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Metal Ions/Metal Implants
World Renowned Surgeons Video & Written Interviews discuss concerns regarding Metal Ions PDF Print E-mail

Watch Videos of Six World Renowned Surgeons discussing the recent concerns about metal implants, metal ions and pseudo tumors, click here

Also read my comments as well as comments from various Top Surgeons regarding metal ions, click here

I would also like to direct you to a new and extremely important lecture on the current McMinn site – a talk he gave in Glasgow in September 2010. If you click on this link it will take you there
http://www.mcminncentre.com/
Plus if you would like to see the debate that Derek McMinn has had on his website regarding the ASR device it is called Northern Lights 

as well as Derek McMinn's Response to ABC's 4Corners Program in the UK here

One more video worth watching regarding metal ions and the ASR device, both hip resurfacing as well as ASR THR's click here for video interviews with Tony Nargol, Tom Joyce and David Langton

 
Sheffield Abstract Accuracy of Metal Ion testing PDF Print E-mail

Effect of Analysis on Metal Levels after MoM HRA and Potential Impact on Patient Management and Interpretation of Research Datasets

Click to download IMPORTANT document

 
Metal Ion Level Testing PDF Print E-mail

Info for Metal Ion testing

If you or your doctor suspects that your implant may be placed slightly off and/or you are
experiencing a lot of unexplained pain, it is a good idea to have your metail ion levels
checked.   Or you happen to have an implant that has been recalled like either the Zimmer
Durom or the Depuy ASR, it migh be wise to get your levels tested.  Usually the surgeons
do not advise getting this test done until you are at least one year post op, but check with
your doctor.  Here is the test you need to ask for, print this out.

Metal Ion levels testing
From Dr. Edwin Su (this worked for me personally when I requested the test in 2009)

The metal ion test is usually outsourced to quest diagnostics.  It does have to be done using
special metal-free tubes to avoid contamination, but any quest should be able to do it.
Order "Blood chromium and blood cobalt", and you will normally get results in 1-2 weeks.
There will be some variability between the lab centers used, but I think that you can get
some diagnostically useful results by doing it through quest or an equivalent lab center.
Cobalt 345 Serum
371513 random urine

Chromium 5248 serum
11278 random urine 


Here are other codes available from public websites and I am in the process of getting more
details on testing and what the nunber mean from Derek McMinn, which I will post here as
soon as I receive the info.  Please take note that I was told to stop all supplements for
two weeks prior to my own personal test as many supplements contain minerals such
as chromium in them.  The lab technician should also be aware that they need to have
> special tubes, etc. that do not contain any metal as to not give you a false reading of
high levels when it is from the containers or excess supplements taken.
LabCorp - click on this to go directly to LabCorp's site

Chromium, Serum Test Number: 071522 CPT Code: 82495
Chromium, Urine  Test Number: 071530 CPT Code: 82495; 82570 
Test includes: Chromium, urine; creatinine, urine; chromium:creatinine ratio


Cobalt, Plasma Test Number: 071506 CPT Code: 83018
Cobalt, Urine Test Number: 071514 CPT Code: 82570; 83018


 
Quest Diagnostics - click on links below to go directly to the Quest site for the codes
Chromum, Serum [5248X]  142373  - CPT Code(s):  82495 - Link to TEST code
Chromium Random Urine [11278X]   13787 - CPT Code(s): 82495, 82570- Link to TEST Code
 
Cobalt, S/P Serum [345X]   6519   CPT Code(s): 83018 - Link to TEST code
Cobalt, Urine [37513X] 37513 CPT Code(s): 83018 - Link to TEST code
 


From Tony Nargol, M.D. on converting your numbers
In simple terms  results in nanmoles/L we convert to ppb = microg/L

CHROMIUM  MULTIPLE BY 0.052

COBALT MUTLIPLE BY 0.059

: 1 IS THE BACKGROUND LEVEL OF IONS

:2 IS A WELL FUNCTIONING MOM HIP

:4-7 SUGGESTS A POSSIBLE PROBLEM ISTHE TYPICAL LEVEL FOR A TAPER PROBLEM

7 IS ABOVE mhra GUIDANCE AND IS HIGHLY ABNORMAL.

I WOULD EXPECT THE mhra TO PUT OUT ANOTHER GUIDANCE IN THE 3-7 AREA

AS MOST CENTRES AND SURGEONS ARE MISINTERPRETING THE GUIDANCE.
HOPE THIS HELPS

TONY

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Antoni Nargol, M.D. in U.K. discusses Metal Ions and ASR XL and ASR revisions PDF Print E-mail

August 28, 2011

Tony Nargol: "We are seeing patients with no pain and severe osteolysis of pelvis with ASR’s.  The critical investigation is metal ions testing.  In UK it is exploding and each centre that had not seen the problem is steadily seeing failures.

We are at 100% failure for ASR XL 44 and 46 cups and 50% for ASR XL. 

Chart

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Derek McMinn addresses Metal on Metal AZ May 2011 PDF Print E-mail

Scottsdale, Arizona Orthopedic Conference

Added August 8, 2011 with permission from Derek McMinn
To download the full PDF file click here

1. Is there a specific test that is more accurate for metal level testing and what should a patient ask for when they go to their doctor to order the test?

We use whole blood specimens drawn into lithium-heparin containing tubes with non-contamination
precautions, and analysed with HRICPMS (high resolution inductively coupled mass spectrometry) for the most accurate assessment of metal ion levels. 

The problem with using serum, plasma or erythrocytes is that metal ions are differentially distributed in the intracellular and extracellular compartments and introduces variability. Furthermore the specimen must be centrifuged and separated locally soon after the blood sample is drawn. Delay in achieving this will hemolyze
the specimen and can lead to significant errors in assessment.

Other instrumentations are also used for analysis. Atomic absorption spectrometry and Quadrupole ICPMS are used but they are not as sensitive or reliable as HRICPMS and can also lead to erroneous values and misinterpretations.

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Metal Allergy Testing PDF Print E-mail

If you need to find out if you are allergic to metals, this is the ONLY test that will work.  Skin patch tests are useless.  The way your body reacts to things on the surface is completely different than inside your body.  You can NOT get this test done at just any lab, your doctor needs to send an order to this facility ONLY.  Currently they are the only facility in the U.S. that I am aware of that does this test accurately.

To see the form for Metal Ions Lymphocyte Transformation Testing click here

Metal Allergy Test

 
Vicky's metal levels and reasons for excess metals PDF Print E-mail

May 2009

Got my final test results in for my metal levels, I am almost 3 1/2 years post op and wanted to be a test subject and have my metal ion levels tested.  Dr. Su was kind enough to assist and pay for the testing for my metal sensitivity tests so I had 11 very large tubes of blood drawn at my GP's offices and sent some tubes to RUSH in Chicago and some to a special local lab.  Dr. Su called me and emailed me with my results.  I show no allergies to any metals which was surprising to me since I am very allergic to cheap earrings.  I will have to test out the theory that maybe the implant has made me no longer sensitive to metals by wearing some fake earrings one day.  My metal levels were below normal, read below:

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Derek McMinn discusses Metal Ions and Pseduotumors PDF Print E-mail

Mr. Derek McMinn on Pseudotumors - May 2010 (taken from written interview)

A few centres have reported a phenomenon, which has been named ‘pseudotumors’ by a renowned orthopaedic hospital in Oxford. The term pseudotumor refers to a problem, whereby a hip resurfacing or a metal-on-metal hip replacement fails with a painful swelling or with collection of fluid around the hip joint. The word ‘pseudotumor’ has caused consternation among patients who were worried if this is some kind of a hidden cancer or a pre-cancerous condition. These need to be put into perspective.

Read more....

 
Metallosis of the Resurfaced Hip PDF Print E-mail

by James W. Pritchett MD (added January 24, 2011)

Introduction

Metallosis of the hip is usually defined as aseptic fibrosis, local necrosis, or loosening of the prosthesis secondary to metallic corrosion and release of wear debris.8 It has also been defined as gray discoloration of the tissues of the joint, pain, an effusion, and elevated serum metal levels. Metallosis has been found with stainless steel, titanium, and cobalt chromium alloy femoral prostheses articulating either with a similar metal or (rarely) with a polymer acetabular component. Titanium and stainless steel femoral head prostheses are no longer used, so today metallosis usually refers to tissue changes observed following the use of cobalt chromium-on cobalt chromium (metal-on-metal) implants. Metal-on-metal hip prostheses have been in common use for total hip replacement and almost all current hip resurfacing prostheses are metal-on-metal.12

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Metal Ions By Mark Bloomfield PDF Print E-mail
November 15, 2008
So now to metal ion problems. These fall into 2 broad groups, which are not at all the same.

The first is metallosis. This is when there is a manufacturing or alloy or placement problem that leads to high metal ion or particle production. This causes localised inflammation, swelling, pain and tissue necrosis, but not usually implant loosening. It is something everyone and anyone can have although the threshold level at which the 'overload' becomes a problem will vary. Some alloys are more 'toxic' than others. It is NOT an allergy!
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Metal Ions Study PDF Print E-mail

http://www.jbjs.org.uk/cgi/content/abstract/89-B/2/169

Journal of Bone and Joint Surgery - British Volume, Vol 89-B, Issue 2, 169-173.
doi: 10.1302/0301-620X.89B2.18519
Copyright © 2007 by British Editorial Society of Bone and Joint Surgery

Blood and urine metal ion levels in young and active patients after Birmingham hip resurfacing arthroplasty
FOUR-YEAR RESULTS OF A PROSPECTIVE LONGITUDINAL STUDY

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Psuedotumors Around Surface Replaced Hips PDF Print E-mail

Scientists knew for long that body tissues’ reaction to wear products of metal-metal hip joints, compared with reaction to wear products of polyethylene or ceramic total hips, is different. Microscopic examination of tissues around the failed metal-metal total hips showed that body reacts to presence of metallic wear products by strangling the small arteries in the tissues around the metal on metal hip joints. Death of these soft tissues follows. If the patient is allergic to metals contained in the metal-metal total joint the death of the tissues may be extensive.

See also the chapter Metal-metal total hips

As yet, this finding did not arouse much attention among the surgeons who use metal-metal total hip models.

For full article click here:

Totaljoints.info News 10/07/2008

 
Infections, Psuedotumors - a Patient's Perspective by Alan PDF Print E-mail

by Alan

March 28, 2009

"Any implant can get infected either at time of surgery or seeded later on. That includes valves, skull plates, ortho hardware and even dental implants. Just a fact of life. On psuedotumors, they are nothing new, just a sign of rejection by the body, a big immune complex if you will. Rice bodies, the same, essentially small immune complexes floating around inflamed joints seen in a number of inflamatory arthritis diseases........."

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Pregnancy and metal ions By Pat Campbell PDF Print E-mail
June 2008
Also let me note that the concern about metal ions in pregnancy is actually not about mutation of the sperm or egg, but the exposure to metal ions affecting the developing fetus. That is why they looked at trans-placental transfer. They saw that there were increased levels of ions in the fetal side of the placenta, but thankfully, no abnormalities have been seen in the children.
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Chromium Harvard Study PDF Print E-mail

From http://www.health.harvard.edu/newsletters/Harvard_Mens_Health_Watch.htm

FOR IMMEDIATE RELEASE
Contact:
Harvard Health Publications
Harvard Medical School
10 Shattuck Street, Suite 612
Boston, MA 02115 USA
www.health.harvard.edu

New studies show chromium may help diabetes, cholesterol, and heart disease, reports the Harvard Men's Health Watch.

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