TKR Metal sensitivity questions.

Triker

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Hi, I have a problem to solve and I'd really appreciate some input.

I had a hip replacement with cobalt /chromium and ended up with metallosis, bone loss and tissue damage.

My cobalt and chromium blood work values were not terribly high but the damage done was great, - cobalt was 5 time normal, chrome 2 times normal.

My surgeon believes I am sensitive to or outright allergic to these metals.

Fast forward, I need a knee replacement and it's getting done through the VA by a different doctor. The VA surgeon I was sent to wanted to install a Zimmer Biomet Vanguard knee which is a knee with cobalt chromium components and he said it wouldn't be a problem for me because nickel is the metal most people are sensitive to and that there wouldn't be any metal on metal contact to cause any particles of metal to wear off and cause me another allergic reaction.

He also said the vanguard would have or would develop an oxide layer that would protect me. Does this sound reasonable?

My hip surgeon strongly recommended I not get a cobalt chrome replacement and that he thought I would have a rejection.
He recommends the Verilast oxinium replacement with a protective ceramic coating. I halted the first surgery with the Vanguard system and asked for another consult with the VA.

I'm really torn about this. I hurt this knee 40 years ago while in the Navy and it has gotten to the point where I need it replaced. The cartilage is gone from the middle and inside of my knee and nearly gone from the outside. MY leg is bowed and now shorter than the other leg. It's pretty bad and since it is a service connected surgery that's been treated by the VA it has to be repaired by them, my private insurance won't cover it.

I really want this fixed but I don't want to stick something in my body that's going to cause me more problems. Any advice out there? This is keeping me up at night, The worry as well as the pain.
 
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Celle

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Hi @Triker ,
I don't know enough about how teh VA works to advise you about this, but I have asked for further advice for you.


My personal opinion is that you should not have the device installed that contains the metals to which you are allergic.

Please will you tell us the full dates of your hip replacements and which hip it is, so we can make a signature for you? .
Thank you.:flwrysmile:
 

Celle

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Thank you for your surgery dates.

Can you ask your hip surgeon for a copy of your metal sensitivities test, and also ask for his recommendations about what type of knee replacement should be used?

You might be able to use his recommendations to persuade your current knee surgeon. There are devices that present less of a risk of metal sensitivity than the one your current surgeon wants to use.
 

Jamie

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As Celle mentioned, do you have results from a blood test that show your sensitivity or those high blood levels of chromium and cobalt? If so, or if you can get one, I'd take that to any surgeon you are planning to use. You might have to pay for a blood test to determine if you are actually allergic to either or both of those metals. But since you have had problems that extra $550 might be money well spent. That test is usually not covered by any insurance.

Was your first hip that had the problems a metal on metal one? If so, this may be where the surgeon is coming from. It's possible that you don't have sensitivity as much as you had problems with a metal on metal hip. That is fairly common, which is why they are no longer used to any great extent. The bearing surfaces have tended to wear and release metal particles into your body that can cause the type of damage you experienced.

The problem with trying to dictate which implant a surgeon uses is that you must find a doctor who is very experienced with that implant. Each company and prosthesis has its own procedures and tools to work with and normally a surgeon only uses one or two types in their practice. But, given what you've been through, I can see that you would feel much more confident if you had that extra protection that the ceramic coating gives you.

I suggest you try and get some additional opinions. I know that can be tricky with the VA, but you may be able to enlist the help of a Patient Advocate.
 

Jaycey

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Was your first hip that had the problems a metal on metal one?
Both hips were MoM. Here's Triker's original thread on his BTHR.

Jamie is right. The issue was the metal on metal implants that they no longer use. You probably have no metal sensitivity. Just bad luck that your BTHR was done at a time when they still used MoM implants.
 
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Triker

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Hi @Triker ,
I don't know enough about how the VA works to advise you about this, but I have asked for further advice for you.


My personal opinion is that you should not have the device installed that contains the metals to which you are allergic.

Please will you tell us the full dates of your hip replacements and which hip it is, so we can make a signature for you? .
Thank you.:flwrysmile:
I have copies of all the reports already and plan to bring them with me to the consult and have uploaded them to my VA medical record as well. My problem is that my hip doctor said that the damage I had was what he was used to seeing in people with ion levels 10 times what I had. He took that to mean that my allergic response was way out of the proportion to my levels and he used that as a reason to diagnose me as sensitive.

What do you have to say about the VA doctor who said that the new replacement would develop an oxide layer that would protect me, is that true? If that's true I might take the chance. Really what choice do I have? I can limp around with a non functioning knee or get a replacement that may be a problem sooner or later.
 

Pumpkln

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VA doctor who said that the new replacement would develop an oxide layer that would protect me, is that true?
Yes the oxide layer that comes with the implant should protect you from the metal underneath.
Smith and Nephew for example has an OXINIUM Oxidized Zirconium knee, that protects you from the metals.
Other manufactures have similar products.
 

Celle

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I have copies of all the reports already and plan to bring them with me to the consult and have uploaded them to my VA medical record as well.
That's good. But did you have a blood test for metal sensitivities? That is most important.
My problem is that my hip doctor said that the damage I had was what he was used to seeing in people with ion levels 10 times what I had. He took that to mean that my allergic response was way out of the proportion to my levels and he used that as a reason to diagnose me as sensitive.
There seem to be two distinct things at work here. One is your probable sensitivity to some metals. The other is the metallosis, which is a reaction to the metal filings rubbed off because you had a metal on metal prosthesis.
Metallosis: what is it?

What do you have to say about the VA doctor who said that the new replacement would develop an oxide layer that would protect me, is that true? If that's true I might take the chance. Really what choice do I have?
I'd be very sceptical about what that surgeon said and I wouldn't take the chance. As Pumpkln said, above, there are already implants with the oxide layer in place that would be suitable for you.
I wouldn't count on an oxide layer developing on an untreated implant once it was in place.
Can you request to have a second opinion from several different surgeons?


If you haven't already had a full metal allergy blood test,, you can get it done in the USA by ordering the test kit from https://www.orthopedicanalysis.com/testing/order-testing-panel . You want the Orthopedic Panel Test 2. Once you get the test kit, your GP (or any lab) can do the blood draw and send it in for testing.
This test isn't covered by insurance, but if you haven't already had it, it could be another tool in your bid to get a replacement that won't cause you problems.
 

Jockette

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This test isn't covered by insurance, but if you haven't already had it, it could be another tool in your bid to get a replacement that won't cause you problems.
I will gladly pay for this test, if I have to have another replacement, to avoid possible problems in the future.
 

Jamie

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What do you have to say about the VA doctor who said that the new replacement would develop an oxide layer that would protect me, is that true? If that's true I might take the chance. Really what choice do I have? I can limp around with a non functioning knee or get a replacement that may be a problem sooner or later.
I have to say this is not something I've ever heard of. As the folks above have said, there are implants with an outside coating that serves as a barrier between you and the metal. But I've never heard that one's own body would cause such a shield to develop. That sounds pretty far out to me and I could not find any science that backs that statement up.
 
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Triker

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I have only the before and after ion levels. The diagnosis the hip surgeon made was by his observations during the surgery and the levels in the ion tests. The upcoming consult will be the second VA doctor to take a look at my problem. I've been going to the VA for 40 years and find that for the most part they try to do what's best for the vet. They work for the federal government so they certainly can't be in it for the money.
 
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Triker

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I just sent a request to my VA medical team to see if they will order up a sensitivity test before my consult. Hey they might do it.
 

Celle

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I hope they will order the test for you, @Triker , but even if they won't, it would be worth your while to pay for the test yourself, so you have some solid information to support your cause.
 

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