Sunday, May 13, 2012

How Cobalt Toxicity Affects Patients: Part One: An Introduction to the Problem

A State of Alaska Epidemiology Bulletin article details the difficulties experienced by two patients after undergoing hip replacement surgery using a metal-on-metal implant. Both patients were 49-year old males who were in good physical condition—other than pain or inability to fully participate in normal activities—prior to the hip replacement surgery. Some signs which indicate a patient needs hip replacement surgery include hip or groin pain which either keeps the patient awake at night or waken them. If this hip pain is severe enough to limit normal everyday activities such as climbing stairs or getting out of a chair or limits such pleasurable activities as traveling, shopping or walking for exercise, then hip replacement surgery could be indicated.

Finally, if other treatments have been tried, yet the hip pain persists, and your doctor has considered all your specific factors (age, overall health and bone density) then he may recommend hip replacement surgery. Because hip replacement surgery is considered major surgery with significant risk of side effects, it will not normally be recommended in those who are only limited from performing such activities as running or skiing or those whose pain is alleviated through medication or activity modification. Reports from those who have undergone hip replacement surgery using a metal-on-metal implant indicates a litany of negative health effects, from minor to very severe.

Number of Metal-on-Metal Hip Replacements

Metal-on-metal hip implants are a relatively new design, however accounted for at least a third of the estimated 250,000 hip replacements performed each year. The metal-on-metal implant gained popularity because of the belief that the metal was more durable than other types of implants. Other types of hip implants include a metal replacement of the hip joint ball and socket with a plastic spacer in between or a ceramic-on-ceramic implant which is actually considered to be the most wear and scratch resistant implant. Another commonly used implant uses a new type of cross-linked plastic which has been manufactured to last longer than most plastics.

The metal-on metal hip implant design is believed to wear out less quickly than the metal and plastic implant, however despite the low wear rate it is unclear if the metal-on-metal implants actually last longer. Ceramic implants have also shown problems, with some of them breaking inside the body. Unfortunately, the metal-on-metal implants can release metal ions into the blood stream, accumulating in concentration over time. It is believed that as many as three percent of recipients of metal-on-metal hip implants may require revision surgery due to toxic metal debris in the bloodstream causes from tiny metal shavings as the metal rubs against metal.

This friction between metal plates in the body causes those metal fragments to leach into the blood, subsequently triggering inflammation and as much as two to three times the predicted failure rate. Many hip replacement manufacturers who employ the metal-on-metal device have asserted that the failure risk only applies to the DePuy ASR due to the shallow cup, although others believe the risk exists for all metal-on-metal devices.

Author: Sullo & Sullo Attorneys

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