Cobalt and Chromium Poisoning from Metal on Metal Hip Implants

Metal Reaction from Hip Replacement

Reaction to cobalt and chromium debris from metal on metal hip replacement

Patients with metal on metal hip replacements should be aware of the possibility of metal poisoning from their implants. Your doctor will most likely test your blood for metal toxicity.

Many leading orthopedic surgeons are recommending that patients with metal on metal hip replacements undergo cobalt and chromium testing every three months for as long as they have a metal on metal implant.

Cobalt and chromium blood testing is critical, even if you don’t have any symptoms or physical issues with your hip.   Here’s why:  The friction from the metal cup and stem rubbing together can cause extremely small metal particles to break off and spread through your bloodstream and body.  This cobalt and chromium metal debris can result in devastating medical conditions.


Symptoms of  Metal Poisoning

There may be NO SYMPTOMS at all. You may have cobalt toxicity or chromium toxicity from a hip implant, but not realize it because often there can be no immediate physical signs. The long term damage that these metals can do to your body is significant, so the earlier you get seek medical care, the better. Here is a list of possible symptoms :


  • Gastrointestinal Problems
  • Neuropathy (nerve damage)
  • Thyroid Problems
  • Kidney Failure
  • Skin Disorders
  • Hemorrhage
  • Pulmonary Syndrome


  • Elevated Cancer Risks
  • Reproductive System Problems
  • DNA Mutations
  • Impaired Liver Function


What Is Considered A High Level of Chromium and/or Cobalt?

It’s important to remember that slightly elevated metal levels are normal for patients who have metal on metal hip implants, but excessively elevated levels are very alarming.    DePuy Orthopedics, Inc. has released a report stating that concentrations greater than 7 parts per billion of cobalt and/or chromium are of concern. The Mayo Clinic has a set of different reference values for blood serum testing, listed below.

High Chromium Levels:

According to the Mayo Clinic Medical Laboratories, “blood serum concentrations greater than 1ng/mL in a patient with Cr-based implant suggest significant prosthesis wear.” Their research also indicates that these levels increase the longer you have the hip implant.

High Cobalt Levels:

The Mayo Clinic Medical Laboratories also reports that “cobalt is not highly toxic, but large doses will produce adverse clinical manifestations. Toxic concentrations are greater than or equal to 5.0 ng/mL.  Serum concentrations greater than 10ng/mL in a patient with cobalt-based implant suggest significant prosthesis wear.”

Interpreting The Results

Laboratories, research studies, and other reports about metal ion release often use different measurements. That makes it confusing for patients to compare and understand their own test results.  The good news is that most of these measurements are equivalent and represent the same thing: 1 ppb (parts per billion) = 1 μg/l = 1 ng/ml

What Should I Do If I Have Elevated Metal Levels?

See your orthopedic surgeon and internist.  If your concentration of cobalt and chromium remains above a safe level, your doctor will likely recommend a MARS MRI and/or ultrasound and more testing.

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