Cobalt Poisoning from Hip Implants
Cobalt Chrome is used in the manufacture of various hip replacement components. A number of studies have confirmed that cobalt and chromium ion’s are released into the surrounding bone and tissue causing local detrimental effects. However, Cobalt and Chrome ions are toxic to other tissues and body functions.
Review of the available literature suggests that all patients with Metal on Metal (MoM) hip replacements made of cobalt chrome are likely to have elevated to toxic levels of cobalt and chromium ions, whether they are aware of problems localized on the hip or more wide-ranging systemic problems.
A metal-on-metal hip implant is usually made of chromium and cobalt, and consists of an acetabular cup that’s implanted into the hip with a ball joint that connects to the leg. Cobalt poisoning results when the metal components of an implant begin to wear and microscopic metal shards are absorbed into the blood stream and infiltrate the organs. The tissue damage that results from cobalt poisoning can complicate future revision surgeries intended to replace the damaged metal-on-metal hip implant.
A New York Times report published in March 2010, states that metal-on-metal hip implants have been used in about one-third of the approximately 250,000 hip replacements performed annually in the USA. However, many leading orthopedic surgeons have reduced or stopped use of these devices because of concerns that they can cause severe tissue and bone damage.
When they wear, metal particles from these hip implants can infiltrate organs and tissues, and may even create large, painful cysts. The limited studies conducted so far on metal-on-metal hip implants estimate that 1 to 3 percent of implant recipients could be affected by the problem.
That may not sound like a whole lot but that is up to 7,500 people per annum – so you are one of them then that matters a whole lot!!!
An October 2010 article published in The Journal of Bone and Joint Surgery linked metal-on-metal hip implants to cobalt poisoning (see below).
The article described two patients from Alaska who developed the condition after receiving DePuy ASR metal-on-metal hip implants. Both were “fit, well, forty-nine-year-old men at the time of metal-on-metal arthroplasty with ASR implants,” the article said. Thirty months after surgery, one patient’s blood cobalt level was 122 µg/L, while the second patient’s measured 23 µg/L one year after receiving a metal-on-metal implant. According to the study’s authors, normal serum cobalt level is 0.19 µg/L, and 95 percent of those who are unexposed to cobalt have a value of <0.41 µg/L.
Within one year of the hip implant surgery, both patients experienced symptoms of persistent hip pain and shortness of breath as the microscopic metallic particles from the hip implant were released into the bloodstream and tissues. Two years after the hip implantation, the patients in the study experienced even more symptoms of cobaltism, which can include irritability, fatigue, tinnitus, hearing loss, headaches, loss of coordination, cognitive decline, and depression. After revision surgeries, the patients’ symptoms improved. The authors called for a larger group study to define the prevalence and spectrum of cobalt poisoning due to hip replacement surgery.
Hip replacement patients should be relatively pain-free three months after surgery. Any new pain or increase in pain at that point should be promptly communicated to your surgeon, as it may indicate a complication.
Signs that you may be the victim of a failed metal-on-metal hip implant and cobalt poisoning include:
- Metal-on-metal hip implant failed prematurely.
- Pain and inflammation in the hip area.
- Swelling, Extreme Pain & Discomfort
- Dislocation of Implant
- Clicking, Popping or Grinding
- Loosening of the Implant
- Unexplained Hip Pain
- Thigh Pain or Groin Pain
- Pain with Walking
- Pain Rising from a Seated Position
- Pain with Weight Bearing
- Difficulty walking due to the pain in the hip that has been replaced.
- Non-cancerous tumors (cysts) since receiving your metal-on-metal hip implant?
Cobalt Poisoning
Cobalt poisoning is extremely serious.
If it is left untreated, it can result in:
- Tinnitus (ringing in the ears)
- Vertigo
- Deafness
- Blindness
- Optic nerve atrophy
- Convulsions
- Headaches
- Peripheral neuropathy
- Cardiomyopathy
- Hypothyroidism
- Cognitive problems, including dementia.
Key Website
This is a key website to look up and some of the key points are highlighted below: http://www.cobalt-poisoning.com/
This particular paper highlights the issues in two patients:
Cobalt Toxicity in Two Hip Replacement Patients [click here to download]
Patient A, a fit, otherwise healthy, 49 year-old male received a MoMHA for osteoarthritis. An echocardiogram performed prior to his MoMHA showed normal myocardial function. At 3 months post-op, he complained of bilateral axillary rashes. At 8 months post-op, he reported unaccustomed shortness of breath. Pulmonary function tests and allergy testing for metals were normal. At 18 months post-op, he reported anxiety, headaches, irritability, tinnitus, and hearing loss. An audiogram confirmed high-frequency hearing loss. At 30 months post-op, he reported pain interrupting sleep, hip creaking, hand tremor, diminished coordination, slow cognition, poor memory, and lassitude. At 36 months post-op, a non-refractive loss of peripheral visual acuity was noted; at this time, his SCoL was 122 mcg/L.
The patient was indicated for revision surgery due to progressive hip pain and high SCoLs. An echocardiogram performed prior to the revision showed diastolic dysfunction. The revision was performed 43 months after the first surgery. At revision surgery, the periprosthetic tissues showed necrosis and staining with metal debris and visible wear of the retrieved bearing. At 1 month post-revision, Patient A’s SCoL was 14 mcg/L. At 6 months post-revision, he reported that all symptoms were improved except the visual changes.
Patient B, a fit, otherwise healthy, 49 year-old male received a MoMHA for a failed arthroplasty. At 12 months post-op, he complained of mental fog, memory loss, vertigo, hearing loss, groin pain, rashes, and breathlessness. At this time, his serum cobalt level was 23 mcg/L. At 18 months post-op, an echocardiogram showed diastolic dysfunction. He was observed until 40 months, when revision surgery was performed for progressive hip pain. Just before the revision, Patient B’s SCoL was 23 mcg/L. At revision surgery, the periprosthetic tissues showed necrosis and staining with metal debris and his retrieved bearing showed visible wear. At 2 days post-revision, his SCoL fell to 11 mcg/L. At 3 months post-revision, his symptoms were improved.
Related articles
- ‘Metal on metal’ hip implants leave some recipients in pain, at risk (earlsview.com)
- Bruce Greenfield may be the last New Zealander implanted with a faulty hip joint (earlsview.com)
- How Long Do Hip Replacements Last? (earlsview.com)
- Options for Hip Replacements – different materials (earlsview.com)
- Associate Professor Michael J. Neil – Doesn’t Recommend Resurfacing (earlsview.com)
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As a Newbie, I am always searching online for articles that can help me. Thank you Wow! Thank you! I always wanted to write in my site something like that. Can I take part of your post to my blog?
Hi – feel free to take anything you want! Pleased to help!
finally, a website, with excellent info, i had a stryker trident hip system installed insept. of 07, shortly. after receiving it, i started experiencing pain from the operation that gradully started gettiny worse, and then i had to go to the emergancy room, for autoimmune hemolytic anemia, which i attribute to the accolade tmzf hip-stem which is on a class 2 recall due to the hydroxylapatite coated, titanium plasma spray, coming off the hip stem. i recently found out my chromiun and cobalt levels are thru the roof,if any body has exsperienced this type of symptoms please respond, im very desperate, they want to put me on chemo, drugs to counter act this although i do not have cancer, i will check back with this site often, bless all you people, helping the sick and weak, my prayers are with you curtis
Hi there – you need to get to your surgeon and have the implant removed – that is the only way to get your toxic chromium and cobalt.
I really suspect that the chemo will do nothing except make you sicker.
I am having my hip implant replaced 1 September – very painful and elevated cobalt levels.
Go see your orthopaedic surgeon ASAP!.
Earl
I have told you all my story on my hip replacement failure and am now recovering from my revision that was done almost 3 weeks ago. seen the doc yesterday and he said they tested my metal levels in the fluid around the replacement during surgery and he gave me the results, they are as follows cobalt 513.9 ug/l and chromium is >1000.0 ug/l can anyone explain how high that is to me? or what it means. Also I have a lawyer who wants me to talk to him about a case, but i was wondering how long is the statue of limitations is on this kind of case. My first surgery was less than 2 years ago and revision was 2 1/2 weeks ago. Any help would be nice. thanks so much!
68 yr old male – 1st hip resurfacing (Birmingham) done in 2000 failed when blood supply to femoral head failed 3 yrs post op. Revision in 2004 with Metal on metal prosthesis. No symptoms until recently when very mild occasional discomfort in hip developed. Blood tests showed cobalt levels of 120 (6 times higher than upper level of normal) and normal chromium levels. X-rays showed large cysts above acetabular cup. Revision 3 weeks ago with new cup and ceramic insert and ceramic ball. Stem in femur retained. Bone grafts necessary for cysts. All seems to be going well at this stage
Hi Robert
That must be a relief. I had to have a total revision of the THR and two bone grafts. Like you ceramic on ceramic was my choice and I will do the same when my left hip is replaced next year for the first time!
All the best with your recovery. You will feel so much better if my recovery 7 weeks out is any thing to judge by!
Earl
Hello Earl,
Yes, it is a relief (fingers crossed). My surgeon had assured me that the first revision of my right hip with MoM prosthesis in 2004 would see me through to the end even though longevity runs in the genes (my dad and mum both lived into their nineties). Like you I will need a revision (the 1st) of my left hip (THR in 1997) as the polyethylene insert in the cup is wearing (normally). No problems with the left hip after 14+ years – but x-rays show some osteolysis in the acetabulum above the cup. I have been (and hope to continue to be) a very active person (surfing, walking etc).
I am annoyed that my surgeon used the MoM in 2004 even though it was not the faulty DePuy product as there was the option of using Ceramic then and the MoM problems of metallosis and osteolysis were well known then. I haven’t had it out with him yet!
Best wishes
Robert
Hi Robert
And my surgeon told me my MoM was a new type of stainless steel – the best way to go, when clearly all the MoM problems were well known in 2008…
Question – how to get four years of pain instead of one? A. Get a surgeon who has no bloody idea….
I would like to be a fly on the walk when you talk to your surgeon!
Regards
Earl
Hello again Earl,
I must confess to reading some of the info in your posts in reverse order – I’ve just now finished reading your whole story. And what a story – hopefully with a happy ending. The posts about dysplasia were very interesting as my surgeon believes that my osteoarthritis had its origins in congenital dysplasia (undiagnosed) and one of my sisters who had confirmed dysplasia is now preparing for her 1st hip op (age 67).
For me the info about Birmingham Hip Resurfacing was most interesting as I got the impression that the BHR 2 piece prosthesis had the advantage that if a revision was needed the cup in the acetabulum could be retained and used with a polyethylene insert.As I had a BHR in 2000 which failed when avascular necrosis of ther femoral head developed some 2-3 yeras later a revision was required and a metal femoral head was used with the original BHR acetabular cup. This resulted in MoM and not Metal on Plastic as the BHR info seems to recommend.Was this just an experiment by my surgeon (reputedly one of the best in Sydney)? I’m sure I’ll never discover the truth. And maybe I should just be happy that the MoM components causing the cobalt poisoning are now out and all seems to be going well now (4 weeks post op). It seems that the only obvious symptom of cobalt poisoning that I might have had was a body rash on the lower chest. Rashes are reported as one of the possible symptoms of cobalt poisoning.
Will I have it out with my surgeon? Who knows. I see him in 2 weeks. He certainly knows how to charge! The gap for his fee alone is over $6000 and this is not recoverablre from my private healt fund. I should ask for a loyalty discount! LOL!
Anyway, I must congratulate you on your posts and site generally. I’m sure many have both been reassured and better informed as a result of the info you have presented.
Best wishes
Robert
Hi Robert
I didn’t realise you were a fellow Aussie!
Yes – dysplasia is very interesting & explained a lot for me!
Interesting with our surgeons that we didn’t get presented with the facts in a sensible fashion before they did the original operations.
Fancy mine telling me it was stainless steel – what a dork!
It is coming up 8 weeks for me and I see my surgeon again next week too – and should start physio as the 2 bone grafts should be OK now.
I am happy the MoM is out – I feel so much better!
It just goes to show that the doctors are just super technicians, something they didn’t like to hear when I was teaching at uni years ago (vets in this case).
I just posted up a NY Times article – seems one group has thrown out resurfacing totally – when really it is more a metal on metal issue I feel!
Have a great weekend.
Earl
Hi again Earl,
I believe it is early days yet in the Cobalt Poisoning Story. The faulty DePuy product only serves to distract and confuse as it was a clear case of faulty design but there are many other MoM prostheses that are likely to cause Cobalt problems in the future in many cases quite a few years post op. I am an engineer (civil/structural) and a lawyer (but never practised as such) and this maybe explains why I feel there should be someone I should be able to sue (and waste a lot more money in the process!
I note that my surgeon now recommends against hip resurfacings which necessarily require MoM prostheses.
I had my first dip in the saltwater pool at Bronte this morning – a great relief to be getting back to doing normal things. I will continue my hydrotherapy now under my own supervision at this venue.
I hope your recovery continues to go well.
Robert