Can I have a Metal on Metal Hip Device if I am Allergic To Metals?
Dr. Bose
Dr. De Smet
Pat Campbell
Dr. Bose
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
interesting issue. One must
keep in mind that the co-cr-mo alloy has been in
clinical use for 45
yrs and is present in 99% of all hip and knee
replacement surgery.
Even if a component is titanium the articulating
part would be always
co-cr-mo. Therefore metal sensitivity is not
exclusive to metal on
metal joints. It is a factor in every joint
replacement surgery and
therefore has been used in millions of patients.
Skin allergy is quite different from deep tissue
allergy which is
mediated by different mechanisms of immune
response by the body. Thus
skin testing is of no value when trying to gauge
deep tissue
hypersensitivity. There have been reports of
hundreds of patients who
had skin sensitivity but went on to have very
successful resurfacing.
Only one thing can be said about deep tissue
sensitivity at this point
in time --- it is very very rare.
with best regards
vijay bose
chennai
Dr. De Smet
Although very rare, an allergy can occur
after a hip replacement. The following is a
story about a problem that Dr. De Smet thinks is
associated with an alergic reaction to the metal
in a BHR.
Sent: Thursday, November 08, 2007
Subject: [surfacehippy] Re: Metal allergy - an
OS writes
While metal allergies are indeed rare, they can
be (or have the effect of being) all too
real.....
My wife is 31 yrs old and had her right hip
resurfaced 2 years ago by Dr. De Smet (she
originally broke her hip around 10 years,
developed AVN, had an osteotomy 7 years ago,
developed arthritis, which ultimately led us to
Ghent - can't say enough about the experience
there).
Around a month ago she started experiencing
terrible hip pain. X-rays (and a CT Scan) show
that the bone just below the bottom end of the
femoral cap is essentially dissolving (osteolysis).
Blood tests were performed and, while it is not
an exact science, there does appear to be
sensitivity to both chromium and nickel -
chromium being one of the main by-products of
the resurfacing components.
While there certainly could be other factors at
play (e.g. improper load bearing due to prior
surgeries/injuries or decay of the cement used
in the femoral cap [which, according to one
prominent surgeon I spoke to, can happen,
particularly in cases where the femoral head has
already been significantly damaged]), I don't
believe it. Both of those factors can, I
believe, be worked through with exceptional
surgical technique - and I have the utmost
confidence in De Smet.
According to De Smet, around 1 out of every 500
patients has this type of reaction to the metal.
To quote De Smet, "That indeed is a possibility.
Metal sensitivity is a risk of 1/500 in my
series. A lot of people do not believe it and
say it is non existing or very rare. If [metal]
is the problem......she has really bad luck".
We are now looking at a THR (which will most
likely happen in the next week or so) and, while
there is no way to know for certain whether a
"metal allergy" is causing the problem, at this
point, we certainly can't risk having a MoM THR
- ceramic is the only option.
Joel Feldman (Meg: De Smet - Sept 05)
Metal Allergies to Joint Replacements by Pat
Campbell
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