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Metal on Metal warning (old but ongoing news)

Discussion in 'Hip Replacement Pre-Op Area' started by Dingbat7, Jan 28, 2012.

  1. Dingbat7

    Dingbat7 Senior

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    Apparently following the breast implant saga , there is now a scare re metal hip joints that have been fitted with metal sockets as they wear causing metal fragments to go into the blood stream, apparently these have been withdrwan in the UK since 2010 .

    I assume there is no such problem with the ceramic hip joints which I'm supposed to be getting , is ceramic now the standard material used ???
     
  2. alexthecat

    alexthecat Forum Advisor

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    My understanding is that there have been problems with a certain model of artificial hip from one particular manufacturer. That model was recalled and is no longer in use. Other metal-on-metal hips are still in use and there are many happy hippies walking around on them with no problem at all.

    Selection of an artificial hip is really best left to the surgeon, as he is the one with the training to make that decision.
     
  3. Jamie

    Jamie Administrator

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    Alex is precisely correct. This is not a new issue and the particular implant that was identified as a potential problem was removed from the market some time ago. You should have no worries about this.

    I'm curious, though. Where did you hear about the metal on metal problems?
     
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    • GrahamDee

      GrahamDee Senior

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    • Jamie

      Jamie Administrator

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      Thanks.....there has actually been a ton of information put out there in the media and on the web. I was really just curious about where Dingbat7 had received the information.
       
    • Dingbat7

      Dingbat7 Senior

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      Saw it on Sky News last night and like always only told half the story it was intimated that all metal on metal dangerous, they didn't say only one type of hip they had a copy of a newspaper up on screen during press preview with it announced on front page, which again seemed to indicate new news.

      A bit out of order causing a panic if only applies to one type of hip, those people already probably aware

      As you can see from the headline in the Telegraph makes no mention in the headline or first paragraphs about only applying to one sort of hip looks to me like jumping on the breast implant news bandwagon
       
    • Jamie

      Jamie Administrator

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      Yes, we do dearly love our "impartial, fact-based" media systems......seems all countries do the same thing to sell papers and airtime.
       
    • Bumpa

      Bumpa Sr Bonesmartie

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      Hi, thanks for this attention and scare story. As Josephine will know some of the original metal-on-metal McKee-Farrars functioned for over 30 years. I referred to the news story under 'which prosthesis' topic.
      From what I have read the most important aspect for survival of ceramic-on-ceramic is the correct orientation of the cup component.
      I'm sure Dinbat7 you will be fine.
       
    • Josephine

      Josephine NURSE DIRECTOR, BONESMART Administrator

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      Indeed, the ceramic is a good device.
       
    • Dingbat7

      Dingbat7 Senior

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      It's certainly doing the rounds , had a big mention again on breakfast TV today (This Morning) again no mention that it applied to one type ..It was suggested those with metal on metal went to GP to have a blood test to see if any trace of metal in blood.
       
    • Josephine

      Josephine NURSE DIRECTOR, BONESMART Administrator

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      This latest one might be because the notes of a conference in early December (which I attended) were recently released. This was held at the Royal College of Surgeons in London but was organised by Orthopaedic Research, UK which anyone can join and then any members could book into the conference. Yet the papers reported this as a meeting "held behind closed doors"! :DOH: I can tell you there were many non-medical delegates at the meeting.

      The title of the meeting was "Metal-on-Metal Hip Replacements: Solving The Uncertainties" and the whole issue was discussed frankly and openly amongst the 150+ delegates which included a considerable number of very senior and prominent hip surgeons. Basic conclusions by the end of the meeting were that there appears to be an awful lot of questions we now need answer to but in years past, who knew these were even going to be issues? Even as late as the 1980s we had no idea because there was no technology to make us aware of it. Now that technology does exists it is advancing more rapidly than we could ever have imagined, posing questions to which we have no answers because, in the days of our naivety, we never knew the questions needed to be addressed. So now we need to start collecting this information and do research into the data to get those answers. The sting in that tail is that such research can take upwards of twenty years to be of much use.

      So .... watch this space!
       
    • Bumpa

      Bumpa Sr Bonesmartie

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      The latest from the US of A on this subject - also gives some information on the sensitivity of metal ions:

      Surgeon discusses rate, presentation of metal allergy in joint replacement
      Although metal allergy with total joint replacement exists, the prevalence of this condition is unknown, according to Joshua J. Jacobs, MD.


      “Metal allergy [with] orthopedic implants has been well documented in isolated cases,” Jacobs said during his presentation at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting/Orthopaedics Research Society symposium. “The true prevalence is unknown. Clinically significant symptomatologies seem to be rare in total knee replacements and metal-on-polyethylene total hip replacements, but much more common in metal- on-metal total hips.

      Based on case reports and device literature, Jacobs said that metal allergy exists and has been seen as a temporal association. It can have different presentations and many involve a rash. In some examples, patients suffer skin reactions after implantation of total joint replacement devices. In other cases, the reaction goes away after the implant is removed for nonunion or refracture, only to return after re-implantation.

      “In my mind, those sorts of cases prove to me that this is a real clinical entity,” Jacobs said.

      Using patch testing, 14% of the general population would be sensitive to nickel and 10% would be sensitive to cobalt and chromium. However, Jacob said that patch testing may be flawed because it may have no bearing on what is occurring happening in deep tissues.

      “Metal-on-metal allergy is the cause of clinical symptomatology, such as pain and swelling,” Jacobs said. These allergies present as skin reactions such as dermatitis, or patients may have a history of allergy to jewelry. The responses to these allergies can present as stiff knees, pseudotumors, necrosis or unexplained pain, Jacobs said.

      “In patients with metal-on-metal surface replacements, there is a direct correlation between serum metal levels and metal sensitivity determined by [lymphocyte transformation testing] LTT,” Jacobs said. “Current diagnostic methods, both patch testing and in vitro, do require more robust clinical validation, but it can be useful in preop screening for patients with in vitro metal allergies when there is a history of reaction to jewelry.”

      Reference:
      Jacobs JJ. Clinical manifestations of metal allergy. Adverse reactions to byproducts of joint replacements (AAOS/ORSI). Presented at the American Academy of Orthopaedic Surgery 2012 Annual Meeting. Feb. 7-11. San Francisco.
      Disclosure: Jacobs is a paid consultant for Johnson & Johnson, Medtronic Sofamor Danek, Smith & Nephew, Spinal Motion and Zimmer; is an upaid consultant and owns stock in Implant Protections; receives research support from Medtronic Sofamor Danek, Nuvasive and Zimmer; and receives royalties from Taylor and Francis.
       
    • Josephine

      Josephine NURSE DIRECTOR, BONESMART Administrator

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      Great stuff, Bob. That's gone in the Library!
       
    • paul-crip

      paul-crip Junior Member

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      Last year my hospital primary care trust / consultant wrote to me where they where contacting everyone they had performed MoM replacements on withint he last 5 or 6 years. I was invited back for a consultation and xray, and had a blood test to check for elevated metal levels but had to push the consultatnt myself to get the blood test done.

      I am for the foreseeable, having an annual check, my GP has referred me for this again recently so hopefully should be seeing them around Easter time for xrays and bloods again.

      Not sure what other UK hospitals and PCTs are doing for their MoM patients but could be worth asking your GP, at least that should go some way to putting your mind at rest if your affected.
       
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      • Josephine

        Josephine NURSE DIRECTOR, BONESMART Administrator

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        I thought he'd done that - haven't you, Dingbat? If not, you should do.
         
      • Dingbat7

        Dingbat7 Senior

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        Haven't I done what ? I am having a ceramic.
         
      • Josephine

        Josephine NURSE DIRECTOR, BONESMART Administrator

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        Asked your GP - oh, nm - no surgery yet = no need. Silly me! :doh:
         
      • Dingbat7

        Dingbat7 Senior

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        Back in the News NEWSNIGHT tonight at 10:30pm whole programme on it.
         
      • Josephine

        Josephine NURSE DIRECTOR, BONESMART Administrator

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        Did you watch it? Not a whole programme, about 10mins only.

        Actually, it's been resurrected because of the recently published notes from the seminar I attended last December. I published my notes here Metal-on-Metal Hip Replacements: Solving The Uncertainties

        I am also going to the follow up seminar in May called "Resolving the Uncertainties". Let's hope so!

        I was a bit ticked off by Jeremy Paxton when he said to that chap "So essentially you were using people as guinea pigs". Does he not realise that hip replacements have been done since the early 50s? Long before the science to reveal all these issues was ever invented? That's a bit like blaming Henry Ford for all the lead pollution from cars! Who knew at the time that such things were happening at all, much less how dangerous they would be to humans. They do say that hindsight is always 20/20.
         
      • Dingbat7

        Dingbat7 Senior

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        Yes I saw the whole thing , was told by a mate the whole programme was about hips.
        Yes he was a bit out of order, but then if you go on that show as the sacrificial lamb for the industry/organisation don't expect not to get slaughtered by him and the chap from the agency involved didn't seem too phased.

        I see what he was saying that a new drug needs years of testing before being allowed onto the market but a hip doesn't and the patients are the testers over time , one bit mentioned a hip can be authorised onto the market in three days. I was a bit concerned that the industry knew about this in 2006 but didn't suggest anyone was tested re MRI'd until more recently

        Dunno what the answer is could they test them on animals , me thinks the animal welfare people would have something to say if we started to saw away and fit ceramics to the PG Chimps, can't see them observing the 90 degree rule either. :loll:
         

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