The FDA further noted that patients who are at risk for “increased device wear and/or adverse local tissue reactions should be followed more closely.” Those identified as being at higher risk are:
- Women;
- Patients who are overweight or with high levels of physical activity;
- Patients with bilateral implants, resurfacing systems with small femoral heads (44 mm or smaller), suboptimal alignment of device components or suspected metal sensitivity (e.g., cobalt, chromium, nickel);
- Patients taking high doses of corticosteroids;
- Patients who have evidence of renal insufficiency; and
- Patients with suppressed immune systems.
“As a practicing rheumatologist, I would say [that for] any patient you see who has new-onset thyroid disease or unexplained heart failure and [has] either a metal-on-metal or metal-on-polyethylene joint, think about metal poisoning,” Dr. Bunning recommends. For rheumatologists, if a patient with an artificial hip has hip pain, “the usual reflex is to send [the patient] back to the orthopedic surgeon,” he says. However, rheumatologists also may opt to order a cobalt level or MRI with the appropriate sequences. If cobalt levels come back elevated or the MRI is abnormal, he says, it’s appropriate to work together with the orthopedic surgeon to manage the patient’s treatment.
Kimberly J. Retzlaff is a medical journalist based in Denver.
Acknowledgment: The author and The Rheumatologist thank Dr. Bunning for his assistance in the development of this story.
References
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- Dahms K, Sharkova Y, Heitland P, et al. Cobalt intoxication diagnosed with the help of Dr. House. Lancet. 2014 Feb 8;383(9916):574.
- CBS Evening News with Scott Pelley. Feb. 7, 2014. https://archive.org/details/WUSA_20140207_233000_CBS_Evening_News_With_Scott_Pelley#start/1260/end/1320.
- Kolata G. As seen on TV, a medical mystery involving hip implants is solved. The New York Times. 2014 Feb 6;A7.
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I have recently had a second revision one right hip. I’ve had balateral hips for 33 years. For 18 before this most recent surgery 6 months ago ibegan experiencing life altering back pain. The revision revealed significant deterioration of the old implant. Now 6 1/2 months after surgery my body feels inflamed – IBP gives me relief. But this generalized feeling of inflammation is not improving ! I’m wondering if I have cobalt poisoning? I do not know who do see. My surgeon told me the prosthesis looks good and the pain is not from that. Should I see a rumatologist?
Get the blood work done to see if you have cobalt poisoning, ask your Primary doctor to do the blood work then you’ll know!! If you do have cobalt in your blood, you can get help.
You should see a Naturopathic Physican who specializes in testing and treating heavy metal toxcity. First an unprovoked urine test will be provided.
There is no treatment for treating heavy metal toxicity caused by an implant, other than to remove and replace the implant with a non metallic version.
There could be many things causing your back pain. Is the new replacement a metal on metal hip? Has your cobalt & chromium levels been tested?
I have elevated cobalt and a long list of issues, some very serious, yet the surgeon refuses to believe any of it could be caused by metal toxicity…Why would he? He has installed thousands of these crappy devices and doesn’t want to be liable!
So very true, surgeons don’t care they already got their money. They want to replace again so they can make more money. Piss on that, I will heal myself naturally!
I had hip repacement in 2012. Months after surgery, I developed contant fatigue and spells of mild dizziness. It was eventually discovered that I was allergic to cobalt. Replacement of the head of the hip occurrred. For the past six years I have dealth with fatigue, dizziness, and other nagging ailments. Needless to say, life has been a struggle. I hope the we can soon get some answers.
I am lucky to have a pro-active surgeon who has sent me for cobalt screening regularly since my hip replacement 7 years ago. As the levels rose dramatically,I was strongly advised to have the revision surgery .I reluctantly agreed to have surgery, despite the fact I had no pain.
I am now 10 days post-op, still having pain and swelling. Hoping for the best, but I had a knee replacement in same leg a year ago, and I can feel a lot of pain in that area, as well as my quads.
My doctor has me on mega vitamins, as well as pain management.
Keep having the blood test at least 2x a year if you have medal on medal! Argue if you have to! Anything over .03 Cobalt should be investigated throughly! Only one going to advocate for you is Yourself! Lots Of GOOD LUCK!
My wife had total bilateral in 2011 and ended up with a compressed nerve in her left leg; requiring a mobilizer on that leg any time trying to be mobile. A day after surgery in ICU I was assisting her to the bathroom and noticed bruises All over her body, from head to toe, front and back; including her back and breast. Seven days after surgery she was discharged to a rehab facility closer to home. The attending physician at the Rehab retrieved her discharge plan from the Orthopedic surgeon with further instructions for physical therapy before going home. That attending physician wrote up instructions for his staff omitting the restriction; which lead to a Fall in the shower causing excruciating pain on her right hip area. For nine months she suffered from pain and gained very little in the way of mobility. Nine months later the original orthopedic surgeon determined her Right hip was fractured and needed replaced yesterday; no one took any responsibility for the fall or fracture and when I spoke to Rehab facility attorney he shared that it was an assisted fall! I inquired as to how they got her up off the floor and he shared that he could not tell me but that they called me as soon as they got her back into bed…..I shared that someone was lying because I was there and that it was me that picked her up!
Follow up! Five years later at a follow up with the orthopedic surgeon I requested a blood test as my wife still was not gaining, experiencing memory issues, hair loss, high blood pressure, diarrhea daily. The surgeon declined to perform the test. Once home, I connected with my wife’s primary and asked to have a Cobalt / Chromium blood test performed; results, Cobalt was 17.6, Chromium 9.7; All indications that a revision was required on her left hip, even thought the pain seems to be more in the right hip area. It’s been just a little over a year now! Mobility still an issue, hair continues to fall out, blood pressure better and diarrhea stopped the day after surgery for about a year and has recently resumed! I’ve asked for another Cobalt / Chromium blood test as the Right hip is still metal on metal even though replaced. Honestly! It’s been a rough 8 years !