A Brief Background of Metallosis – Cobaltism and Metal-on-Metal Hip Implants

By: Jim Moreland PA-C, MHS

A great concern facing the public now is the failure of metal-on-metal hip arthroplasties using systems like the recently recalled DePuy ASR hip implants. According to Stephen Tower, the current concern is due to tissue damage resulting from periprosthetic metallosis that can compromise subsequent revision arthroplasty.

In Tower’s article and case report published in the Journal of Bone and Joint Surgery, he says that The United Kingdom recently advised their patients with metal-on-metal implants who are experiencing pain, prosthetic malposition or implants that have excessive failure rates need to be evaluated with the level of serum cobalt in their system.

“A serum cobalt level of > 7 mg/L indicates possible periprosthetic metallosis. A normal serum cobalt level is .19 mg/L and 95% of those who are unexposed to cobalt have a value of 1 mg/L indicates excessive cobalt exposure, and levels of >5 mg/L are considered toxic.”

Excessive cobalt can damage a patient’s organs. Consequences of cobaltism are tinnitus, vertigo, blindness, deafness, peripheral neuropathy, headaches, optic nerve atrophy, convulsions, cardiomyopathy, and or hypothyroidism. There are about six case reports of cobaltism related to arthroplasty implants. The diagnosis is being called arthroprosthetic cobaltism.

The arthroprosthetic cobaltism, in the case studies mentioned, were attributed to metal-on-metal implants. The patients in the case study had periprosthetic metallosis from the wear of steel femoral heads by ceramic and their serum cobalt level was >60 mg/L.

More than 34,000 patients since 2005 have received the now recalled DePuy Orthopaedics ASR Hip Implant which utilites the metal on metal system discussed in this and related articles.

Tower advises: “Surgeons need to be aware that the high serum cobalt levels found in some patients with metal-on-metal hips may cause neurological or cardiac damage that is in part reversible with timely revision surgery.”

Before signing any documents with DePuy or its agent Broadspire, you need to contact the DePuy ASR Recall Attorneys at Childers, Schlueter, & Smith, LLC for a free consultation and review. Childers, Schlueter & Smith, LLC continues to investigate and review the claims of patients nationwide who received a DePuy hip implant device since July of 2003. If you or a loved one has received the DePuy ASR XL Acetabular System or DePuy ASR Hip Resurfacing System and have experienced some type of hip pain, cobaltism, developed metallosis, required an additional hip surgery, or any of failure with your hip replacement device, you may want to contact CSS Firm for a free case evaluation and consultation. Our experienced team of ASR hip implant lawyers will work closely with you and see to it that you get the medical treatment you need and receive adequate compensation for your injuries.

In the case study, Tower notes that patients with metal-on-metal implants experience high serum cobalt levels which place them at risk for cognitive and cardiac impairment. Those particularly at risk include patients who have shell malposition or persistent hip pain, renal impairment, and ASR implants. The study recommends close monitoring of the serum cobalt levels. Specifically, according to the case study, “A serum cobalt level of > 7 mg/L indicates possible periprosthetic metallosis. A normal serum cobalt level is .19 mg/L and 95% of those who are unexposed to cobalt have a value of 1 mg/L indicates excessive cobalt exposure, and levels of >5 mg/L are considered toxic.”

Current standards that I have found, anything above 7 is considered high enough for revision surgery and, depending on other findings – like pain and other systemic dysfunction with elevated cobalt and chromium levels – each individual’s case is different. But cobalt and chromium toxicity are immunotoxic and have been known to cause heart damage. If you are having symptoms and newly found medical problems like hearth failure, seek advice immediately from a medical profession.

Serum chromium levels normally range from less than 0.05 up to 0.5 micrograms/milliliter (mg/mL).

This was a guest article submitted by Jim Moreland PA-C, MHS and does not necessarily represent the views of this website. We occasionally will accept guest posts from experts in certain fields, but such posts are always filed in the editorial section.

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There are 26 comments. Add yours.

  1. Sheila

    What were your serum chromium levels? (You said off the charts). And what unit of measure was used for the test. Thanks

    Reply
  2. gabe

    Can anyone suggest a doctor anywhere that has a clue about cobalt expose sickness? I’m a grinder that was exposed heavily at work and cant seem to find a doctor to help me out. I have chronic kidney stones(3to5 a month) cardiomyopathy, numbness in lower extremities constant tingling, complete loss of bowel feeling (bowel confusion) facial hair loss in spots, ringing in ears, and the worst problem I have is severe arthritis, I’m in my mid 30s and know this is not old age! Any help would be great

    Reply
  3. Linda

    Doe s anyone know what cracking and popping is, they tell me bone/on/bone no cartalidge
    Linda

    Reply
  4. scott hardesty

    i recieved my first implant 1-5-2010 Trident. i was walking within a week. second week no meds. second hip done 9-21-2010 rejuvenate modular system. 20 months late cant walk without pain and doc discontinued prescriptions. and says its JUST CRAZY that i am still in pain. well now suffering for two months i see my hip is on recall in canada and heading to the U.S. SO i call my doctor and say i want to be tested for metallosis. He denies my request and says well the recall isnt here yet. I am at a loss for words 39 yrs old cant go back to my trade of 16yrs and cant even be an active father for my children. during this peroid i went to six weeks of physical therapy (what a joke),so started the gym lost 75 lbs,and am now 5,8 190lbs construction build.healthy as an ox. at some point THE PEOPLE with be heard. dam those doctors and manufactures. I am blessed to have a great family and most of all a wife who stands by me,through thick and thin. GOD BLESS

    Reply
    • sandy

      Scott it is so difficult to hear story after story;;but i will pray for you and your family that u get a doctor who will help you;;i had hip replacement in 09 from day one i knew something was wrong;;felt like i had a stroke;;severe light headedness and nausea for over three years and now getting groin pain sciatic nerve pain and pain by my incision which is still caved in;;i live downstairs from my grandson’s and i can’t even go up often to tell them i love them and give them hugs and kisses;;but “never” give up;;like they say one day at a time;;i will pray and God bless

      Reply
  5. Linda Mattison

    Jim I have been trying to find you please email and let me know this really you. I am leaving for Clevland clinic tomorrow, still don’t know my metal yet
    2 complete hips , 2 knee, both ankles have been in and out hospitals 4 times Jan.- Feb. Nursing home for a month
    Linda

    Reply
    • sandy

      linda i will pray for you also;;i was also in nursing home for a month;;left there still in deep fog;;they said boy they did a job on you;;i was all swelled up and black and blue;;i have a stryker hip replacement and they just recalled them in 2012;;very frustrating i am asking my family dr. to please do toxicity test;;i have had heart;eyes;ears;;testing all okay but i developed diabetes this year wondering if this had anything to do with toxicity;;i live in Ohio also;;please let me know update and again i will pray for you;God bless

      Reply
  6. jay

    does anyone know if a non metal implant or possibly some metal in the implant can cause iron levels to drop?? my mother had hip surgery like a year ago and her iron has dropped to like 2 or something, (whatever seems plausible and low) she was on high iron pills for a bit but no change, could the iron be getting bonded to the implant i dont mean the metalosis miligma hoax lol, but they think its her stomach or bowells. just wondering if there is another reason possibly, non sure answers are accepted any thing will help also there is a lump in her other knee could that be iron deposit or most likely calcium, also she has mild osteoporosis one pill every week possibly this could be interfering with it ? no idea except what i mentioned, she is 65 and not anemic so what could this be happening??.

    Reply
  7. chrystine

    i had a mom implant in sept 2007, it went wrong so they did a revision again 8 days later with a longer stem but the same mom implant(dupuy)…….. i changed surgeon and hospital he has been monitering me since 2008. 3 years ago i had an isotonic xray which showed a hotspot on the trocanter, my blood levels of cobalt were 19.4 last august 2011 had another isotonic xray in jan 2012 surgeon dismisses me when i tell him i have rashes over my kidney area and headaches with nausea, my pain is getting worse , could do with a bit of advice about my next step

    Reply
  8. mike

    3 weeks away from having hip revision due to a 40mm depuy pinnacle metal on metal installed 10/09, never felt or worked right, and for 2 years I was told ” I should expect SOME level of discomfort” . I think it’s about time we go to congressmen and senators about a solution to the problem. The manufacturers, doctors who installed the failing implants, and the fda (who allowed them to be snuck into the system through some 501k loophole) dont want to take responsibility, I guess 5,000 + people suffering from similar debilitating symptoms must be a coincidence. I was recently told virginia or west virginia has a 2 year from installation law, which patients lose their rights for compensation and lawsuits cannot be filed. The firm I am with doesn’t file unless the time limit is expiring, or revisions are done, because the response has been ” if it is that bad or dangerous, why hasn’t it been removed?” I can’t wait any longer, too painfull,can’t work in the construction trades without walking or bending. Hoping for the best, I trust the new surgeon out of Philly, he said he feels he can ” get me fixed up”

    Reply
    • Steve

      Mike,
      I agree with you %100 the government needs to help us out with these defective hip parts. I had my hip replaced on 9/15/2008 (stryker acolade) and within 6 months I was having problems with it. It started with fluids building up on my hip and kidney stones and I was told it was my body getting used to the implant. I have had this fluid drained off my hip 8 times now and hospitalized 3 times because the fluid was horribly infected and had metal in it. I have been told by 4 different ortho dr’s that my muscles have torn away from my hip, (most likely due to the metallosis) and my hip replacement needs to come out asap before it gets any worse. But since I dont have medical insurance none of them would fix me, but they all told me how bad it is and all the messed up side effects I have going on. I have contacted 20+ lawyers who are only about the MONEY and since my hip implant is not yet on the recalled list I cant get a lawyer to take my case. Something needs to be done, when a vehicle is recalled for faulty parts they fix it, so why do we have to jump through hoops to get fixed when we can hardly walk!!

      Reply
  9. Pamela Snook

    To Jane and All;
    My son finally made it into the orthopedic surgeon, who told him something was definitely wrong. He has now been waiting since October to hear when they are going to do the MRI they told him needed done. They have also told him it would be a 2-3 year wait for surgery. They told him, according to him, that the wait is because that is how many people are already in line. In the meantime, he continues to have chronic pain, falls, even in traffic, breaks glasses he needs with accidents, and the pain is spreading. He actually has a lumbar fracture as the result of one of these falls. As far as I can tell, his provider isn’t following this at all. It’s like, an issue is made, and then they promptly forget it. And, he is constantly afraid of offending someone.

    Reply
  10. DENISE ISELLA

    I HAD A BIOMET MOM HIP REPLACEMENT IN 2006. I was 47 yrs old, healthy, not overweight, just had OA. For 5 years it was amazing, then May of this year I developed severe pain, whcih was treated as bursitis. When symptoms did not improve, my Dr. tested me for metallosis- my chromium and cobalt levels were off the chart, a metal supression MRI confirmed the diagnosis. I had revision surgery within 2 weeks (12/13/2011) and am recovering well, thanks to a very proactive Dr. But do not be fooled if they say a particular hip brand has no reported problems- I have been told I am the first case in the world (yeah, right) with the Magnum hip, but I am certain I will not be the last. If you develop pain, please have your Dr. do the testing for metallosis.

    Reply
  11. Donna

    Have a question. I have a Cervicore Disc implant in my C-spine and it is Metal on Metal. Where does the law stand with this type of Implant? I have heard that several other subjects who recieved the Cervicore Implant has been diagnosed with Metallosis. So I am just wondering where things stood with this? If anyone knows anything. Please email me.
    Thank you,
    Donna

    Reply
  12. Rhonda

    I am a very active 55 year old woman. I had a left total hip replacement in 2003 and have never had a problem. However, I had a right total hip in 2007 have had severe pain from the moment I was awake in recovery. Since then I have repeatedly complained that something is wrong, because the first hip replacement never gave me any problems. Finally 4 1/2 years later a doctor order blood work. My cobalt level is 7.1 mcg/L and my chromium is 8.1 mcg/L. I am not sure exactly what that means. I do not know whether to live with the pain or have a revision surgery. I am fearful that if there is too much damage, I might not walk again. I am an avid cyclist, any suggestions? Anyone?

    Reply
  13. Jane

    To Maggie on April 23rd, 2011
    Get a lawyer, They know what tests to order for you and they will listen. A judge ordered our blood work because no doctor would. Don’t class action suit, get your problems taken care of through them. They can get the doctors to listen to you. You are in to the fight for your life too. Get started quick.

    Reply
  14. Jane

    To Pamela Snook on March 12th,
    I have had a revision of my hip, found metallosis in the tissue. They put another cobalt and chromium hip back in. After 2 years, and 3 bowel obstructions, no diagnosis, cardiac symptoms, kidney symptoms, memory changes, gait problems, unbelievable pain in the hip and groin since day of surgery, NO DIAGNOSIS for any of these problems, I had to get a lawyer to order a blood test for metal poisoning. All my doctors treated me like a hypochondriact and I have never been that. Now the fight is on for my life. My levels for metal poisoning was off the wall. No one wants to dive into a new problem and try to find a cure. I don’t know my life expectancy but I am going to fight.

    Reply
  15. Maggie

    I have had a Depuy Pinnacle which was put in 2005 and the right hip was put in 2007 which was a Smith and Nephew and it was revised 7 times a couple years ago and it’s another Smith and Nephew. I have so much pain in both hips but the left Depuy hip hurts me more…pain that keeps me from sleeping/sitting thru a mea/walking just being alive pain etc etc. I have had xrays, bone scan and an MRI . The MRI pretty says I have swelling in both hips with more so in the left side and less swelling in the right, and the bone scan indicates there may be a small amount of loosening in the left hip. I had my ION levels done my cobalt is at 6.6, chromium 1.5 and titanium at 19. Some other blood work done was an ANA Screen showing I was positive for Lupas. I have constant headaches, cognitive issues, major memory issues, my thyroid is way wacky, had urine tests showing I have blood coming from my kidneys for 4 weeks now off etc etc but according to Dr’s…”THERE IS NOTHING WRONG WITH ME”! My question is…. do i have any thing to be concerned about ?? Or should I continue to find a Dr that knows something???

    Reply
    • Bill Polisak

      Metallosis affects the immune system and that explains the lupus and thyroid issues. I suffered both thyroid and skin (psoriasis) issues, both immune system malfunctions. Go online and find a lawyer versed in these issues. He or she should be able to get a knowledgeable doctor for you.

      Reply
  16. Donna

    Hi, I have a cervicore disc implant at the C5-C6 level. Shortly after the surgery, (2006 all my joints got inflamed. I felt that it was a reaction from the implant. It finally resided, but still flares up at times. A lot of the time, I can feel the metal on metal in my neck and it is very painful. My neck swells and I get a really strange headache. I dont know if this has anything to do with the implant, but I would like to know how to go about being checked for the METALLOSIS. I have felt as tho my body has been trying to reject the implant. Any information on this would be greatly appreciated.
    Donna

    Reply
  17. Gerald Harris

    In your article you indicte that micrograms/mililiter is also expressed as mg/mL Is this correct? I have always thought that micrograms is expressed as mcg and that mg is miligram.

    Reply
  18. Pamela Snook

    What does it take after 3 years of complaining of hip pain, mental changes, unusual headaches etc. post hip implant to get the wonderful University Health System to pay attention and to 1) Actually provide a work up or info on orthotics that were ordered for the effective leg to help with pain on August 2010 (It’s now March 2011) 2) Now that we finally have proof that family member does have all three components of the ASR, to get a cobalt level even drawn, (all the resident could do was refer the poor kid to an orthopedic surgeon thru the University system, that will take 3.) Until October 5, 2011 to even be seen. I could go on and on and name said University Health System. Is anyone else having these problems, especially in the state of OREGON. I should add that after several requests for surgical records since disability occurred, my family member just now received confirmation that this is what is in him. The surgeon has made NO effort to even notify him of the problem. But he did indicate to social security that he couldn’t see any reason for the young man’s pain when they got the records.

    Reply
  19. Beth Davis

    I had a Depuy ASR total hip replacement on the left hip 3 yrears ago and scheduled for a total right in approx 3 weeks (Not a Depuy). I had my levels checked and the results shown are FLAGGED HIGH:
    Chromium 37 ppb
    Cobalt 80 ppb

    I’m not sure how to read this as everything I’m finding is measured in mg/ml, nor do I know how to covert to mg/ml? My Dr. has advised that they will have to contact a speciallist as this is all new info to them. My only symtoms are the squeaking, grinding and popping….NO PAIN !!

    Reply
  20. JIM MORELAND PA-C, MHS

    FRED

    THE PASTE THAT I DID ON THE COBALT NORMAL VALUES ARE FROM .001 TO .009., SO THE ARTICLE THAT USED THE INFO IS INCORRECT. YOU HAVE VERY HIGH VALUES. FRED. IN LIEU OF NO SYMPTOMS I WOULD SAY YOU ARE SITTING ON A TIME BOMB. YOU HAVE APPROXIMATELY 350 TIMES THE NORMAL LIMIT AND THESE METALS HAVE BEEN PROVEN TO IMMUNOTOXIC, NEUROTOXIC, CARDIOTOXIC AND LINKED TO SOME CANCERS. I POSTED A LENGTHY ARTICLE ARGUING THIS VERY POINT. I HAVE LUPUS, THEREFORE IN COLLABORATION WITH MY RHEUMATOLOGIST, I AM HAVING BOTH HIPS REVISED AS I AM HAVING SIDE EFFECTS FROM COBALTISM. YOU ON THE OTHER HAND HAVE VERY TOXIC NUMBERS AND I KNOW YOU ARE DOING GREAT WITH YOUR HIPS, BUT AT WHAT EXPENSE. COBALT HAS BEEN LINKED TO HEART FAILURE, SOMETIMES IRREVERSIBLE DAMAGE IS DONE BEFORE SYMPTOMS APPEAR. I WOULD CONSULT A TOXICOLOGIST AND MAYBE SOMEONE IN INFECTIOUS DISEASE AS SOMETIMES THEY ARE VERSED. THE MINIMUM I WOULD ADVISE IS THAT YOU BE CLOSELY MONITORED AND HAVE A STRESS TEST AND ELECTROCARDIOGRAM DONE AS WELL PULMONARY STUDIES. CHECK IN WITH THE PEOPLE WHO LOVE YOU AND ASK IF THEY HAVE NOTICED ANYTHING DIFFERENT ABOUT YOUR HEALTH, THEY USUALLY OBSERVE THINGS BEFORE US, MEN, ARE WILLING TO ADMIT IS WRONG..LOL…I AM THAT WAY. IT IS A PRIDE THING WITH ME. BUT I HAVE LET IT GO AND I AM TAKING CARE, BUT AGAIN I HAVE DRASTIC COGNITIVE CHANGES AND EXACERBATION OF MY AUTOIMMUNE DISEASES.
    SORRY IT TOOK SO LONG BUT I AM POSTING ON THE OTHER SITE, SO COME AND JOIN US OVER THERE.

    BOTTOM LINE YOU ARE APPROXIMATELY 350 TIMES NORMAL, THAT IS ALARMING AND ANYTHING THAT SURELY CAN NOT BE DOING YOU SYSTEM ANY GOOD. JUST MY THOUGHTS BROTHER.

    TAKE CARE
    JIM MORELAND

    Reply
  21. Fred

    If I have 7.1 mcg/L of cobalt and 8.9 mcg/L of serum chromium in my blood after 3 years with the new left hip and 21 months with the new right hip, should I think about re surgery? No other symptoms. X-ray proves the hip is sound.
    Tha ms,
    Fred

    Reply

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