Blood Tests to Diagnose Tissue Death from Metal Hip Problems

Research Title: Adverse Local Tissue Reaction After a Metal-on-Metal Total Hip Prosthesis Without Elevated Serum Metal Ion Levels

Background

Recent studies show a correlation between high cobalt and chromium levels and failed metal on metal hip (MoM)  implants. Typically a MoM hip patient with cobalt blood levels above 7 parts per billion (ppb) requires follow-up testing to make sure they’re not experiencing tissue death or other metal ion reactions.

Case Report

This study focuses on a 70-year old man whose blood work showed NO elevated metal ion levels.  The man had gone through 3 hip revision surgeries because of fixation problems and infection.  During the 3rd surgery, performed in 2006, doctors used a metal on metal 58mm Biomet Magnum head and acetabular component with a Taperloc stem.

In March 2017 the man went to the ER for pain in his left flank, which doctors thought was a kidney problem.  A CT scan unexpectedly showed fluid collection in the hip and pelvis area.  The patient did report swelling in his left hip over the previous 6 months.

X-rays uncovered bone loss (osteolysis) in the femur and pelvis.  An MRI showed a 16cm fluid collection in the buttocks, hamstring, and pushing up against the sciatic nerve.   When doctors performed another metal ion blood test, it once again turned up a panel of completely normal results, which is unusual for the type of tissue and bone damage discovered.

The patient had yet another hip revision surgery to remove the metal on metal parts.  When surgeons opened up the area, they found a large amount of brownish fluid and inflamed tissue with a brown rubbery appearance.  They replaced the MoM hip bearing with a metal on polyethylene hip implant. 6 weeks after the operation, the patient walked without help and said he felt no pain on the revised left hip.

Discussion

Metal on metal hip implants popular in the early 2000’s are known to shed metal debris and cause massive soft tissue and muscle damage in patients.  Surgeons use a common set of symptoms and test results to find out if a MoM hip is causing internal damage. Those diagnostic tools include x-rays, blood tests, testing for infection, ultrasound, MRI, and patient reports of pain or swelling.

One of the most useful tools to diagnose tissue damage from a metal on metal hip implant is a simple blood test for elevated metal ion levels.  However, this study shows that blood testing alone may not be enough.  The authors believe this is the first reported case of a failed MoM hip implant WITHOUT elevated metal blood levels.

Conclusion

Doctors need to look at the whole picture when treating a patient with a metal on metal hip, including a review of the patient’s demographics, symptoms, implant history, x-rays, blood test, CT scans and other diagnostic tools.

Reference

Tetreault M, Jacobs J, Mahmud W, Nam D. Adverse Local Tissue Reaction After a Metal-on-Metal Total Hip Prosthesis Without Elevated Serum Metal Ion Levels. Orthopedics. Dec 2017; 19:1-4.

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