My Ion Levels are High

[cwg]

It has been a while since I posted here , and it may be a bit premature because I don't really understand what my latest x-Rays that indicate "failure of bone growth to inplant", actually means. And why this is only showing up now five and a half years later.

I just got back from a trip to Hong Kong and the x-ray was taken by my Australian BHR surgeon, Dan Hooley. I left HK 3 years ago and during this time have had continuing problems.. Besides the clinking clunking and pain, my ion levels are more than 50 times the "safe level". An ultra sound and x-rays  taken one year ago here in Vancouver showed "perfect placement" and no pseudo tumours etc.
Am curious what the xray in Vancouver showed last year as far as bone growth to inplant, and will have them compared

I doubt I am the only one on this site with similar problems so  back to reading.

Appreciate this site that shows all sides

[hernanu]

I'm really sorry to hear that, cwg. You always have support here.

I would also be curious about what was shown by the XRays last year. I know we have a couple of folks here who have had the same failure and were revised, with good results. Not saying that you need a revision, but you want all of the good information you can get.

Maybe to help you see what happened, you could get those XRays and send them to some of the surgeons listed here to get their take on what happened.

Please let us know what happens and how you're doing.

[cwg]

Hi Hernanu- Thanks, and yes, I will keep posting, in particular with the Xrays.  And this time, I am ready to ask "some of the surgeons listed here", for outside opinions... It's all been very weird since my BHR in 2007
Cheers

[Tim Bratten]

Hi Hernanu- Thanks, and yes, I will keep posting, in particular with the Xrays.  And this time, I am ready to ask "some of the surgeons listed here", for outside opinions... It's all been very weird since my BHR in 2007
Cheers

Hi cwg

I am not a doctor, but looking over some of your old posts it seems to me your ion levels are too high and have been for some time. De Smet et al have come out with recommended upper limits :

http://www.clinorthop.org/journal/11999/0/0/2526_10.1007_s11999-012-2526-x/2012/The_2012_Otto_Aufranc_Award_The_Interpretation_of.html

http://www.healio.com/orthopedics/hip/news/print/orthopaedics-today-europe/%7B3ff58413-c747-4495-ba51-bbf8ecaa7fba%7D/researchers-set-safe-upper-limit-metal-ion-levels-for-metal-on-metal-hip-resurfacings

http://www.hipresurfacingnews.com/categories/20-Metal-Ion-Issues

If I understand the numbers you posted you are well above the limits where "Revision should be considered even without symptoms" and I think your best move would be to contact a very experienced revision surgeon.

In the study referenced in this particular thread (from Lancet) they compare five year revision rates of HR with a 28mm plastic on metal cemented THR. Looking at your age and speaking from considerable personal research, as well as my own personal experience, I would highly recommend that you do not revise to such an implant. You might try to contact one of the very experienced revision surgeons listed on this site (for example Koen De Smet). I had a poorly done HR (in my case 100% surgeon error) that I suffered through for more than a year and a half before having a revision to a 40mm (with screw) ceramic on ceramic THR done by De Smet. At more than eight months I can say the revision seems to be working very well and I am quite active rock climbing and hiking.

Good luck with your problems. From what little I know, it seems to me picking the right surgeon is the most important ingredient of all.

PS: now it seems the second reference I gave is not loading without a login. At any rate, in the reference given they recommended with ion levels above 20 micrograms that revision should be considered without any additional symptoms.

PPS: I got the second reference to load again and here is the relevant part:

If the researchers find metal ions levels lower than 4 µg/L in the absence of clinical and radiological symptoms, patients undergo routine follow-up. If levels are between 4 µg/L and 10 µg/L, metal ions are moderately elevated and “thorough diagnostic investigations have to be repeated until you find the cause,” Van Der Straeten said. If metal ion levels are higher than 20 µg/L, there may be systemic toxicity and diagnostic investigations are required. Revision should be “considered even without symptoms,” she said.

[Tin Soldier]

CWG - good to hear from you again.  Hope you're finding some answers, or will soon.  I'd recommend talkiong to Pritchett, he's close but in the US and I don't know how that works with insuracne across the border.  He might offer a free consult or even just a phone call with a little background (x-rays and your story).  Good Luck

Danny - with regards to the very experienced surgeons, we can see pretty easilly that McMinn has a lower revision rate than the national registries.  I believe the same can be said for a number of the other well-known surgeons, although I don't recall where I've seen their data.  Might just be from folks here reporting revision rates after asking the doc about their stats.       

Also none of the docs that were referenced in that Lancet article are experts on HR.  As Pat pointed out, it seems very unfounded to generalize and say women should not have HR when the data don't really support that argument.  And another thing, Sedrakayan in the article refers to using "evidence based" approach to support or not support the HR.  Hello, evidence-based means using the latest and greatest epidemiological studies (ie national registries, datasets from specific centers, datasets from specific studies...).  His argument that women in general should not have HR is unsupported by the available data. 

I'm really starting to wonder if there is an underground anti-HR campaign by big money.  Maybe another well-known prosthetic maker is trying to squash HR?  Maybe in a few decades this will be similar to the Ford and Rudolph Diesel theory. 

[Spanielsal]

Hi Rosie

I'm female, 40 and in the UK.  I had a resurfacing in 2003 which is doing well despite pain this year which turned out to be referred from the other hip.  My surgeon is no longer doing resurfacings.  He says that I am a prime example of why they do work and work well in some women but he prefers to do the minihip arthroplasty.  I have perfect ion levels, good placement and no issues on the MRI. .  My left hip (resurfacing) components are 40mm femoral and 46mm acetabular and my right hip (mini thr) are 36mm and 50mm I think the acetabular component is larger due to a plastic liner.  i have no restrictions other than bungee jumping and marathon running although I think my surgeon knows I will be cautious with it as I have no wish to be back on the operating table anytime soon.  with my first op he did say how long it lasts is pretty much up to you, I walk, I garden i have done a little jogging but my unoperated hip went on strike for a month so I haven't tried that again.  I will one day ski again, ride again and a little mountain biking but nothing too scary.  the incapacity was scary enough.

 I think the THR is an easier operation and certainly an easier recovery for me this time around. my question about the minihip is longevity, but being a new item there isn't data, I believe in resurfacing, i wanted another but due to my problems not showing up on xray well I needed help and my surgeon was the only one listening to me.  He wasn't doing resurfacing so I was having a mini hip or nothing. It is the next best thing and I have still kept a lot of bone for future revisions.  The pain i was in meant that i was just incredibly grateful for being operated on. 

If you want a resurfacing, I suggest you go to one of the most senior experienced surgeons (2000 resurfacings plus) and get their opinion on whether or not you would be a candidate.  Trust them.  I do believe it is a better solution and leaves you in a better place for the future if done by the right surgeon.  all operations have their statistics of failure, no hip surgery is ever undertaken lightly it is pain that drives you to the surgeon's knife.  You just want the odds stacked better in your favour and you can achieve that by doing exactly what you are doing, your own research. 

the media are certainly seeming to vilify HR, i can't understand it, i'd rather have the choice as a patient, to conserve more bone.  My surgeon pretty much blamed it on the ASR, most devices are very sucessful but that was so poorly designed.  some MOM THR are as bad and have been recalled.  the Metalosis issues are generally non issues if you have perfect placement although some are unlucky.  if you are sensitive to metal then perhaps you should think hard about it but I have topical nickel allergies and as it turns out no hip issues from my 9yr old resurfacing.

I hope you come to a satisfactory conclusion, i'm always around if you want to chat - being a hybrid means that i've experienced both sides of the equation and am now bionic, pain free and grateful.  pm me if i can help.

Sal 

[obxpelican]

Just ask Dr. Bose about small Indian women..... ask what his results are.

This is all about the quality you pick is the results that you will get.



Chuck

[Dannywayoflife]

Well put chuck