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Type of implants and Metallosis

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maryboo
maryboo

i am in the US and waiting for a surgical appointment for a Lt. THR. At my appt. with the surgeon he told me he uses an anterior approach with the HANA table and uses a metal on metal implant.  I went home to research this implant and scared myself into wanting to cancel because of all the lawsuits over Metallosis, necrosis, pseudo tumors, kidney failure, heart myopathy, rashes etc.  and the fact they don’t all go away with a removal and a revision.  So I tried to find out what implants are used for those with metal allergies or those who need revisions but I am having trouble finding an alternative to the MoM hip. I am not allergic to any metals that I know of and have set up another appointment to discuss any alternatives with my doc. The complication list due to metal ion infusion and blood levels of cobalt and chromium really freaked me out, especially since they might be permanent.

Can anyone enlighten me on alternatives or tell me That I am being overly anxious?  I’m a very active 70 with no complicating diseases, and I’d like to not invite a lifetime of monitoring blood levels and wondering when or if my symptoms get so bad it will need to come out. My level of pain required medication and I am pretty restricted in walking and bending over.  I would rather get the revision one the first time. I read that here is one being worked on in Germany that is ceramic but no date when it might be released and no idea at all when the FDA here would approve it.  So there is no use waiting for that.  Does anyone out in hip land have any info that could help me with my decision?  Thank you all for being here.

0 likes, 11 replies

11 Replies

  • m05
    m05 maryboo

    Posted

    Hi seems very strange as far as I am aware most THR s are now either a combination of metal and ceramic or highly cross linked polyethylene the only time metal on metal seems to be used is for resurfacing. I was going for a Birmingham hip resurfacing procedure which is metal on metal but changed plans I am now booked for THRs ceramic on ceramic think you may need to talk to your surgeon and or get a second opinion PS I am in the UK.
  • chrisa306driver
    chrisa306driver maryboo

    Posted

    I had an anterior hip replacement 6.5 weeks ago. My surgeon implanted a polyethylene cup in my hip and used a ceramic ball on the femoral stem. He stated that there have been many metal on metal problems. He will not use them. Period. Good luck. 
  • auntiebeanie
    auntiebeanie maryboo

    Posted

    Mary in the UK we no longer use metal on Metal because of the complications. Mine is ceramic ball and cup and titanium stem. It is made by Du Puy. It is good for younger or more active people. I was 56 when I had mine done. We are also hearing of alot of complications with anterior approach on this forum esp nerve damage. I would look for another. The Hana table Ihad to look up. Cannot comment on that but looks like a torture table but is supposed to aid surgeons doing anterior. I would seek a second opinion from another surgeon to compare.
  • Rocketman_SG6UK
    Rocketman_SG6UK maryboo

    Posted

    I think you have very understandable concerns there given the well known problems with MoM (Metal on Metal) hip replacements.

    It is my understanding that these were being actively replaced even where they had not worn out because of the problems with minute metal particles and ions released from them.

    In the UK, the most common seem to be

     1. Ceramic head with Ceramic acetabular cup 

     2. Ceramic head with polyethylene acetabular cup

    Both come with Titanium stem and shell to hold the cup in place I believe.

    There must be Ceramic-on-Ceramic that are approved in the US.

    There is a lot of detail on Wikipedia about it, just search for "Hip replacement"

    Best wishes

    Graham

  • RichardKen
    RichardKen maryboo

    Posted

    Dear Mary

    I would not have a metal on metal at any price for the reasons they have had so many problems and I would not want to risk an anterior approach.

    The so called benefits of the interior approach IMO pale into insignificance when you look at the downsides of this approach.

    Any hip replacement as can any medical procedure not go as wanted and there are no guarantees. What is beyond doubt is that if you need a hip replacement your hip if left will only get worse and generally the sooner it is done when that stage is reached the better.

    My hip replacement was carried out just over twenty years ago and gave me excellent service with a fast pain free recovery to normality with no issues.

    The revision of a few months ago has been good too with no issues. Actually I have to think which hip it was! Both times the prosthesis was titanium stem and ball and a poly cup. Both times it was done posterior.

    Hop this helps.

    Cheers Richard

  • maryboo
    maryboo

    Posted

    I definitely will not use the MoM implant.  There are alternatives for those allergic to metal, which I am not, but these are ceramic on ceramic and ceramic on poly cup.  The metal on metal is way too big a risk and I am questioning why my surgeon is still doing these. I will seek out another opinion and probably another surgeon.  Thank you all for getting me through this freak out moment. I was thinking I need to just keep getting this hip injected.  It takes so long to figure out if there is a problem with these implants, and exactly what those problems are. By then many people live with these issues.  My heartfelt thanks to you all.  I’ll keep reading your notes and will let you know what going on.
    • RichardKen
      RichardKen maryboo

      Posted

      Dear Mary

      If your hip needs a hip replacement then it does and the longer you put the surgery off the less good or easy your recovery is likely to be.

      What makes you think you need a hip replacement Mary?

      Injections to the hip MAY give short term relief but most likely not and in any event they are not a cure, it is just giving you a shirt breathing space at best.

      I was able to delay hip surgery back in 1994 by seeing a chiropractor who helped me to deal with the pain and got me to strengthen my muscles.

      At the time I was refused a hip replacement due to my age but in 1997 when my chiropractor could no longer do anything more I was allowed a hip replacement.

      Your plan to seek an alternative opinion is sound but please make your choice based on the surgeons ability by checking records. It really makes no practical difference if you like him or not because you will be lucky to see him or her apart from your initial consultation unless things don't work out with your recovery. Proven ability is key!

      Don't concern yourself what prosthesis may or may not be available down the line as even my prosthesis of 1997 gave me a trouble free twenty years of extremely physical trouble free service. Also the revision used the same design components!

      The posterior surgical technique used for me back then is still shown to be the most reliable and prefered method today.

      Hope that helps you and others.

      Cheers Richard

  • ptolemy
    ptolemy maryboo

    Posted

    There are a large number of law suits on the metal on metal implant by du Puy and hundreds of people have been told to have theirs replaced in the UK anyway. I am not sure if your surgeon is using a new variety perhaps? My surgeon said he did not like ceramic as he felt they could have debris, he preferred the plastic hip, this may be total rubbish of course. Anterior seems to be becoming very popular in the US and Europe. It is supposed to allow you to do more things more quickly at the beginning. Probably in the long term there is not much difference although anterior tends to have a smaller scar. I had posterior as I was worried about nerve damage and had virtually no pain and even packed in the crutches when I got home, mainly because I was rubbish at using them! I just furniture surfed. I did have a really good contraption for getting in and out of bed, a strip of material tied into a loop. You could use a dressing gown cord instead I suppose. 
    • RichardKen
      RichardKen ptolemy

      Posted

      Dear Ptolemy

      With the recent revelations reported on this forum last week it would seem that there has been some relaxation on the bending rules. However I still think it is only prudent to keep them in mind whilst the muscles are regaining strength. This is because they are basically what is preventing a dislocation as I posted a few days ago when this was discussed.

      Yes certainly the ceramic on ceramic is not a perfect solution and they are known to cause squeaking issues. Personally from an engineering point of view having bearing surfaces using identical materials....seems all wrong! Certainly the titanium stem and ball with a poly cup has had a very good track record and no recalls.

      I do not think I could have had a faster or easier recovery from an anterior approach than I had with my posterior approach though doubtless the scar would have been less obvious, but after a few weeks it had pretty well disappeared anyhow.

      Apart from the possibility of nerve damage with the anterior or other approaches that involved a much smaller incision is the reported visibility issues.

      I really would prefer that my surgeon had as good a view of the operating site as possible. Also the more limited the working space the greater the difficulty in using a long stem if this proved desirable. As there may be an amount of test fitting and modification going on I cannot see that it would be ideal working in a tight space.

      All the best

      Richard

    • ptolemy
      ptolemy RichardKen

      Posted

      Dear Richard, I so totally agree. I would much prefer that my surgeon had an easy access to my hip rather than having a tiny scar, even though it may interfere with the wearing of a mankini on the beach! 
  • erin1956
    erin1956 maryboo

    Posted

    Mary:

    NO NOT allow your surgeon to put a MonM implant in your body. There are a ton of law suits plus people's lives are being affected adversely due to metalosis as you have already researched.  Your surgeon should know better.

    There are many choices of ceramic on plastic (ethylene) combinations for your surgeon to work with. They can be cemented or not cemented.

    I would surmise that your surgeon gets compensated from the manufacturer for using these particular implants. This is borderline malpractice and not in your best interest (or health).

    I would run as fast as I could and get a second opinion. The anterior approach, in my opinion, is the correct, least invasive procedure. That is good. The choice of type of implant is not.

    I've had both hips replaced via the anterior procedure and have had a Medacta implant used both times. It is a versafit cup with a polyethylene liner with a ceramic head. The stem is a titanium alloy but is implanted into the femur and is cementless.

    You are not being overly anxious.You are being a good consumer and looking out for yourself and future health.

    Get a second opinion/ use another surgeon.

    Take care,

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