What is Considered a High Metal Level?
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Cobalt and Chromium Metal Poisoning from Hip Replacements

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 Tests for Metal Poisoning

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/mL

Additionally, 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:

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.

Report Your Problems to the FDA

FDA MedWatch Form Metal Hip Replacements

Fill out the FDA MedWatch Report

There is something you can do:  Report your adverse metal on metal hip experience to the FDA by filling out a MedWatch form.

Hip manufacturers are required to report all hip failures to the FDA but often find loopholes to keep this data hidden.

If the FDA doesn’t have accurate reporting of patients suffering from serious complications, then neither does your surgeon.  Your doctors rely on FDA data to diagnose problems and know when a specific type of hip implant is having issues.

Don’t let the hip implant makers brush your information under the rug. Most people don’t know that you can self-report problems.  The FDA needs to hear from you.  Empower yourself against these huge corporations who put profits above your health.

It’s simple to fill out and an important way to make your voice heard.  Here is a link to the form:

File an FDA MedWatch Report

Video of Metallosis Reaction During Hip Revision Surgery

cobalt chrome metal poisoning surgery pictures

Image 1- Click on image for video of metallic colored fluid gushes from the area.

Sometimes the best way to understand severe metal reactions is to see for yourself. Image 1 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 linked to a research study about adverse tissue reactions from metal on metal hip implants.

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.





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. A revision 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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Adverse Reaction to Metal Debris (ARMD)

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.


This 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 replacement

Pseudotumor from a metal on metal hip implant

A 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.  They 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.

Meet Our Metal on Metal Hip Legal Team

MCT Law 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.

William Christopher, Of Counsel

William Christopher, Of Counsel


Michael J. Cowgill

Michael J. Cowgill


Theodore J. Hong, Esq.

Theodore J. Hong, Esq.


Altom M. Maglio, Esq.

Altom M. Maglio, Esq.

Managing Partner

Ilyas Sayeg, Esq.

Ilyas Sayeg, Esq.


Michele S. Stephan, Esq.

Michele S. Stephan, Esq.


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.

➨ Our attorneys 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.

Talk to Us Now About Your MoM Hip Situation

Review of Metal Poisoning Research

Metal on Metal Hip Replacement Lawsuits Cobalt Chromium Toxicity