Derek McMinn addresses Metal on Metal AZ May 2011
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.
World Renowned Surgeons Video & Written Interviews discuss concerns regarding Metal Ions
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 recently. If you navigate to www.mcminncentre.com and the "lectures" and then "BOA September
Metal Ion Level Testing
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
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
Metal Allergy Testing
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 Rush 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
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:
Derek McMinn discusses Metal Ions and Pseduotumors
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.
Metallosis of the Resurfaced Hip
by James W. Pritchett MD (added January 24, 2011)
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.
Metal Ions By Mark Bloomfield
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!
Metal Ions Study
Journal of Bone and Joint Surgery - British Volume, Vol 89-B, Issue 2, 169-173.
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
Psuedotumors Around Surface Replaced Hips
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
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........."
Pregnancy and metal ions By Pat Campbell
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.
Chromium Harvard Study
FOR IMMEDIATE RELEASE
Harvard Health Publications
Harvard Medical School
10 Shattuck Street, Suite 612
Boston, MA 02115 USA
New studies show chromium may help diabetes, cholesterol, and heart disease, reports the Harvard Men's Health Watch.
Possible Causes of Groin Pain:
From the Implant
- Aseptic loosening
- Femoral neck stress fracture
- Bony impingement
- Soft tissue impingement
- Reaction to excessive metal wear
- Metal sensitivity