April 16, 2014
Metal-on-metal hips seemed like a good idea, in theory. In reality, some have become an implant patient’s worst nightmare.
Nearly four years ago, I wrote a blog about a very personal matter—the fact that a metal-on-metal implant inserted in my right hip had been recalled because of possible bodily damage related to the metal parts wearing on each other. I had just learned that I was the proud owner of a DePuy (Johnson & Johnson) ASR XL Acetabular System, one of 93,000 units that had been recalled, and I was both angry and afraid. Replacement surgery, like any major surgery, is a big ordeal—something no one wants to undergo unless they absolutely have to. And to find out that this device could cause major problems and might require revision surgery was disconcerting, to say the least.
The initial guidelines for monitoring the situation called for annual blood work to determine the amount of metal ions, specifically chromium and cobalt, in the bloodstream. (Metalworkers can relate.) Elevated levels, along with signs of implant deterioration, such as limping caused by a loosening of the joint, called for revision. Imagine how relieved I was each year to get my numbers and to find out that they fell within the acceptable range.
Now, imagine my dismay when I learned this year that although the levels still are pretty good, serious tissue damage had been taking place for a while. This damage was revealed by a MARS MRI, a newly recommended precautionary procedure. The test revealed considerable fluid buildup along the outside of the hip joint and some possible muscle deterioration. And this test in itself did not reveal the extent of the damage. That wouldn’t be known until the surgeon operated and examined the surrounding tissue.
A week ago today, I had the revision surgery. We‐my surgeon and I—had hoped that it would be a relatively simple straight-forward change-out of the ball and liner, replacing the metal parts with ceramic. That was not the case. The entire joint was encircled by a fluid sac dusted with metal. Surrounding tissue showed metal damage. The surgeon ended up replacing everything but the stem collar, removing the damaged tissue, and revising the implant angle to ensure that the stem would seat correctly with the ball.
My body definitely was under assault on the operating table, but this procedure was necessary to combat the silent assault I unknowingly had been undergoing. So far, my recovery is going well, and I am grateful. I’m especially grateful that rather than give me a “pass” based on the blood level tests, my doctor ordered the MRI that revealed the damage. I shudder to think what might have transpired had I continued to rely solely on blood levels as the definitive indicator that all was well.
My doctor took photos of the damage that I will see at my first post-op visit in May. He also preserved the implant material and tissue he removed from my body. I’m glad to be rid of it all.
Meanwhile, I encourage all of my metalworking friends to make sure you are being tested regularly for conditions linked to your work. Nip any trouble as early as possible.
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