Symptoms of metallosis, or metal poisoning, from hip surgery
It’s a pain enough (literally and figuratively) to get a hip replacement. You have to get diagnosed, receive a prognosis, schedule pre-surgery checkups, plan for your time away from work and make sure all is well for you to take a break from life, all before you even actually get the surgery. Then you have to deal with recovery and strengthening. This can take months to achieve.
Then there is the risk of hip surgery complications.
What if the hip implant you so desperately needed actually does you harm? What if, after a little while, you notice that the surgical site is swollen, that movement hurts, that something feels wrong deep inside?
Metal-on-metal implants are notorious for the problems they create and have been the subject of numerous product recalls. At first thought to be sturdier and more durable, it was discovered – after lengthy trial and error – that these implants can cause many more problems than bargained for.
What is metallosis?
Metallosis is a condition in which debris from metallic implants shed from the device. These particles build up in soft tissue and leak into the bloodstream, which can ultimately lead to metal poisoning.
Cause of metallosis
Manufacturers initially believed that metal hardware would result in a sturdier, more durable device. Sometimes the entire unit (a “monoblock”) was made out of metal, ranging from materials like titanium, chromium, nickel, cobalt, iron or molybdenum. Others had ceramic or plastic heads paired with metal stems. However, the smooth nature of metal-on-metal implants causes a high friction rate whenever the patient moves. Like starting a forest fire, the pieces rub together; this causes particles to shed.
Symptoms of metallosis
Hip implants are supposed to last up to 15-20 years. Many of the metal versions only lasted a few years because they led to significant health issues, such as:
- General hypersensitivity reaction (skin rash)
- Bone loss
- Increased pain in hip or groin
- Osteolysis (inflammation causing the device to loosen from the socket)
- Changes in your ability to walk
- Renal or thyroid function impairment
- Blood poisoning
- Cobalt poisoning
- Titanium metallosis
- Circulatory and cognitive issues
- Neurological changes
If these are happening to you, your surgeon will likely make a metallosis diagnosis and recommend a revision surgery. Additional surgeries mean additional risks, as well as recovering once again.
How likely is it that I have metallosis?
Even if you’re experiencing pain from your hip replacement implant, it does not always mean you are suffering from metallosis.
How prevalent is metallosis?
In a study of hip resurfacing patients, 18% were experiencing groin pain, but only 2%-5% received a diagnosis of metallosis.
Cobalt levels are determined by micrograms per liter of blood. If a patient has between 1-5 micrograms per liter, he might experience heart and memory issues. If there are more than 7, the patient might feel hip pain and have either tissue necrosis or pseudotumors. At 23, the patient could possibly also have mental problems, vertigo or deafness. At 66 or more come blindness, seizures, tremors, heart failure, depression and weakness, among other symptoms.
The FDA reports it does not know how often local tissue reactions to metal-on-metal hip implants occur, but rather says it depends on the individual and how they react to metal ions in their bodies.
Factors that increase risks
If you already have a metal allergy, you will be at higher risk for a metallosis diagnosis. Many Americans have nickel allergies, and that is a common building part for hip replacements. Additionally, smokers are at a higher risk for developing this condition.
The following are also at a higher risk:
- Bilateral implants
- Femoral heads 44 mm or smaller
- High levels of corticosteroids
- Renal insufficiency
- Suppressed immune systems
- High levels of physical activity
- Misalignment of device
Even if your hip replacement is only partially metal, you can still get metal poisoning. Some devices are ceramic-on-metal, which has significantly lowered the prevalence of this condition, but still presents with some cases.
Sometimes a device can fracture, opening up internal metal parts that hadn’t been exposed to the body before. Additionally, the procedure doesn’t need to be a total hip replacement for it to occur. Even the resurfacing of hips can present an opportunity for metallosis to develop.
What if I think I have metallosis?
Symptoms of metal poisoning are hard to miss. If you are suffering from increased pain, skin rashes, breathlessness, brain fog, poor memory, vertigo or hearing loss, you should speak with your doctor immediately. Your doctor will perform a blood test to confirm whether you do indeed have metallosis.
What treatments are available?
Your surgeon might decide that corrective surgery is the only way to truly fix your metal poisoning. There are also drugs available that bind to the metals and eliminate them through urination. However, the medications would only remove the metal, not keep them from building up again. Removal of the implant is the only sure method of curing the condition. Once the implant is taken out, full recovery is much more likely.
Other problems from metal hip replacements
It’s one thing to have a surgery for a painful condition and still experience pain afterward, despite the corrected condition. Chronic pain can arise for any number of reasons. It’s another thing for an implant to be defective. The most common problems regarding metal-on-metal implants (besides metallosis) are:
- Patient required additional surgeries that could have been avoided
- Bone loss
- Device or bone fracture
- Device loosening (osteolysis)
- Implant failed earlier than anticipated
- Joint dislocation
What if I have a metal hip replacement but I don’t have problems?
Let’s say you have a metal-on-metal hip implant, but you’re one of the lucky ones who aren’t experiencing side effects or issues. Should you have it changed out? Should you expect something to develop?
Not necessarily. Just because a device has been recalled doesn’t mean you need to worry. Not every metal hip device causes problems. If you haven’t developed metallosis, you may not at all. You and your surgeon should sit down and discuss whether removing the device is warranted. As mentioned, a revision surgery is another surgery. You should not go under the knife unless you absolutely need to. Follow up with your surgeon on at least an annual basis.
What is the FDA doing about metal-on-metal hip implants?
The FDA actually published a notification regarding metal-on-metal implants because they received so many consumer complaints. As of 2016, they required any manufacturer to get premarket approval for specific metal-on-metal devices. They determined there was not enough evidence to support the fact that these implants were safe to use. These devices are Class III (higher-risk).
Additionally, the FDA is doing the following (this is not an exhaustive list):
- Working with manufacturers to evaluate metal-on-metal devices in an MRI environment, attempting to ensure safe scanning
- Supporting the development of technology to improve image quality around metal implants
- Reviewing published literature around Medical Device Reports (adverse event reports), along with postmarket studies and data
- Addressing the differences among orthopedic registries
- Reviewing device analyses to help understand why metal-on-metal devices fail over time
- Issuing Safety Communications
When to call a lawyer
If you are experiencing pain at your surgical site or any of the above symptoms regarding metallosis after a hip replacement surgery, first speak with your doctor. Staying healthy should be your primary concern.
However, after that, you should call an attorney. There are many, many active cases that you can join as a plaintiff, and a defective products attorney can help. Make sure you are within the statute of limitations for your case. (This is the length of time in which your state allows you to file a claim.)
Remember that you don’t have to do this alone. Check out the Enjuris law firm directory to find a legal match.
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