here is Dr Steve’s reply to the points you raised:

Christy ought to request a “Metal Suppression MRI” (MSMRI) and get her implant inventory from her surgeon or from the hospital to confirm that her Rejuvenate stem has a modular connection between the neck and stem body.
New and progressive groin pain with flexion of the hip is common in patient with Adverse Reactions to Medal Debris (ARMDs), this is because the tendon that flexes the hip runs directly over the joint such that increased fluid in the joint or inflammation of the tissues this tendon gets involved and that generates the pain.

I have seen patients with(ARMD) in patients with blood cobalt level of < 3 mcg/L. That Christy's metal levels are elevated at all suggests that her hip is generating debris somewhere and given that she has a metal-plastic or metal-ceramic bearing couple it is likely that the debris is generated the modular junctions, either at the head neck couple, or at the neck body couple.The metal products generated at the couples tends to be more reactive that that generated at metal-metal bearing surfaces.

Christy can also request her X-rays, I can review them in the context of her implant inventory.

If Christy does get a MSMRI she ought to do some research that the machine and the imaging protocol at the imaging center are current, otherwise the study may be a waste of money. Dr. Hollis (radiologist) is the authority on imaging protocols for hip implants, her work will come up with a "Google Scholar" search. Within my community some imaging centers produce excellent images and some do not. I have found the high quality studies to be very helpful. The imaging time is significantly longer to get a proper study (upward of 45 minutes), a good opportunity to take a nap. There is no exposure to radiation with an MRI, just a magnetic field.

My suggestions are consistent with the recommendations that Styker sent to all of the surgeons known to use Stryker's implants..Her surgeon's attention should be directed towards the letter that Stryker likely sent him. If Christy's surgeon remains reluctant to pursue the recommended imaging she might try to find another surgeon with a specific interest in revision hip arthroplasty. Surgeons that put the Rejuvenate stems in my be in a state of denial, it is human nature not to go out of ones way to find trouble. Addressing premature failure of a hip implant is a time consuming and painful process for the surgeon, the patients are (understandably) distressed about the prospects of a possible early revision surgery and the added hassle and expense of the metal level determinations and the MSMRI. The Stryker stems used with the modular necks can be difficult to extract, particularly if they have been in for a while because the bone grows into the implant surfaces very well with this design (a desirable thing unless one needs to be removed). The last one I took out, just removing the stem took several hours, so the entire time to revision the hip took about four hours (twice the time of a typical first time artificial hip operation) and I am very experienced with this type of operation. If Christy needs to have the hip revised she ought to find a surgeon that is experienced at doing hip revisions, her surgeon may or may be her ideal surgeon to do the revision.

st