Medical & Legal Information on Metallosis: Causes & Treatment Options
• Metallosis Overview
• Who Is at Risk?
• Symptoms of Metallosis
• Diagnosing Metallosis
• Treating Metallosis
• What to Do Next
• When Hip Implants Are Recalled
• Metallosis Lawsuits
Metallosis is a reputed blood poisoning condition that often develops when high levels of toxic metals are present in the blood. Metal particles in the body are often slough off metal hip implants and are released into the individual bloodstream and soft tissue typically at the site surrounding the implant. Exposure to environmental heavy metals can also cause metallosis as can the use of some natural remedies or bad drugs that the FDA defines as medications from an unknown source or a questionable pharmacy.
Metallosis can often lead to bone and tissue death, implant failure and ongoing severe pain. In addition, it can cause a loss of cognitive functioning, tissue damage, a loss of tissue, and significant damage to the individual’s nervous system. Severe metallosis often necessitates painful revision surgery where a surgeon exchanges the metal-on-metal hip implant causing the blood poisoning and tissue damage with another implant made of ceramic or other nonmetal material.
Who Is at Risk?
Certain populations have an increased risk of acquiring metallosis especially those who have a suspected metal sensitivity, are allergic to nickel, or those with joint implants. Other risk factors include:
- Individuals with bilateral (right and left) hip implants
- Overweight patients
- Patients with renal problems
- Patients who have a suboptimal alignment of their implant
- Men and women with renal insufficiency
- Highly physical individuals
Statistics reveal that even though approximately 18 percent of patients who have had hip resurfacing experience growing pain, less than five percent were proven to have metallosis.
Symptoms of Metallosis
Even though extreme pain is often associated with metallosis, it is not necessarily the indicator that tissue damage has occurred from the poisoning condition. The most common symptoms associated with metallosis include:
- Health problems (cardiomyopathy) like heart failure
- Nerve problems (neuropathy)
- Anxiety, depression, and other psychological status changes or mental issues
- Skin rash
- Thyroid problems leading to weight gain, fatigue, and temperature sensibility
- Implant loosening
- Cognitive impairment
- Visual impairment that could cause blindness
- Noise or clatter created when the hip is moved
Because every individual reacts differently when exposed to high levels of metal, the symptoms are often greatly varied. The pain is usually associated with bone or tissue necrosis (death) when the tissue surrounding the implant becomes blackened or a gradation color from exposure to the metal debris that flakes off the implant. Over time, this can cause significant instability in the replacement joint leading to a spontaneous dislocation, bone fracture or bone loss.
Pseudo-tumors or noncancerous pockets of built-up fluid can occur on occasion that forms around the damaged tissue. The fluid is often cloudy, rust, gray or yellow in color.
Severe Cases of Metallosis cause additional symptoms that include:
- Intense pain
- Mental fogginess/poor memory
- Audio problems/Hearing loss
- Vertigo (loss of balance or sensation of whirling)
- Goiter development
- Abnormal blood pressure
The World Health Organization International Agency for Research on Cancer has yet to make a correlation between metallosis and cancer. However, the organization does list trivalent chromium and cobalt used in joint implants as carcinogens.
Diagnosing the disease usually requires conducting a series of comprehensive blood tests in individuals who complain of symptoms. That said, elevated levels of cobalt ions can be detected in the bloodstream, urine, hair or joint fluid of patients experiencing no symptoms at all. Due to a lack of comprehensive research, the United States FDA (Food and Drug Administration) has not yet provided guidance on safe levels of metal ions in the bloodstream. Even so, normal cobalt measurements in (serum) joint fluid are thought to be less than two micrograms per liter.
Some doctors diagnose the condition using MRI (magnetic resonance imaging) and x-rays to determine the presence of tissue damage.
If the metallosis is due to a hip or joint replacement, revision surgery is usually required to avoid any further shredding of the implant’s metallic particles into the bloodstream or surrounding tissue. After removal of the offensive device, the body’s buildup of metallosis will begin to drop. However, from then on, the patient will likely experience a heightened sensitivity to low levels of metals for the remainder of their life. Additional treatments for metallosis involve:
- Chelation Therapy – The doctor can recommend the chelating agents to treat the disease by administering it orally, intramuscularly or intravenously. The therapy binds metal ions to remove the poison from the body. Chelation therapy has been proven highly successful at treating other poisons including mercury, iron, arsenic and lead.
Unfortunately, excessive amounts of cobalt cannot be removed (chelated) from fluid or the joint. Because of that, early detection is crucial to the patient to ensure the most positive surgical outcome. This is because severe metal poisoning can produce unfavorable and undesired side effects including tissue damage and fractures during surgery that can often cause a more challenging recovery.
What to Do Next
Patients experiencing adverse events related to metal hip implants such as hip dislocation, infection, device fracture, loosening or any other issues with the implant should seek medical help from an orthopedic surgeon who can further evaluate the problem. The doctor will take note of specific symptoms that could include hip noise, groin/hip pain, degrading previous symptoms, challenges with walking and others.
If the new symptoms or newly developed medical conditions are occurring in areas other than the hip, it is essential to seek out help from a primary care physician and mention that there might be problems with the metal hip implant. The surgeon will likely recommend hip revision surgery if necessary, where the original implant is removed and replaced by a different type of device, which is usually non-metal in design.
When Metal Hip Implants Are Recalled
Sometimes, the Food and Drug Administration or the hip manufacturer will recall the metal on metal hip replacement device. However, the action by the FDA or manufacturer does not necessarily mean that the doctor will need to remove the device and replace it with another. Sometimes, the recall is simply recommending that the doctor performs ongoing monitoring of the device before determining the most appropriate medical course of action.
Individuals unsure if their metal on metal hip implant is under a recall can find all the information they need through their orthopedic surgeon.
Doctors have reported many cases a metallosis related to metal joint replacement devices. Attorneys, scientists, and researchers have determined that many manufacturers of hip and joint replacement devices failed to properly test the units before making them available to surgeons and the public. Specifically, many injured patients of filed lawsuits against the manufacturer of all-metal hip replacement devices seeking the financial recompense they deserve for their damages, injuries, and losses.
These cases are typically handled by a reputable medical malpractice law firm that has an extensive history of handling metallosis and hip replacement cases. These claims for compensation are typically resolved through monetary payments awarded to patients who suffered serious injuries by the devices that were implanted as a solution for improving the quality of their lives.