~12 month post BHR right hip -- <2 weeks away from BHR on left hip

[johnny_canuck]

Hi --

About a year ago, as I was pondering 'options' to treat wonky hips, I lurked on this forum quite frequently, and found a lot of useful advice (despite what I found to be a tendency for people to be wildly enthusiastic about any opinion which said that things 'are fine', regardless of any empirical clinical support for such optimism -- of course people are happy hearing what they want to believe to be true). At the time of my first BHR, I was a mid-50's still very active (train 4-6 days a week, 1-2 hours a day), ex-national-level athlete. I decided on resurfacing, because I wanted to continue this lifestyle to as fair a degree as possible. Chris Drinkwater (Rochester) did the surgery, and it went swimmingly (which is ironic, since swimming is not my favourite sport - although aqua therapy is...see below).

In the lead-up, and recovery from this first BHR, and based on an extensive personal background in orthopedic procedures (my BHR was my 10th orthopedic surgery -- shoulders, knees, elbows, etc...), I learned several things that might be helpful for others to consider (before or after surgery):

1\ ignore the YouTube videos of the various person(s) you might find doing cartwheels (or some such) within a week or two of the procedure. Such videos are basically 'showing off' ('hey, look what I can do. What? You can't? I must be better/stronger/braver than you...(or worse, the suggestion there must be something 'wrong' with your recovery)'). They provide no particular service, except to fool you into thinking that you'll be the same. The statistical reality is, you probably won't be. For 95% plus of all patients, this will not be your experience. The soft tissue trauma involved in a resurfacing (compared to a standard athroplasty) means that you're more than likely to take quite some time getting to the point where you feel 'normal' again. For me, it was in the 4-6 week range, 8-10 before I was completely over my limp.

2\ I have small femoral head diameter (relatively speaking), and there is increasing concern in the literature that this may contraindicate the procedure for some people. I just nudged in above the threshold to let me use the Brimingham appliance. This is fine (for me, obviously), but the reason for possible continued concern has to do with the fact that the smaller the femoral head diameter (and thus, the acetabular cap and femoral had appliance), the greater the likelihood of possible 'issues' at some point.

For me, it has been the very recent development of the 'squeak' (or 'squeal', whichever you prefer). 2-3 days back, my hip starting squeaking in certain positions/movements. Intermitent, without any concordant pain. For grins, I did a quick search on this forum, and there seems to be lots of 'hype' about the squeak having to do with 'hydration levels'. Possible, although I think pretty unlikely, since hydration doesn't immediately influence production of synovial fluid, or its viscosity. So, simply assuming its 'nothing' but a benign, albeit annoying artefact of 'hydration levels' may be premature. If you read the clinical literature, evidence suggests that there might be myriad reasons for the squeak -- including some pathological (i.e., not solved by 'consuming sports drinks'). Especially if you have 'small diameter' devices. At the minimum, you should contact your surgeon's office to alert them. Some surgeon's will immediately echo the 'its nothing, it will pass' line of thinking (which of course, is happily accepted by patients because its what they want to hear), but others will point out there is in fact some chance that 'something has changed' -- cap slippage, for example (unlikely, but..), and so forth. If squeaking indicates a potential problem (and, if nothing else, it is an outcome of metal on metal friction, which likely increases  metal ion release rates -- not a good thing), have it checked out. Radiological exams help the surgeon evaluate the implants, and make sure nothing untoward has happened.

Sometimes (as has been documented by personal stories on this forum), the squeak starts as a result of a behavior change (like, deciding to climb a mountain when previously you haven't). In my case, I was doing nothing more than walking down the aisle of a hardware store (ironic at several levels), when all of a sudden, my hip started squeaking. And I was/am fully hydrated (as above, I tend to think that 'explanation' is overly simplistic -- while we're on the subjkect, I'm also not too confident that the argument I've seen occasion that the 'devices are just breaking in' holds much water. These are high density metal compounds we're talking about, with the intent being they don't wear out. So what, pre tell, is 'breaking in'?). Could be, might be, but I see no harm in getting things checked.

And, referring to the literature, the squeak appears to be more likely to arise in small diameter cases. The has been shown for standard hip replacements (ceramic on ceramic, for example), as well as resurfacing. In fact, there is at least one paper that says that the medical community should do a better job in alerting patients who are getting a small diameter appliance that the squeak mught be more likely for them.

3\ on the positive side (assuming new squeak is benign), my expriences have been outstanding. I've recovered a range of motion I haven't known for years. One major thing to try during rehab is 'aqua therapy'. While I've spent 40-45 years doing high level training, and know more PT moves and PT people than I can count, I was astounded at how much better, and how rapidly, aqua therapy advanced my recovery. Knowing that, I'll start walking the pool sooner this next time.

4\ small negative related to (3) is that my better right hip only amplified how lousy my left hip is. So, in theory, unless I hear that the squeak in the right hip is a real problem problem, I'll have the left hip done at the end of the month.


If I hear anything more on the hip squeak, I'll post.  Heck, maybe I'll squeak in both hips, and can become a recording star if I could work out the melodies.

[Pat Walter]

Johnny
Thanks for the update. The stories are so helpful to new people wondering about hip resurfacing.
As you mentioned, hip squeaking sometimes happens. most people feel it is because they are dehydrated.

Water walking and exercises really helped me.  Dr. De Smet in Belgium offers it and encourages it.  Easier on the newly operated hip.
I am glad you are doing well.  I wish you the best with the next hip.
Thanks again for telling your story.
Pat

[johnny_canuck]

8 days aways from my left hip BHR (maybe...see 1, below).

1\ squeaking as reported in OP has subsided, but my surgeon (Drinkwater) requested a blood scan for chromium and cobalt. Basically, if (i) you have squeaking, its metal on metal (MoM), without a synovial barrier, (ii) persistent MoM releases more ions (metal ions being generally bad for children and other living things), and (iii) this is more likely to occur for patients with smaller diameter hardware (which is what I have). Had the blood draw yesterday -- we shall see. If ion levels too high by various measures, surgery for left hip will (probably) be postponed/rescheduled (and we'll have a chat abut revision to standard total hip... ).

2\ one thing I should have mentioned in my OP that the resurfacing not only took away the hip pain and restrictions in the hip socket (i.e., the groin), but also elimnated secondary issues the restricted hip was causing. Specifically, significant SI dysfunction. Basic point -- if the hip is restricted, then this can translate into increased torque on the SI joint, amongst other things. In my case, fixing the right hip *completely* resolved the SI pain I was having. I'm having the same issues now with the left hip/left SI joint (plus nasty tendonitis of left hip flexors). If I get the procuedre done on left hip as planned (see 1, above), I'm hoping it will alleviate the problem(s).

[hernanu]

8 days aways from my left hip BHR (maybe...see 1, below).

1\ squeaking as reported in OP has subsided, but my surgeon (Drinkwater) requested a blood scan for chromium and cobalt. Basically, if (i) you have squeaking, its metal on metal (MoM), without a synovial barrier, (ii) persistent MoM releases more ions (metal ions being generally bad for children and other living things), and (iii) this is more likely to occur for patients with smaller diameter hardware (which is what I have). Had the blood draw yesterday -- we shall see. If ion levels too high by various measures, surgery for left hip will (probably) be postponed/rescheduled (and we'll have a chat abut revision to standard total hip... ).

2\ one thing I should have mentioned in my OP that the resurfacing not only took away the hip pain and restrictions in the hip socket (i.e., the groin), but also elimnated secondary issues the restricted hip was causing. Specifically, significant SI dysfunction. Basic point -- if the hip is restricted, then this can translate into increased torque on the SI joint, amongst other things. In my case, fixing the right hip *completely* resolved the SI pain I was having. I'm having the same issues now with the left hip/left SI joint (plus nasty tendonitis of left hip flexors). If I get the procuedre done on left hip as planned (see 1, above), I'm hoping it will alleviate the problem(s).

Good luck Johnny. Hope the blood scan goes well. I'm glad your squeaking subsided, mine did in time as well. 

I'm one of those that believe in hydration, since the synovial fluid is not a solution, but a suspension of protein based complexes that rely on "water pools" for some of their function. It's by no means the only variable involved, but with our reliance on synovial fluid, why not up our chances for success?

Anyways - I know the suspense of waiting for metal test results, mine just came back at the nine year stage on two hips.

[johnny_canuck]

Good luck Johnny. Hope the blood scan goes well. I'm glad your squeaking subsided, mine did in time as well.

Alas, not so good. Levels in the 10-12 range for both cobalt and chromium, well above what Dr. Drinkwater is comfortable with wrt to the BHR on the right side (despite perfect alignment), and definitely more than he would want for bilateral (meaning, we're on hold for the left hip, which is -- or, rather, was -- scheduled for this Friday).

The usual discussion points -- (1) the elevated ions could simply reflect the MoM that was characterized by the squeaking (which has abated), (2) said  squeaking potentially reflecting issues that seems to be more likely (at least probablistically) for people with small diameter hardware (like me -- 44). It is conceivable that (3) the levels will stabilize or go down if/when any 'breaking in' is finished (I'm still not sanguine about this being likely, but I'll accept it's possible).

Of course, the bigger uncertainty is if there is attendant metallosis impact on bone and surrounding tissues. I have no superficial symptoms at this stage, but I'm generally a believer in being proactive, rather than reactive. We shall see.

I'm one of those that believe in hydration, since the synovial fluid is not a solution, but a suspension of protein based complexes that rely on "water pools" for some of their function. It's by no means the only variable involved, but with our reliance on synovial fluid, why not up our chances for success?

Yes, synovial fluid is a colloid suspension. This much I know. ;-) Hydration is only a small part of that -- but, point taken.

Anyways - I know the suspense of waiting for metal test results, mine just came back at the nine year stage on two hips.

As above -- for the moment, looks like I'm in the percentile of the distribution that has 'issues'.

[hernanu]

Good luck Johnny. Hope the blood scan goes well. I'm glad your squeaking subsided, mine did in time as well.

Alas, not so good. Levels in the 10-12 range for both cobalt and chromium, well above what Dr. Drinkwater is comfortable with wrt to the BHR on the right side (despite perfect alignment), and definitely more than he would want for bilateral (meaning, we're on hold for the left hip, which is -- or, rather, was -- scheduled for this Friday).

The usual discussion points -- (1) the elevated ions could simply reflect the MoM that was characterized by the sqeuaking (which has abated), (2) said  squeaking potentially reflecting issues that seems to be more likely (at least probablistically) for people with small diameter hardware (like me -- 44). It is concivable that (3) the levels will stabilize or go done if/when any 'breaking in' is finished (I'm still not sanguine about this being likely, but I'll accept it's possible).

Of course, the bigger uncertainty is if there is attendant metallosis impact on bone and surrounding tissues. I have no superficial symptoms at this stage, but I'm generally a believer in being proactive, rather than reactive. We shall see.

I'm one of those that believe in hydration, since the synovial fluid is not a solution, but a suspension of protein based complexes that rely on "water pools" for some of their function. It's by no means the only variable involved, but with our reliance on synovial fluid, why not up our chances for success?

Yes, synovial fluid is a colloid suspension. This much I know. ;-) Hydration is only a small part of that -- but, point taken.

Anyways - I know the suspense of waiting for metal test results, mine just came back at the nine year stage on two hips.

As above -- for the moment, looks like I'm in the percentile of the distribution that has 'issues'.

Sorry to hear about the results, it's good you're working with your surgeon to chart a good way to go. Good luck, brother.

[johnny_canuck]

Indeed, thanks. Much to consider.

But, you can now put me firmly in the camp that advocates regular metal ion testing, especially if you have small(er) diameter hardware. Basically, once a year. The consequences of having high ion levels, even if asymptomatic, aren't worth the risk of not knowing (one of my hats is toxicology, so trust me when I say that elevated metal ions is a *bad* thing in the long run). Seriously. If I hadn't 'squeaked', and if I'd bought into the 'nothing to worry about, its just hydration', I'd not have contacted my surgeon, not had a blood test, and not had a clue. All my imaging is/was 'perfect'. But,  apparently, my blood isn't.

[hernanu]

Indeed, thanks. Much to consider.

But, you can now put me firmly in the camp that advocates regular metal ion testing, especially if you have small(er) diameter hardware. Basically, once a year. The consequences of having high ion levels, even if asymptomatic, aren't worth the risk of not knowing (one of my hats is toxicology, so trust me when I say that elevated metal ions is a *bad* thing in the long run). Seriously. If I hadn't 'squeaked', and if I'd bought into the 'nothing to worry about, its just hydration', I'd not have contacted my surgeon, not had a blood test, and not had a clue. All my imaging is/was 'perfect'. But,  apparently, my blood isn't.

Completely agree with you. The one thing that can affect all of us is problems with metal ions. I insisted on the test every time I went in, and now the doctor insists on it every two years.

Always have to be aware, it's your body and the doctors work for you, not otherwise.

[johnny_canuck]

Completely agree with you. The one thing that can affect all of us is problems with metal ions. I insisted on the test every time I went in, and now the doctor insists on it every two years.

Always have to be aware, it's your body and the doctors work for you, not otherwise.

Indeed -- agree entirely.

At present, looks like the resurfacing I had scheduled for Friday is 'cancelled' (or, deferred). The options are to either (i) go with a standard total hip on Friday (probably CoC or mini-hip, anterior approach), since the OR is already booked, or (ii) wait and watch ion levels on the right hip, and if they come down (suggesting that the elevated levels I have a present are transient), then re-consider resurfacing the left hip at a later date.

One thing that comes up a lot in things I've read is that elevated ion release, as a result of MoM, is very likely due to edge loading. And, it is surmised, that such things reflect some level of 'misalignment' duing the surgical procedure, which is causing the problems. While I think the clinical evidennce clearly indicates that the mechanical argument is sound (being, edge loading), there are other non-surgical factors I can't help but think also a factor, like, basic non-surgical realignment of the hip during certain activities that puts the femoral and acetabular components out of alignment. Do that often enough, and perhaps thats where the problem starts in some cases. In my case, for example, I suspect that post-surgical activity might be a factor, exacerbated by the intensity (1.5+ hours) and frequency (5-6 days a week) I 'exercise'. Even a 'non-impact' elliptical might be problematic -- 160-180 revolutions a minute, for 30-40 minutes, might in and of itself cause an issue (in fact, one of the 'factors' that keeps popping up in the literature for people with high ion levels is 'intensity of exercise'. The other key factor is 'small diameter size'. In my case, the two combined might be contributing factors).

[johnny_canuck]

Completely agree with you. The one thing that can affect all of us is problems with metal ions. I insisted on the test every time I went in, and now the doctor insists on it every two years.

Always have to be aware, it's your body and the doctors work for you, not otherwise.

Indeed -- agree entirely.

At present, looks like the resurfacing I had scheduled for Friday is 'cancelled' (or, deferred). The options are to either (i) go with a standard total hip on Friday (probably CoC or mini-hip, anterior approach), since the OR is already booked, or (ii) wait and watch ion levels on the right hip, and if they come down (suggesting that the elevated levels I have a present are transient), then re-consider resurfacing the left hip at a later date.

And, if the ion levels *don't* come down, broach the subject of a revision. [Has anyone ever heard or seen a clinical report of someone with high levels of Co and Cr coming down w/o removing the MoM implant?]

[Saddlepal3]

Johnny,
Sorry to hear that you’ve encountered problems with metal ions. I also ran into issues, albeit 12 years post-op. The metal ions were not as high as yours (7s and 8s), but a MARS MRI showed fluid accumulation in the joint capsule. Dr. Pritchett in Seattle was my original surgeon and he recommended a revision. Last Sept (2018), he switched out the cup with a poly lined version, so no more metal on metal. Recovery has been very smooth. I don’t know where you live, but Dr. Pritchett has a lot of experience with revisions. Good luck!

[johnny_canuck]

Thanks for the info -- I think it worth noting that revision might be needed even for hardware put in by 'super experienced surgeons' (my surgeon being one of them, Pritchett a very well know one as well). Of course using experienced surgeons is a key step in the decision, but 'experience' is not a proxy for 'foolproof'. Its surgery, and they're putting foreign objects in your body. Occasionally, things don't go as planned.

My surgery was cancelled/post-poned, as expected. At this time, we're not discussing revision, and at ~1 year post-surgery, likelihood of a MARS MRI showing anything 'useful' is pretty small (so we're not doing that just yet). Game now is to re-test blood in ~3 months, and see what the Co and Cr levels look like. Hypothesis is that the elevated levels are an artefract of the 'squeak' - being created by direct metal on metal.  So, this might present a couple of interesting data points -- to see if Co and Cr ions are especially generated by a 'squeak event' (which hasn't returned since my OP), and if their profile in my blood declines on the assumption I'm not creating more ions. I'll update when I have new blood measures.

[hernanu]

Thanks for the info -- I think it worth noting that revision might be needed even for hardware put in by 'super experienced surgeons' (my surgeon being one of them, Pritchett a very well know one as well). Of course using experienced surgeons is a key step in the decision, but 'experience' is not a proxy for 'foolproof'. Its surgery, and they're putting foreign objects in your body. Occasionally, things don't go as planned.

My surgery was cancelled/post-poned, as expected. At this time, we're not discussing revision, and at ~1 year post-surgery, likelihood of a MARS MRI showing anything 'useful' is pretty small (so we're not doing that just yet). Game now is to re-test blood in ~3 months, and see what the Co and Cr levels look like. Hypothesis is that the elevated levels are an artefract of the 'squeak' - being created by direct metal on metal.  So, this might present a couple of interesting data points -- to see if Co and Cr ions are especially generated by a 'squeak event' (which hasn't returned since my OP), and if their profile in my blood declines on the assumption I'm not creating more ions. I'll update when I have new blood measures.

Good luck - hope no revision is needed, and the more we know about the sources of generation of metals ions, the better we are.

[johnny_canuck]

Good luck - hope no revision is needed, and the more we know about the sources of generation of metals ions, the better we are.

Thanks, but I'm mentally prepping for a revision. What kind of revision is an open question (althout I suspect I'd opt for standard CoP, or some such -- but who knows, I could change my mind). I know with ironic amusement my right hip BHR was performed on Friday the 13th of last year. 

One factor that one of my high-end PT folks suggested might be in play is that the acetabular and femoral components are placed assuming that the 'geometry' of the articulation through the range of motion doesn't change. If it does for some reason (say, a minor sublux of the SI joint, or some muscle imbalance), it is quite possible that the 'correct allignment' gets thrown out of whack, and surfaces/edges start rubbing. Given how hard I push my body (that being the whole point of the 'no restrictions' resurfacing in the first place), this wouldn't surprise me in the slightest.

[hernanu]

Good luck - hope no revision is needed, and the more we know about the sources of generation of metals ions, the better we are.

Thanks, but I'm mentally prepping for a revision. What kind of revision is an open question (althout I suspect I'd opt for standard CoP, or some such -- but who knows, I could change my mind). I know with ironic amusement my right hip BHR was performed on Friday the 13th of last year. 

One factor that one of my high-end PT folks suggested might be in play is that the acetabular and femoral components are placed assuming that the 'geometry' of the articulation through the range of motion doesn't change. If it does for some reason (say, a minor sublux of the SI joint, or some muscle imbalance), it is quite possible that the 'correct allignment' gets thrown out of alignment. Given how hard I push my body (that being the whole point of the 'no restrictions' resurfacing in the first place), this wouldn't surprise me in the slightest.

I guess you can't tell what can happens, if your architecture changes, then that may cause some issues. I've been pounding my body all my life and continue to do so, so hopefully in your (and my) case, we are structurally sound.

I'd be readying myself mentally too, if less happens, then that's a happy moment. Good luck again, hoping that better news comes your way.

[jsblock11]

I'm in a similar situation as you, 1 year and 7 months postop with elevated ions (4.1 Chromium, 3.6 Cobalt) that put me in a gray area. My ions aren't as high but I have had problems since the beginning: impingement, clunking, popping, stiffness that have yet to resolve and for the most part I'm no better than pre-op. Given that my cup angle is "perfect" per Dr. Gross, Pritchett, and Brooks, they don't know why I'm having pain. Given all of that combined, I'm in wait and see mode on a THR revision. If we do a revision my surgeon has suggested keeping the BHR acetabular component and putting in a dual mobility femoral component which is his preferred method if the cup is well placed. 

Have you talked about that with your surgeon? There is still one metal bearing surface that concerns me with that approach, but at least no MoM. The dual mobility is a ceramic ball that articulates inside a poly shell, and that poly shell in turn articulates in the BHR cup. I know that at least Dr. Pritchett uses that method if the cup angle is good and secure. I do honestly fear the possibility of metal sensitivity though, and I would think the Poly on metal articulation may still create metal ion release?

[johnny_canuck]

Have you talked about that with your surgeon? There is still one metal bearing surface that concerns me with that approach, but at least no MoM.

Basically, if they leave the current metal accetabular component in place, and reivse the femoral component, you don't have a lot of options beyond ceramic. If they put a 'liner' in the acetabular component (which is pretty new, to the point where only a few doctors will try it), then they have more options. The dual mobility approach is one such option.

Poly on metal is pretty safe. All the clinical studies show that there will be no metal ions. Plastic bits and pieces, on the other hand. The super cross-linked poilypropylene stuff is about the best they have now.

Look, until they figure out a way to re-grow hip cartiledge (stem cell research is one approach, but probably not in our lifetime), we're all stuck with having bits of metal or plastic put in our bodies as a solution to arthritic degeneration. For some people, it works great. For others, not so much. So be it. About all I can say is that I'd absolutely have blood chemistries checked, regularly - no matter what the doctors say (which is typically, 'if there are no symptoms, don't test for metal ions'. Gee, wonder if all the women who get tested regularly for breast cancer are told not to get checked, unlessa they find a lump? Or, men with normal urine stream - no need to check for prostatic changes since there are 'no symptoms'. Patently silly. You should get checked for metal ions because you have hunks of metal in your body. Period.) . And if there is any problem, ask for more diagnostics.

 My blood tests are end of September. I'll report here what they find. If its still as high as they were (10-11), then no real decision -- hack it out, and start over with THD. Harder decision is if its (say) 4-6. Down, but not 'healthy'  down. And 2 points don't consitute a trend (I do advanced statistics and probabilities for a living, so a 2-point inference is a bit of a stretch for me).  We shall see...

In the meantime, my left hip (which I was supposed to have done in June) feels like crap. Can't get it 'taken care of' until we resolve the re-surfaced right hip.

[johnny_canuck]

Well, just got the results of metal ion test #2, from ~1 week ago (another scheduled for 26 September).

Cobalt Serum   2.2      
Chromium        5.2   

Test #1 which was ~1 week after my BHR started squeaking like a rusty door hinge) was *much* higher (11 and 12, respectively).  2 points isn't sufficient for a trend, but it at least moved the *right* direction. One explanation might be that the 'squeaking epsoidoe' dumped a bunch of ions into my bloodstream, which take a while to 'filter out'. We'll se what test #3 shows.

In my mind, the end points of the concentration spectrum are easy to work through: if levels stay mega high, hack the stuff out, and go to standard hip replacment of some sort. If the levels went to 'normal' (whatever that is, but, say, <2), then keep BHR, and consider getting left hip done.

Mid-points harder to know what to do. When ion levels are neither here nor there, do you wait, and see if they continue to drop (hence interest in test #3), or assume that is status quo for the device in your body, and order up a MARS MRI to see if there is metalosis. Etc. We shall see...

[coloradopatrick]

Thank you Johnny for the detailed posts.  This is very helpful for the rest of us.  I am scheduled to have a BHR in about a month and am concerned about the metal ion issue. You have done a great job outlining all the realities, pros and cons.  I hope your ion levels continue to drop. I have found it interesting that you have not opted for a THR for the other side - does this mean that you are convinced that the advantages of the BHR outweight the potential risks of metal ion elevations?

Also, am I correct in my recollection that many surgeons suggest that the ion levels increase in the first year and that is considered "normal"?  I agree with your skepticism about the idea of a "break in" but it seems this idea is quite entrenched and is consistent with the idea that ion levels that are elevated in the 1st year are somehow less concerning than thereafter.

[johnny_canuck]

So, some updated data -- if you've followed this thread, ~180 days ago, a couple of weeks before I was supposed to have a second BHR (left hip - right hip done earlier in summer 2018), I developed a squeak. Simply put, a squeak is metal-on-metal. And, metal-on-metal means ion release. Period. So, I had a blood test, and sure enough my coboalt and chromium levels were very high (11 and 12, respectively). So, my surgeon and I decided to defer the scheduled surgery, and 'try an experiement'. His working hypothesis is that the elevated levels were a transient aritfact of the squeak.  The time-series of blood tests I have had since then seems to corroborate the gist of the hypothesis:

June 11, 2019 -- [cobalt] - 11, [chromium] - 12.4     

September 6, 2019 -- [cobalt] - 2.2, [chromium] - 5.2 

September 23, 2019 -- [cobalt] - 2.4, [chromium] - 5.6   

December 9, 2019 -- [cobalt] - 1.8, [chromium] - 4.4 

So, clear trajectory down (exponential decay function, characteristic of system clearance of a lot of things). Cobalt is clearing very quickly -- faster than average based on clinical rates of clearance from people who had the BHR device removed in a revision (which would be a 'Gold standard' - no device, no source of ions, body clears on its own). So, thats good. Cobalt is the nastier of the two. Chromium clears more slowly -- current view is that a lot of it gets 'stored' in various tisses and interstitial fluids, and takes longer to clear. Of course, worth remembering that there are no universally agreed upon standards for 'acceptable' levels.

So,

1\ if you've had a 'squeak' get checked (since squeak = direct metal-on-metal,  without the cushioning of synovial fluid). Levels will likely be high, but if the squeak is transient, and if the ions are an artifact of the squeak, then ion levels will probably decay over time (data above over half a year).

2\ I'm having another test in March. If generally trajectory continues, then I'm scheduled (or, rather, re-scheduled) for the left-hip BHR end of May.

Someone asked earlier why still focussed on BHR? Simple -- BHR = no restrictions. At all. ~6 months after my procedure, I was doing 2+ hours of exercises a day, lots of leg work in weight rooms (squatting hundreds of pounds), skating, lacrosse, you name it. Sorry, but you can't do that with a THR (and besides, all my small-boned friends who had a THR complain about thigh pain after activity). I haven't had a sinlge problem with the BHR, if it weren't for pesky ions.

I still contend that resurfacing has a risk, relative to THR and other modalities (exacerbated by high levels of activity, and small diameter of the femoral head -- if you have both, I'd double the risk rate of 'issues' relative to the published values). Ions from MoM are a real problem. Probably the gen X types will, by the time they get to the age when hip surgery is on the horizon, have full ceramic/cross-linked polypro devices that last forever with no degradation. In the short run, I figure I have about another 10 years of serious activity left, so I'll roll the dice for a BHR.