has a lip on it that would reduce chance of dislocation, and could be particularly useful if he has to take significant soft tissue away.  I'm trying to convince him if there isn't too much damage instead to put in ceramic on ceramic.  I ought to add I'm only 45, and hope to have the prothesis for a looooong time.

I guess my concern is that even today's poly's tend to shed particles (albeit slower than MoM) and given my body's apparent extreme reaction to seemingly low levels of foreign particles whether I will likely have a similar extreme adverse reaction with plastic, or could it be that I'm just oversensitive to metal perhaps.  Is there any way of checking?  Any advice greatly appreciated.

hernanu

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Re: Confusion about metal ion levels - advice appreciated please
« Reply #1 on: March 27, 2012, 05:02:03 PM »
Hi and welcome to the site, sorry to hear about the issues, but it sounds good that you're getting them addressed. I think while a lot of focus has been put on metal ion issues as causes for problems, they are actually a minor reason for an HR not working out.

The percentages of failure due to metal ion issues is about 8% of all failures in the Australian registry that accumulated statistic on both HR and THR. A larger percentage of the failures (about 40% or more if I remember right) was cup loosening or lysis. That sounds like it is what the issue is with your cup. That's when a cup or femoral component is not able to integrate properly with the bone, and becomes loose over time.

That's more of an issue with the shape and design of the components, or to some kind of an infection which interfered with that process. One of our hippies just had a revision to a THR for the same reason, loosening of the components. In that case, metallosis is not an issue or the main issue, but integration of the components to make a strong fit with the bone.

I'm not at all an expert, but I believe the new polyester is a much stronger material, but I am outside of my comfort zone on anything THR.
Hernan, LHR 8/24/2010, RHR 11/29/2010 - Cormet, Dr. Snyder

imgetinold

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Re: Confusion about metal ion levels - advice appreciated please
« Reply #2 on: March 27, 2012, 06:15:00 PM »
I'm really sorry about your situation.

My take-away from your post is that a) you are unsure about the type of THR that's best for you, and b) do not trust your surgeon's suggestion implicitly.  Most of the people on this site did a TON of research, and many were told by their surgeons that they should deal with the pain for as long as possible, then get a THR.  If you are unsure, postpone your surgery (if possible) and get some second opinions.  There are a lot of choices, and you should should be really comfortable with the decision, and go in with a full understanding of the benefits/drawbacks of whatever implant you get.

Many of the surgeons on this website give free evaluations, and they all do revisions to THRs.  If it were me, I would do the same amount of research in to my replacement as I did my HR.

Good luck.  Keep us informed.
Andy
- Right Biomet uncemented HR with Dr. Gross on 1/11/2012
- Left Biomet uncemented HR with Dr. Gross on 10/28/2020

BOILER UP!

obxpelican

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Re: Confusion about metal ion levels - advice appreciated please
« Reply #3 on: March 27, 2012, 06:24:17 PM »
I concur with Andy, get other opinions, especially if you have any hint in your mind that what you are getting is not what you think will work.

BTW, the reason for ions being shed is because of a misaligned implant, the ASRs failed because the cup was too shallow.  Some people have no problem with metal ions some people react badly, those are rare but it has happened.

You have many doctors, many options and many devices.  Pick one that will last the longest.  BTW, a cup coming loose is usually the result of doctor error.


Chuck
Chuck
RH/Biomet U/C Dr. Gross/Lee Webb
8-6-08

chimera191

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Re: Confusion about metal ion levels - advice appreciated please
« Reply #4 on: March 27, 2012, 06:54:04 PM »
Thanks for the quick replies all.

A common thread being expressed is that cup likely hasn't bonded with the bone.  Not sure if it changes the advice significantly, but I understand that the cup and head were both cemented in the original resurface rather than the types where the bone is encouraged to bond with prosthesis.

Thanks again

Dannywayoflife

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Re: Confusion about metal ion levels - advice appreciated please
« Reply #5 on: March 27, 2012, 08:00:39 PM »
Hi mate,
           it would be highly unusual for the cup to be cemented that is normally reserved for really old people with terrible bone quality ie noy someone who is a HR candidate!
Train hard fight easy
LBHR 10/11/2011 Mr Ronan Treacy Birmingham England
60mm cup 54mm head
Rbhr 54mm head 60mm cup 12/02/15 Ronan Treacy ROH Birmingham England
;)

hernanu

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Re: Confusion about metal ion levels - advice appreciated please
« Reply #6 on: March 27, 2012, 08:10:06 PM »
Danny's right (again), in both of mine, and in the ones I've heard of, the cup is not cemented, but the femoral component can be. In either case, good coexistence that promotes proper bone growth is crucial. I'll echo the others that you need more information on the alternatives - especially if you don't feel comfortable with the alternative.
Hernan, LHR 8/24/2010, RHR 11/29/2010 - Cormet, Dr. Snyder

obxpelican

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Re: Confusion about metal ion levels - advice appreciated please
« Reply #7 on: March 27, 2012, 08:26:31 PM »
Cups are NOT cemented in.  A loose cup was probably loose to begin with, most of the time it is surgical error.  Within weeks you develop bone ingrowth which holds the cup firmly. 

There are uncemented femoral components but femoral components are generally cemented.


Chuck
Chuck
RH/Biomet U/C Dr. Gross/Lee Webb
8-6-08

Pat Walter

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Re: Confusion about metal ion levels - advice appreciated please
« Reply #8 on: March 27, 2012, 10:21:49 PM »
I am sorry to hear you require a revision.  Acetabular cups in hip resurfacing are not cemented.  They are not cemented in THRs either.  There are special cups with have screws to hold them in special needs.

I would ask what size ceramic on poly you are getting.  If the ball size is not large enough, you could end up with dislocation problems. 

You can get several free opinons about your revision if you want to contact a few other hip resurfacing surgeons like Dr. Gross of SC, Dr. De Smet of Belgium, Dr. Bose of India, Dr. Rogerson of WI.  You can send them emails with a copy of your x-rays in a digital format as a .jpg.  They will give you a free opinon about what they would do in your case.  It is unusual to have both the acetabular cup and femur cap slip.  I have not heard of any cases where both were lose - but I don't know about every revision case.  It might have been that the cup was not placed properly and that put pressure on the cap to slip.  I don't know since I am not a doctor.

I would just make sure you know what restrictions you are facing with the revision.

Pat
Webmaster/Owner of Surface Hippy
3/15/06 LBHR De Smet

 

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