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Comment: Hi Earl,

Congratulations on your website, it is such a valuable tool to provide current information and experiences to the many different patients that have experienced negative or difficult results from their joint replacement surgery.

I thought that if I could share my story with your readers that I could hopefully help others in further prevention and identification of issues surrounding their hip replacements.

I received my DePuy (Johnson and Johnson) ASR XL full hip replacement in my right hip in June 2007 at the ripe old age of 37 after years of battling Osteoarthritis that was caused by years of Rugby Union, Martial Arts and generally growing up as an active kid in Australia! I was able to jog after 3.5 months, I returned to work as a Nurse 6 weeks after surgery and was generally a hell of a lot more comfortable than I had been in hte previous years leading up to surgery.

By October 2008, I was starting to have some pain and mobility issues around the right hip and by December 08/January 09 I was suffering with these on a daily basis. I was limping quite noticeably, was having to take pain killing (over-the-counter type) medication to be able to maintain my work life, was irritable in my interactions with others (especially family and those close to me), and was having more frequent headaches and bouts of fatigue. Around this time my GP also noted that my Red Blood Cell count (or Haemaglobin levels) were setting a pattern of being consistently low. In early 2009 I was referred to a Haematologist who informed me after further blood tests that I had a rare form of Anaemia (Macrocytic Anaemia) that was caused by ‘heavy metal poisoning’. I was tested for the usual suspects, lead, mercury, iron, etc, and when these came back clear, the Haematologist told me that there was obviously another source of metal, however he quickly ruled out my hip prosthesis as in his words: “that wouldn’t be the cause as they wouldn’t put an implant in you that wasn’t safe!”.

Throughout 2009 and in to 2010 I became sicker, I was always tired, even then had great difficulty sleeping, suffered from ever-increasing pain and mobility issues to do with my right hip (that my orthopaedic surgeon assured me was actually my right knee or my back), continues to be anaemic, and seemed to catch any little ‘bug or virus’ that those around me contracted. It was almost with a sense of relief in September 2010 that I found out that the ASR had been recalled, had a Cobalt and Chrommium Ion test to find out that I was in the toxic range for both and then a nuclear bone scan to tell me that my implant was that loose in my femur, I might as well have been walking around with a broken leg! Subsequently in November 2010 my ASR was removed completely and my revised hip was installed.

I was surprised again how quickly this appeared to heal at first, I was mobile and relatively comfortable (pain wise) in about 2 months and returned to work after 3 months. The only issue that developed in to 2011 was I had major issues with the Left (opposite) knee as a result of limping for so long prior to my revision and after June 2011 I would get the occasional sharp pain in my right hip which never seemed to last too long but was relatively intense when it came, again i thought that maybe as this was a revision, and I had a larger prosthesis in place, that this was normal. I had an arthroscopy on my left knee as a day proceedure on September 28 (Wednesday) and was due to return to work on the following Monday after a couple of days rest!

On the Thursday (Sept 29, 2011) I was resting at home when I stood up out of a chair and experienced pain like I had never felt in my life coming from my right hip, initially for some reason I thought I had dislocated it. After a week in a wheelchair in hospital, it was discovered with a simple xray, that I had snapped the Titanium femoral stem from my prosthesis without breaking the bone (apparently this is rare, some doctors have told me impossible, however I have the xrays to prove it!). Considering the revision was only 10 months old, I was asking a lot of questions, as to were the many surgeons who took it upon themselves to come and look at my xrays in Hospital!! I had emergency surgery to ‘re-revise’ my right hip, with a femoral Osteotomy (splitting of the femoral bone in half to remove the lower broken portion of the femoral stem) and consequent femoral cabling/wiring repair to put the bone back together. When the surgery was carried out, my surgeon found significant metalosis within the Femur (which had caused a necrotic area where the femoral stem had snapped), there was also metalosis around the top of my femur and in the tissue (muscle and fat) around my femur and hip joint. The surgeon (who carried out both revision operations) has gone on record as blaming the ASR for this condition and a subsequent Cobalt test (since this most recent surgery) has shown that my Cobalt level is actually mildly higher since I had the ASR metal-on-metal implant removed 12 months ago.

I have now been told that with current technology, I will never be able to have another hip replacement, as there is little bone left to work with that is healthy and there are no guarantees on the work that has been done this time around as I only got 10 months out of my last revision. The only ‘sure-fire’ way of testing in the future for my leg, to assess if there is any further risk of metalosis occurring is to have bone biopsies every 6 months from the 12 month anniversary of this recent surgery, as the Doctor feels that this will be the only accurate way to determine if metalosis has returned or re-occurred.

I urge any patient who has currently a metal-on-metal joint replacement and is having any symptoms at all, to please demand not only the appropriate blood tests or imaging necessary to determine if you are having problems with your prosthesis. I would also advise that if you aren’t having any symptoms, but also have a similar prosthesis to please get the tests regardless, as there is now research evidence that even patients who aren’t symptomatic, can still have toxic levels of cobalt in their systems or still also have a physical problem with their implant.

Regards and all the best to you all for 2012,
Stuart Cain

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