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 – Metallosis

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 are no immediate physical signs. However, the most common symptoms of metallosis include pain, swelling, limping or difficulty walking.  The long-term damage that these metals can do to your body is significant, so the earlier you get medical care, the better. Here is a list of possible symptoms:

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 primary care physician.  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.

You should contact our attorneys for a case evaluation immediately because there is a time limit to file a claim.  Please fill out the contact form below or call us toll-free at 888-952-5242.

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.


CI-PseudotumorMasses or lesions can form around the soft tissue of the hip joint because of the metal on metal implant.

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