Revision Surgery for Metal on Metal Hip Replacements

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What is Hip Revision Surgery for Metal-on-Metal Implants?

If you have a Metal-on-Metal (MoM) hip implant, you may have heard the terms “revision surgery” or “revision total hip arthroplasty” before. Revision total hip arthroplasty, or hip revision surgery, is a corrective surgery; its goal is to replace or repair a hip implant that is defective, dangerous to your health, or even lethal.

Because of their high failure rates, MoM hip replacements often require at least one revision surgery, although some patients end up having to get multiple revision surgeries on the same hip.

The simple answer for why so many MoM hip implants fail is this: bad design. These implants are made of multiple metal parts that rub against each other whenever you walk or move your leg. As the metal components rub together, they shed tiny metal particles into your bloodstream and body.

The build-up of these metal particles in your body can lead to harmful side effects, ranging from pain and swelling to muscle death and heart failure. For many of these conditions, revision surgery is the only effective treatment.

 
 
 
 

Symptoms that May Require Hip Revision Surgery

Metal-on-Metal hip implants are known to have some pretty negative side effects. One of the ways to reverse the side effects of metal poisoning from a MoM hip is to remove and replace the bad hip implant.

If you have experienced any of the problems listed below, you should talk to your doctor.  These symptoms could be signs that your hip implant is failing and putting your health at risk:

  • Pain, squeaking, popping, or clicking in the hip
  • Dislocated, loosened, or fractured implant
  • ARMD
  • Infection in hip joint
  • Metallosis
  • Pseudotumors / ALVAL
  • Cobalt cardiomyopathy: heart failure caused by cobalt poisoning
  • Vision loss
  • Hearing loss or ringing in ears
  • Dementia
  • Depression and/or anxiety

Many patients who get hip revision surgery never have any symptoms of metal poisoning.   For this reason, leading orthopedic surgeons recommend that their MoM implant patients get blood tests for metal ion levels every 3 months, EVEN IF THEY HAVE NO SYMPTOMS.

What Are the Benefits of Hip Revision Surgery?

Revision surgery is both financially and physically challenging. Your doctor could decide revision surgery is the best way to treat the symptoms of metal poisoning from a MoM hip implant.  A revision surgery can have all of the following benefits:

  • Relieve hip pain caused by a bad implant
  • Lower your metal ion levels
  • Improve your leg/hip mobility
  • Increase the range of motion in your leg
  • Reverse vision/hearing loss caused by your implant
  • Reverse heart problems caused by your implant
  • Prevent you from suffering future health complications from metal poisoning.

Defective Metal on Metal Hip Replacement?

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What is the Cost of Hip Revision Surgery? What are the Risks Involved?

Because revision surgery may be done for a variety of reasons, the costs, operation time, and recovery time vary from case to case.

In general, hip revision surgery tends to be more costly than regular (first) hip replacement surgery. The recovery period for revision hip arthroplasty also tends to be longer than regular hip replacement surgery; it can take anywhere from 6 weeks to 6 months to return to your normal activities.

Hip revision surgery is also a higher-risk operation than regular hip replacement surgery. The risk of suffering complications — such as infections, fractures, and bone loss – during and after surgery is higher for revision than regular hip replacement operations.

However, in most cases, the risks of not replacing a failed implant are almost certainly higher than the risks involved in revision surgery.

What is the Likelihood that my Implant Needs Revision?

A “revision rate” is the likelihood that a patient will need to get revision surgery on their implant. According to a study published by the British Medical Journal, the average revision rate for Metal-on-Metal hip implants is TWO to FOUR TIMES higher than implants made of other materials. However, some hip device brands have worse outcomes than others. 

What to do if you Think you Need Hip Revision Surgery:

If you think your MoM hip implant needs revision surgery, there are some steps you can take. First, you should meet with your doctor to discuss your concerns and test your blood metal ion levels. If you have any symptoms, you should discuss these with your doctor as well. Afterwards, your doctor may recommend any of the following procedures to determine if you need revision surgery:

  • MRI scans
  • Ultrasounds
  • X-Rays
  • Removing some joint fluid with a needle (joint aspiration)
What Happens During Metal-on-Metal Hip Revision Surgery?

The actual process of revision surgery varies from case to case, depending on the type of implant you have, your reason for getting revision surgery, and the amount of damage your implant has caused to your body. In general, your physician may take any of the following steps during revision surgery:

  • Replace the damaged/recalled component(s) of your implant
  • Replace the entire implant if necessary
  • Remove any build-ups of metal debris or abnormal fluid from your hip socket
  • Remove any damaged, diseased, or dead tissue, muscle, or bone from your hip socket

It is important to note that if you have a Biomet M2a-Magnum implant, your revision surgery may end up being riskier and more invasive than normal. A 2016 study found that the Biomet M2a-Magnum is unusually difficult to revise; this is because the device’s head gets stuck to the stem, which can make it impossible to remove damaged components during surgery.

The same study found that, in Biomet revisions where the head and stem got stuck together, patients faced longer operation times, increased bleeding, and a higher risk of infection and fracture after surgery (Mantymaki et al).

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