Cobalt Chromium Poisoning from Metal on Metal Hip Replacements
Cobalt Chromium Metal Poisoning from Hip Replacements
Cobalt chromium metal poisoning is an adverse 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.
Why is Blood Testing Critical?
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. released a report stating that concentrations greater than 7 parts per billion of cobalt and/or chromium are of concern. The Mayo Clinic has 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/mLAdditionally, the Mayo Clinic Medical Laboratories 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:
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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.
Some adverse reactions can be cured by a revision surgery or other medical interventions, but only if done early enough.
This is why it’s important to be aware of the type of metal on metal hip replacement you have, and to ask your doctor if you should be getting regular blood tests for metal ion levels.
Need Metal Blood Testing?
Sometimes the best way to understand severe metal reactions is to see for yourself. The image below shows a still shot of metallic colored fluid gushing from the surgical area near the hip implant. Click the photo to see the full video of research done on adverse tissue reactions from metal on metal hips. In this research, the patient is a 70-year-old man who reported swelling in his hip. During the revision surgery, doctors punctured the fluid-filled tissue surrounding the muscles of the hip to find a surprising amount of discolored fluid, along with corrosion at the head-neck junction of the hip implant. The pathology report confirmed it was an adverse local tissue reaction (ALTR) from the metal on metal hip implant. Click the image to watch the video.
Other Adverse Reactions to Metal Ions
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. Click the image to learn more about ARMD.
ALVAL happens when the metal particles from the defective metal implant interact with the body's immune cells, causing the body's defense system to act like it's being attacked. Symptoms of ALVAL include pain in the hip and groin area, clicking/popping/squeaking of the hip implant, lumps or inflammation around the hip implant or groin, and more.
Metallosis is a type of metal poisoning. It involves a build-up of metal debris in the body’s soft tissue. This happens when parts of a metal on metal hip replacement rub together, releasing tiny cobalt and chromium particles into your bloodstream and the tissue surrounding your hip. These particles rot healthy red tissue and muscle around the implant and turn it into a dry, gray, and dead mass of gunk. This means pain and loss of mobility.
Bone loss is the destruction of bone around an implant. Bone loss is also called “osteolysis” or “aseptic osteolysis.” It is a common yet serious side-effect of Metal on Metal (MoM) hip replacements. A leading cause of MoM hip failure is bone loss. In fact, according to the Rheumatology Network, “implant loosening resulting from aseptic osteolysis accounts for more than 75% of [implant] failures” (Rheumatology Network).
ALTR stands for “Adverse Local Tissue Reaction,” and it’s a type of inflammatory response, similar to an allergy, that can happen in the hip joints of people with Metal-on-Metal (MoM) hip implants. Some symptoms of ALTR are similar to an infection, like swelling and collections of fluid, but ALTR is not an infection at all. Rather, ALTR is an immune reaction to the metal debris floating around in the surrounding tissue.