Abstract: Total hip arthroplasty (THA) has been performed for nearly 50 years. Between 2006 and 2012, more than 600,000 metal-on-metal THA procedures were performed in the United States. This article reviews the production of metal wear debris in a metal-on-metal articulation and the interaction of cobalt and chromium ions that ultimately led to a dramatic decline in the use of metal-on-metal THA articulations. Additionally, the article reviews mechanisms of metal wear, the biologic reaction to cobalt and chromium ions, the clinical presentation of failing metal-on-metal articulations, and current diagnostic strategies. Further, the article discusses the use … Read the Rest
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Although metal allergy with total joint replacement exists, the prevalence of this condition is unknown, according to Joshua J. Jacobs, MD…
…”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.”
Jacobs JJ. Clinical manifestations of metal allergy. Adverse
Do Metal Ions or Debris from a Metal on Metal Hip Device Cause Health Problems?
Metal-metal bearings have advantages for active patients because their wear resistance is much greater than that of polyethylene, they do not fracture and they perform better with larger diameter balls. It has been known for three decades that the serum and urine levels of cobalt and chromium (the main elements in a metal-metal hip bearing) are increased in patients with a metal-metal bearing. The health impact of such ion levels has not been established and continues to be debated. Trace element analysis requires … Read the Rest
Pat from Surface Hippies contacted me. I want to make it clear that I am not a qualified pathologist, nor a medical doctor, I am just a researcher with an interest in hip resurfacing and biomaterial compatibility. I run an independent implant retrieval research laboratory within the J. Vernon Luck Snr MD Orthopaedic Research Center at UCLA/Orthopaedic Hospital in Los Angeles. As such, I am the fortunate recipient of specimens and information from several orthopaedic surgeons, including Dr De Smet, who care enough about their patients to seek out knowledge to help solve patient problems, among which is metal sensitivity. … Read the Rest
Can I have a Metal on Metal Hip Device if I am Allergic To Metals?
Skin allergies to metals does not mean you will be allergic to a hip replacement device inside your body at the deep tissue level. This is a question that many people ask. The best way to know if you can have a hip resurfacing when you have skin allergies to metals is to ask an experienced hip resurfacing surgeon.
Dr. Bose has written this explanation about the metal allergy problem:
“Allergy after artificial joints is an … Read the Rest