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
- Allen LA, Ambardekar AV, Devaraj KM, et al. Clinical problem-solving. Missing elements of the history. N Engl J Med. 2014 Feb 6;370(6):559–566.
- 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.
- Family practice. House M.D. Feb 7, 2011. http://www.imdb.com/title/tt1726372.
- Cobalt poisoning. MedlinePlus. http://www.nlm.nih.gov/medlineplus/ency/article/002495.htm.
- Morin Y, Daniel P. Quebec beer-drinkers’ cardiomyopathy: Etiological considerations. Can Med Assoc J. 1967;97(15):926–928.
- Mao X, Wong AA, Crawford RW. Cobalt toxicity—an emerging clinical problem in patients with metal-on-metal hip prostheses? Med J Aust. 2011;194(12):649–651.
- Cooper HJ, Della Valle CJ, Berger RA, et al. Corrosion at the head-neck taper as a cause for adverse local tissue reactions after total hip arthroplasty. J Bone Joint Surg Am. 2012;94(18):1655–1661.
- FDA safety communication: Metal-on-metal hip implants. U.S. Food and Drug Administration. Jan. 17, 2013. http://www.fda.gov/medicaldevices/safety/alertsandnotices/ucm335775.htm. Accessed May 26, 2014.
Ann Heald says
December 16, 2018 at 11:46 pmI 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?
SeL says
March 27, 2019 at 8:33 pmGet 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.
Katie says
February 11, 2019 at 9:16 amYou should see a Naturopathic Physican who specializes in testing and treating heavy metal toxcity. First an unprovoked urine test will be provided.
Manny says
February 23, 2019 at 12:26 pmThere 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!
SeL says
March 27, 2019 at 8:36 pmSo 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!
David V. Hedin says
May 9, 2019 at 9:36 pmI 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.