Revision THR Has anyone ever heard of late onset metal hypersensitivity in a ceramic on ceramic hip

[Jaycey]

Wow Z15, nothing is easy is it? Glad you are starting to see a way forward. Please do keep us updated. You are part of this great big family now!

 

[Doupie]

Z15 I am praying for a positive outcome for you. Thank you so much for posting this, I want to become more active but I am so afraid that I will damage this new hip even though my OS says no and I can do whatever I want. I have started back attending Bikram Yoga and riding my bike more, but when I went to the beach I wanted to run on the sand but was hesitant so I just walked. I know other people are or have experienced these same concerns. You echoed my concerns when you said this.....

"I asked my surgeon if my activity level CAUSED this flare up, and he said only in this way: Your increased activity level and stresses that you put on your prosthesis freed up more metal into your blood stream faster. If I was gentle on it, it may've taken more years to flare...or perhaps never reached a level that would've bothered me."
I really hate that this happened to you and I'm sure that you will get some relief very soon. Stay positive and lots of {{{{HUGS}}}}.....

 

[Z15]

Doupie,

As I mentioned to someone the other day, the real trick is to do 100% (or 99.9%) of what you can do short of injuring or compromising one's artificial joint. That is what I would wish for everyone. But the impossible part is to know or sense that we are approaching that limit and stop. I will speculate that there are plenty of people who would like to do more, but the fear keeps them way short of doing all the fun things they could. And if they are happy with that...awesome. As long as they are happy and doing enough to keep themselves fit and healthy.

I believe that what I do so far (and what I look fwd to getting back to) is an ok level for me. I stay active, and smiling when I can be out on the trails and feeling less limited hip wise. There'll come a time when other issues slow me down and the hip is not the gating factor. But today, for me, it is.

When I started upping the level early on I would literally switch from walking to "an awkward jog-like movement of some parts of my body" for TWO OR THREE steps,. that's all. It was laughable how uncoordinated and foreign it felt. I think I actually did laugh. And over time I upped the 3 uncoordinated strides to 15 and 20 slightly more coordinated strides. And had to be perfectly willing to limit myself to those 2 or 7 or 13 strides if that is all my body was ready for. Slow and steady. Stop if it's not working. There's always tomorrow and the day after that...

But thanks for the kind thoughts,

Z

 

[randy62]

Z15 well said, well said. Life be in it.
Fear not for the future, weep not for the past.
Percy Bysshe Shelley

 

[C Mac]

Hi Z,

I'm sorry to see you in this zone and hope that you are going to get good answers and the easiest fix allowable. Keep us posted and you are worthy! We care about you and watched you do amazing things 15 minutes after your new hip was installed

Take care,
Cardie

 

[pt98n]

If you have a modular stem and neck, is it the recalled Stryker ones? It is not an allergy but metallosis due to the titanium on co-cr. If you have an abnormal MRI I would highly consider thinking of a revision with a new nonmodualr stem before more damage takes place. I had the Stryker ABG II stem about 20 months ago, did great, like you did a little running and had no symptoms. When I learned my modular stem was recalled had my blood metal ions checked and ok. I decided to get an MRI to make sure and it showed a huge effusion. I had a revision this week at Mass General and he had to cut 1/3rd of my abductors out due to metal damage. If this is what you have, it only progresses and damages muscles, bones, etc and you can't get that back. Really be pro active on this, get a few opinions even though I know of your surgeon and he has a good rep. Mass General has a dedicated department for metal on metal issues. Worth just an opinion. I was really surprised how much damage there was as the week before I deadlifted, ran, etc. I bet it has nothing to do with the ceramic but the modular stem.

 

[Z15]

PT98N,

Sorry to hear about your ordeal. I have a Wright Prosthesis that does mount a Co-Cr neck to a Titanium stem. Before everyone panics, I have read numerous studies that are very positive about this technology (modular necks) in general, but it does sound like there are some bad ones out there.

Did all your blood levels test normal before the surgery?

Thanks for the input,

Z

 

[pt98n]

I like the technology too about the modular stems, that's why my original surgeon used it and I agreed. There really was never a consideration that a metal on metal problem would occur with this construct. This is proving to be wrong. The problem is the titanium, co-cr interface. Even though yours was not recalled, the potential is there.

Yes all my blood level tests were normal prior to surgery and I had two blood tests, one at a year and one at 18 months. You can have normal levels and still have metal problems and damage. I also didn't really have any symptoms, no pain with activity or walking maybe a little soreness. I decided to do an MRI due to the recall knowing things could be happening prior to me having pain. If something was present I wanted to catch it early. I am glad I did, I was really suprised about the amount of muscle damage I had. At this time my surgeon is predicting a good outcome but no more running, and if I would have waited, damage would be way worst and the outcome not so good.

I am not telling you this to scare you, just want you to stay on top of it. Please feel free to ask any questions and continue to be pro active on this. I had my MRI at Mass General then got opinions from my original surgeon, one at New England Baptist and my current surgeon at Mass General who is one of the metal on metal experts in the country.

 

[Jaycey]

Hi Z15, just checking to see if there is any update?

 

[Jamie]

Fear not for the future, weep not for the past.

Ahhhh.....Shelley.....one of my favorite poets! And this quote is an excellent philosophy for life. Z...I'm glad you're staying on top of things and hope the best for you. This is definitely a time to be an active participant in your medical care. Please continue to let us know how you're doing! You are such an inspiration to many here.

 

[Z15]

Hi Folks,

I was holding off on providing an update until I had jumped thru a couple more hoops...but the hoops are slow in coming so I'll give an interim update.

I'd say that my surgeon and I are both convinced that I am having a reaction to metal (probably cobalt) in my joint even though I am not allergic to the metals. Since I have a chromium cobalt femoral neck attached to a titanium stem, that junction has the potential to shed metal. My understanding is that if all the pieces were titanium it would be highly unlikely for my body to complain.

I had really stopped all activity on the hip around July 4th...and had a blood test on August 5th. At that time, after not using the hip for a month, my cobalt blood level was at 3.0 ug/L. My understanding is that this may already be on the high side. My surgeon is hoping to test me again and see a higher number to justify a revision to an all titanium setup. I am currently awaiting word as to when I should pursue that next test. I am trying hard NOT to be a couch potato prior to the next test as that will not indicate an accurate profile of the metal levels in my blood when i am active. I hope to speak with my surgeon today.

To his credit he is not dismissing me nor is he asking me to wait months. He is thinking that a few weeks between tests should be adequate to show a progression and get us the clearance that we need. If my Cobalt level is higher than last time then I think we have our answer.

I'll let you know what happens. Hopefully AFTER I get the test results.

I'm considering just paying for the metal ion test myself (as my insurance company may balk this quickly) any thoughts on what that might cost in New England??

Thanks for checking up on me folks,

Z

 

[Jamie]

Thanks for the update, Z. It sounds like you have an excellent surgeon on your side and a good plan going forward.

As for the test, you can find out what it costs by calling one of your local labs or your insurance company. Either should know what the going rate is locally for it. You might need the "official" name of the test from your doctor's office.

 

[Jaycey]

Gosh Z, sorry you are having to go through all this! Fingers crossed for you my friend. Please do keep us updated!

 

[Z15]

So the title of this thread is probably misleading. I am not sensitive to metals and my cobalt level actually decreased in a second test. I don't think it's metal.

But I have something new to learn about. I just got back my blood work and 19 months after surgery my C-Reactive protein level is up to 42! It was a bit out of the normal range a month earlier at 11....but clearly something is wrong. i have NO fevers or sweating to date... But the tenderness in the joint has recently switched to swelling.

My doc is supposed to call me tonight to discuss the results and the plan.

Any advice on questions and comments that I should be making? If there are any CRP experts on the board could someone ping them please. Much appreciated.

Z

 

[Jaycey]

I think the only person that may be able to comment would be Josephine. Please so let us know what your OS advises John! We are all in your corner on this!

 

[Josephine]

I'd say that my surgeon and I are both convinced that I am having a reaction to metal (probably cobalt) in my joint even though I am not allergic to the metals.

Well that's a certainly a certainty!

Since I have a chromium cobalt femoral neck attached to a titanium stem, that junction has the potential to shed metal. My understanding is that if all the pieces were titanium it would be highly unlikely for my body to complain.

But it also depends upon where the corrosion is. If it's in the trunnion/ball interface (which is where it usually is) then most likely both parts will be corroded. That's the issue. Remember the photos I posted earlier?

my C-Reactive protein level is up to 42! It was a bit out of the normal range a month earlier at 11....but clearly something is wrong

Yes clearly - you have metallosis which is a reaction to the corrosion. Not a fun conclusion and I dearly wish I could say something else. But you know me - straight to the point as usual.

 

[Z15]

Hi folks,

Here is the poop as I know it, and it is rather (apologies for the profanity) poopy.

I went in for my second hip aspiration (after seeing the elevated CRP). The first one they struggled to get ANY fluid. So they pushed some fluid in that time....drew it out, and cultured that. All clean.

But recently I have developed some swelling...and they got PLENTY of fluid this time only it was (apologies again) thick and yellowish brown. The doctor who pulled it was CONFIDENT they would have a finding/reading/direction from that. So he said they'd culture it immediately and have a preliminary read tomorrow (Wed). Four hours later my surgeon called and asked if I was still in Massachusetts (I wasn't...I was in Vermont at least 3 hours away) Apprently he would have operated tonite.

But instead...I am hydrating, ceasing eating at Midnite, and going in tomorrow.

All we know so far (no cultures yet) is that it is full of white cells. The surgeonindicated that he'll open it, flush it, evaluate what he can, and if nothing obvous is awry, he'll close me up and keep me in the hospital on antibibiotics. Within days they'll know what grows in Petri dishes to help guide the antibiotics.

That's pretty much all I know....other than he is calling me tonite to give me some add'l details on the timing and plan.

So how was your day?

Hope to have better news in some day(s).

Thanks for being there....

Z

 

[sharonslp]

Oh Z....I was so hoping for better news for you. I'm so glad your doc is right on top of this. I'll be sending mental good wishes your way over the coming days....wishes for quick recovery and healing and the ability to get this behind you and move on. All of us hope for that.

Sharon

 

[pt98n]

Sending good vibes your way Z. I hope all goes well and something simple.

 

[sunsetbiking]

I am sorry you are having troubles, it also sounds like you have a good doctor that is on top of everything. Sending positive thoughts your way.