Metal Reaction from Hip Replacement

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

Heavy metal poisoning is a risk factor for anyone who has a metal on metal (MoM) hip implant.  Corrosion from microscopic metal particles in your bloodstream could trigger a hypersensitive immune response in your body.

Your doctor or surgeon will most likely test your blood for metal toxicity. If you have a MoM hip implant and have not gotten bloodwork done yet, you should ask your doctor about it right away.

Blood Serum Metal Testing

Many leading orthopedic surgeons recommend that patients with metal on metal hip replacements undergo cobalt and chromium blood 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 can result in devastating side effects.

What Is Considered a High Level of Chromium and 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 a much lower reference value for blood testing, listed below.

High Chromium Levels: Greater than 1ng/mL

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: Greater than 10ng/mL

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 primary care physician immediately.  This is a situation that requires long-term medical monitoring. If your concentration of cobalt and chromium remains above a safe level, your doctor will probably recommend a MARS MRI and/or ultrasound and more testing.  If not, you may want to request these advanced tests from your doctor, even if you don’t have any symptoms.

What if I DON’T Have Any Symptoms?

Often there are no immediate physical signs of a problem, but the hidden damage that these metals can do to your body is traumatic.  The earlier you get medical care, the better. Read more about the different types of adverse reactions below.

Hip Revision Surgery – Preserving Evidence

If you have higher than normal metal levels in your blood, or other complications, your surgeon will probably recommend a hip revision. This is a second hip surgery to remove parts of your current MoM hip and replace them with a different type of implant.  It’s very important to contact our attorneys before your revision surgery so we can preserve evidence for your case.  This includes getting images of the tissue damage and safe storage of the implant parts removed from your body.

Contact us immediately for a case evaluation because there is a time limit to file a claim.  Fill out the form below or call us toll-free at 888-952-5242.

Talk to us about problems with your metal on metal hip replacement

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Our Extensive Legal Experience in Metal on Metal Hip Litigation

➨ Maglio Christopher & Toale, P.A. is one of only a handful of law firms in the nation that has reviewed the millions of discovery documents involved in this type of litigation. Other law firms contact our attorneys for advice on these types of cases.

➨ Our attorneys have personally questioned under oath dozens of orthopedic hip manufacturer’s employees from all over the world, including surgeons, designers, marketing executives, and corporate CEOs.

➨ In 2008 Maglio Christopher & Toale, P.A. filed the first lawsuit in the United States against a manufacturer of the current generation of defective metal-on-metal hip replacements. Ever since we have been at the forefront of litigation against the makers of these defective medical devices across the United States.

➨ We have developed contacts within the orthopedic community, an understanding of how that community works, and we have extensive medical and technical knowledge about defective orthopedic hip replacements.

➨ We are aggressively and actively litigating defective metal on metal hip cases through the U.S. state and federal court systems.  We are not waiting for a settlement that may never come because our clients need help now.

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Adverse Reaction to Metal Debris (ARMD)

Adverse Reaction to Metal Debris (ARMD) describes general complications to metal debris in the body from corrosion in a metal on metal (MoM) hip implant.

The researcher who coined the term “ARMD” used it to describe all the different types of soft tissue damage found in patients with MoM hips, including metallosis, pseudotumors, and ALVAL.

Symptoms include:

ARMD Adverse Reaction to Metal Debris from Hip Replacement

Image of ARMD from a MoM hip implant

  • Heart problems or heart failure
  • Mental fogginess, memory loss, or confusion
  • Changes in vision
  • Thyroid problems
  • Skin rashes
  • Vertigo or dizziness
  • Nerve problems or neuropathy
  • Bone death or osteolysis
  • Gastrointestinal problems
  • Increased cancer risk
  • DNA mutations
  • Loss of hearing
  • Infection of the hip
  • Noise or squeaking coming from your hip
  • Loosening of the hip implant


Metallosis happens when the parts of a hip implant rub together and release microscopic metal debris into your body.  When these tiny metal pieces absorb into your bloodstream, they can travel throughout your body and cause severe reactions that at first don’t seem related to your hip implant.


ALVAL stands for Aseptic, Lymphocyte-dominated Vasculitis-Associated Lesion. Basically, it’s the body’s  aggressive immune response to metal debris, causing hypersensitivity and inflammation of the blood vessels, muscle, and other tissue around the hip implant.  The ALVAL reaction can also destroy the bone around the hip socket, a process called osteolysis.  Another form of ALVAL is called a pseudotumor.


pseudotumor from metal on metal hip replacementA pseudotumor (SUE-dough-two-mur) is a large soft tissue mass that forms around the hip.  It’s believed to be an immune reaction to the corrosion of metal debris into the muscle and fat of the hip area. A pseudotumor can be made up of either a solid or semi-liquid mass.  Pseudotumors often cause pain and discomfort and can limit a person’s range of motion in their hip joint.  It’s often difficult for doctors to tell the difference between an infection and a pseudotumor.  An MRI or Ultrasound is one of the more effective ways to check for pseudotumors.

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Maglio Christopher & Toale, P.A. has focused its practice on defective hip replacement cases for over a decade.  Our attorneys aggressively litigate these cases for clients across the entire country.  We are a national law firm, and can represent you in any state or US protectorate.

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Literature Review of Metal Poisoning Research

Neuropsychiatric symptoms following metal-on-metal implant failure with cobalt and chromium toxicity

This study shows a link between metal poisoning from MoM hip replacements and emotional and cognitive brain deficits.  Researchers evaluated 10 patients before they had hip revision surgery to remove the defective metal on metal hips.  9 of the 10 patients had toxic levels of chromium and cobalt in their bloodwork.  9 of the 10 patients were screened for clinical depression and short-term memory loss.   9 of the patients matched the medical criteria for depression and 3 of them were getting treatment for depression.  7 of the 9 patients showed significant problems with short-term memory, scoring in the same range as people diagnosed with dementia.  Ben Green 1*, Emily Griffiths2 and Solomon Almond  (Available at Y: Research–Medical Research—hip and knee implants—metal debris—cobalt chromium (all) ).

Carcinogenic metal compounds: Recent insight into molecular and cellular mechanisms

Chromium and cobalt are both widely considered cancer causing in humans. This research describes 3 indirect ways that these types of metals can trigger cancer and damage our cellular systems.  1) DNA damage that leads to the stimulation of cellular growth; 2.) Inhibition of DNA repair system that can cause mutations; 3.) disruption of the processes that stop the proliferation of cancer cells. Some specific types of metal compounds, such as trivalent chromium, bind directly to DNA.  Journal- Arch Toxicol (2009) Authors- Detmar Beyersmann & Andrea Hartwig.

Effects of metal-on-metal wear on the host immune system and infection in hip arthroplasty

This review looks at how the particles released by wear and corrosion in Metal-on-Metal hips may increase a patient’s risk of infection.  The metal particles could lower the effectiveness of the body’s immune system.  They may also impact the speed of bacterial growth, and could also play a role in antibiotic resistance.  Anton H Hosman, Henny C van der Mei, Sjoerd K Bulstra, Henk J Busscher & Daniëlle Neut. Pages 526-534.  Received 01 Feb 2010 Accepted 23 Apr 2010 Published online: 22 Sep 2010.

Joint Registry approach for identification of outlier prostheses

This report outlines how the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) has developed a method to report prostheses with a higher than expected rate of revision. These are called outliers.  Using these methods, this report identified 78 prostheses or prosthesis combinations as being outliers. Richard N de Steiger1,3, Lisa N Miller2, David C Davidson3, Philip Ryan1,2, and Stephen E Graves3 1School of Population Health and Clinical Practice and 2Data Management and Analysis Centre, Discipline of Public Health, University of Adelaide; 3Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia. Submitted 13-01-11. Accepted 13-05-14.