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.