Challenges And Trends To Improve Hip And Knee Implant Materials
The thrust for improved ultra high molecular weight polyethylene bearing materials has been the mainstay of R& D development of metal on polyethylene hip and knee replacement implants as the traditional gold-standard. Much of the challenge has been the reduction of wear particle debris from UHMWP bearings which can cause inflammation, osteolysis, and aseptic loosening of the implant ultimately requiring revision in many past cases. Various UHMWPE wear mechanisms have been cited, including adhesive wear, two-body , and three-body abrasive wear, pitting, and delamination wear . In many cases, extra-articular wear could also result from micromotion between the TKR tibial bearing and the metal baseplate and impingements of the UHWMPE bearing in hips and knees with uncleaned cement, or bone osteophytes not resected during surgery.
Overall regarding UHMWPE wear, it has become not too ambitious for surgeons to anticipate a contemporary hip and knee joint design, which passes the stringent testing and regulatory requirements with oxidation stabilized highly cross-linked UHMWPE bearing, to successfully outlast the lifetime of the arthroplasty patient. The expectation is for bearings not to have any thin enough sections or areas of too high a stress concentration to cause fatigue delamination wear.
Figure 1
Cobalt Toxicity: A Risk Of Metal
It is extremely rare for cobalt toxicity to develop after knee surgery. Cobalt toxicity has been reported in a few cases in which replacement of shattered ceramic heads with metal-on-metal or metal-on-polyethylene implants has resulted in death. Cobalt is an element that is naturally present in the environment but is also commonly used for medical purposes. Cobalt is present in some metal-on-metal and metal-on-polyethylene implants, making them potentially toxic if taken into the body via the skin or bloodstream. Hip replacements and other metal implants are the most common cause of heavy metal poisoning, which occurs from any type of metal-based medical device. If you are concerned about your health after hip replacement, it is best to consult with your doctor.
How Are Medical Devices Regulated
In the UK, the MHRA is the government agency responsible for ensuring medical devices work and are safe. MHRA audits the performance of private sector organisations that assess and approve medical devices.
Once a product is on the market and in use, MHRA has a system for receiving reports of problems with these products and will issue warnings if these problems are confirmed through its investigations.
It also inspects companies that manufacture products to ensure they comply with regulations.
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Failed Joint Replacement Components Cause Cancer
November 3, 2016: Seven substances added to 14th Report on Carcinogens
- Cobalt and cobalt compounds that release cobalt ions* in the body are being listed as reasonably anticipated to be a human carcinogen.
- Cobalt is a naturally occurring element used to make metal alloys and other metal compounds, such as military and industrial equipment, and rechargeable batteries. The highest exposure occurs in the workplace and from failed surgical implants.
*It does not include vitamin B-12, because cobalt in this essential nutrient is bound to protein and does not release cobalt ions.
Contact our team to discuss your case.
1 Laitinen M, Nieminen J, Reito A, et al. High blood metal ion levels in 19 of 22 patients with metal-on-metal hinge knee replacements. Acta Orthop. 2017 Jan 26:1-6. doi: 10.1080/17453674.2017.1283846.
2 Guenther D, Thomas P, Kendoff D, Omar M, Gehrke T, Haasper C. Allergic reactions in arthroplasty: myth or serious problem? Int Orthop. 2016 Feb 40:239-44. doi: 10.1007/s00264-015-3001-6. Epub 2015 Nov 2.
Cobalt Poisoning Knee Replacement Symptoms
Cobalt poisoning from knee replacement surgery is a serious and potentially fatal condition. Symptoms of cobalt poisoning include heart failure, liver failure, kidney failure, and death.
Cobalt is an element found in the earths crust. Cobalt poisoning can occur when large amounts of it are inhaled. If you swallow, inhale, or come into contact with the food, it can be breathed into your lungs, or it can be eaten directly from the stomach. This article does not have any further comment. It should not be used to treat or manage any poison exposure. As a result of cobalt poisoning, rashes and irritation can appear. If you or someone you know has been exposed to cobalt, it is best to leave the area and seek fresh air.
One large dose of cobalt at a time is extremely rare and is unlikely to be harmful. It is possible to wash the area, and a skin cream may be prescribed. If cobalt toxicity symptoms are detected on a metal-on-metal hip implant, it may be necessary to remove it and replace it with a traditional hip implant. cobalt poisoning, as a result of its symptoms and problems, is unlikely to be reversible.
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Zimmer Knee Implant Recalls:
- The Zimmer NexGen LPS-Flex GSF Femoral component
- NexGen MIS Tibial components
- Journey Uni Tibial Baseplate
- Oxinium Genesis II and Profix II
In recent years, several complaints have emerged over knee replacement devices. They include allegations that some popular knee replacement components have failed prematurely or loosened, leading to injuries such as infection, inflammation, and bone or muscle damage.Drugwatch
Some of the devices and components cause complications like wear on the bones, bone loss, and instability in the joint. One DePuy knee component was recalled in 2013 because of serious issues.Recall Report
The Rise Of Ceramics As An Alternative To Cocr Metal Components
Ceramic hip replacements have been used for tens of years, in the form of ceramic on ceramic systems, and more common lately as ceramic on UHMWPE bearing couple configurations. The biggest driver from very early on was the superior biocompatibility of ceramics and mitigation of host response in terms of local and systemic reactions, considering both immediate and long-term effects. Ceramics are essentially oxides fired at high temperatures and so can be considered not having metallic content to be released into the human body. They are strong, with hard surfaces and so are wear-resistant, and literally impervious to body fluids and are therefore more biocompatible. This has recently been given much impetus with new European initiatives restricting the use of Hazardous materials in implanted medical devices. For example, Co is a metal that is considered hazardous. In a new regime of management of such materials for implantation, a new criterion has been introduced whereby a concentration exceeding 0.1% in weight in a homogenous material such as a CoCr alloy used in hips and knees to be considered hazardous and should be either banned or especially justified!
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What If I Dont Have Any Symptoms
Often there are no immediate physical signs of a problem, but the hidden damage that these metals can do to your body is traumatic. The earlier you get medical care, the better.
Some adverse reactions can be cured by a revision surgery or other medical interventions, but only if done early enough.
This is why its important to be aware of the type of metal on metal hip replacement you have, and to ask your doctor if you should be getting regular blood tests for metal ion levels.
Do Titanium Knee Replacements Contain Cobalt
Typically made from cobalt-chromium as this material is scratch resistant and safe for use in total knee replacements. The majority of total knee femoral components are made out of cobalt-chromium with excellent long-term success rates.
Do replacement knees contain nickel?
The most common metal allergy is nickel, which is found in very small quantities in knee implants and in some hip implants. While up to 14% of people will have some reaction to certain metal allergy tests, metal allergy is a very rare cause of failure in knee replacements.
Is there nickel in titanium knee replacements?
Most joints are an alloy of several metals, but some of the titanium alloys contain no nickel at all.
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The Risk Of Metallosis In Knee Replacement Surgery
It can cause inflammation and pain if the joint space is inflamed due to metallic debris. Furthermore, it is highly likely to result in infection, which can result in death. Because the prevalence of knee replacement surgery alone is estimated to be 10% of the population, it is not surprising that metallosis is a common complication. Metallosis can occur in as many as one in five knee replacements, according to research. Metallosis can be successfully treated if left untreated. It is typically only the case that the patient will have long-term consequences if the condition is identified and treated promptly. Metalslosis, despite its small prevalence, can be a serious complication of knee replacement surgery, and it is critical to be aware of the risk and take precautions. You should discuss the benefits and risks of a knee replacement with your doctor, so do your homework before making a decision.
Filing A Claim For Cobalt Toxicity From A Hip Replacement An Attorney Can Help
If you’ve suffered from illnesses related to an artificial hip replacement, you may be eligible for monetary compensation, either by joining a settlement or filing a new products liability lawsuit. Even if you haven’t experienced symptoms of illness, you may be eligible for a new replacement in addition to other damages if you qualify.
Discuss your options with an experienced product liability attorney today.
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Let Us Be Your Advocates
Of course it will. Not only will more people need implants, but all the victims of defective implants will require revision surgeries. It is a veritable gold mine for the medical device industry and not one of them cares who they hurt in the process.
That is why, if you were critically injured because of a defective cobalt hip replacement, you need an advocate like McGowan, Hood, Felder & Phillips, LLC on your side. Our defective medical device lawyers have been fighting against medical device manufacturing companies for many years.
If you or your loved one suffered cobalt poisoning, developed an infection or cancer, sustained permanent tissue or bone damage, or were harmed in any way because of a defective metal-on-metal implant, we want to help. To learn more about your rights and options, or to schedule a free consultation at one of our offices, please call or fill out our contact form.
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Metallosis Reaction During Hip Revision Surgery
Sometimes the best way to understand severe metal reactions is to see for yourself. The image shows a still shot of metallic-colored fluid gushing from the surgical area near the hip implant.
In this surgery, the patient is a 70-year-old man who reported swelling in his hip. During the revision surgery, doctors punctured the fluid-filled tissue surrounding the muscles of the hip to find a surprising amount of discolored fluid, along with corrosion at the head-neck junction of the hip implant. The pathology report confirmed it was an adverse local tissue reaction from the metal-on-metal hip implant.
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Cobalt Poisoning From Hip Prosthesis: Risks And Treatment Options
Cobalt poisoning, which occurs as a side effect of hip prosthesis, is uncommon but serious. Cobalt is added to the bloodstream as a result of metal wear and entry into the bloodstream. This is a well-known risk with metal-on-metal implants, but newer studies show that it is also a risk with metal-on-polyethylene implants. According to Professor Christopher O. Keefer, who teaches orthopedic surgery at the University of Pennsylvania, the use of metal-on-metal implants raises the risk of cobalt exposure. A study published in the Journal of orthopaedic Research discovered that approximately one-third of patients with hip replacement hips containing cobalt-chromium alloys have cobalt levels that are elevated. When deciding on a knee replacement prosthesis, it is critical to consider its type and material. Metal-on-plastic implants are the most safe, with the longest track record of safety and implant life span.
Depuy Knee Cobalt Poisoning
Cobalt poisoning from DePuy knee implants is a serious and potentially life-threatening condition. Symptoms of cobalt poisoning can include fatigue, skin rashes, vision problems, and heart problems. If you have a DePuy knee implant and are experiencing any of these symptoms, it is important to see a doctor immediately.
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Does Titanium Knee Replacement Contain Cobalt
There is no definite answer as to whether or not titanium knee replacements contain cobalt. It is possible that some titanium knee replacements may contain small traces of cobalt, but it is also possible that they do not contain any cobalt at all. Ultimately, it depends on the manufacturer and the specific product.
The Best Implant Material For Knee Replacement
Cobalt is a metal that is frequently used in knee replacement implants. Because of their strength and durability, titanium alloys are frequently used in knee replacement surgery. The femoral component is made of metal , while the plastic tibial component is made of plastic, and knee replacement devices have been used for nearly two decades. These knees are estimated to last between 15 and 20 years. Which is the best material to replace the anterior knee for knee replacement? Many metals can be used in knee replacement implants, but metal-on-plastic implants are the least expensive and have the longest track record for implant safety and implant life expectancy.
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Metal Ions In The Blood
Some news coverage has focused on the MHRA’s recommendation to check for the presence of metal ions in the blood.
Ions are electrically charged molecules. Levels of ions in the blood, particularly of cobalt and chromium used in the surface of the implants, may therefore indicate how much wear there is to the artificial hip.
These ions in the blood are not blood poisoning and do not lead to sepsis, which is an entirely different type of illness. Talk of this in some news reports is very misleading and completely wrong.
There has been no definitive link between ions from metal-on-metal implants and illness, although there has been a small number of cases in which high levels of metal ions in the blood have been associated with symptoms or illnesses elsewhere in the body, including effects on the heart, nervous system and thyroid gland.
How Common Is Cobalt Poisoning From Knee Replacement
Cobalt poisoning from knee replacement surgery is relatively rare. However, it can occur if the replacement joint is not properly installed or if the patient has an allergic reaction to the metal. Symptoms of cobalt poisoning include fatigue, joint pain, and skin rashes. If you experience any of these symptoms after having knee replacement surgery, it is important to see your doctor right away.
DePuy is best known for its artificial hips and knee replacement devices. Hip and knee joints made of metal are made of chromium-cobalt, one of the hardest industrial metals available. When you wear out your replacement knee or hip joints, they produce debris that can enter your bloodstream and make you very ill. Cobalt and titanium are the most dangerous metals used in the manufacture of depuy and knees, which are made up of chromium, nickel, cobalt, and titanium. Dr. Tower chose revision surgery to remove the metal in the chromium-cobalt hip and replace it with a plastic ball and socket. Following the removal of his heavy metal hip replacement, he began to feel better.
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Metallosis After Knee Replacement
Metallosis is a syndrome associated with metal joint implants, where friction between two metal surfaces releases metal ions into the joint, and these trigger an inflammatory response.
The term ‘metal-induced synovitis‘ describes those parts of the synovial joint lining that bloat up and become rubbery and filled with a florid black staining due to the metal ions.
Within the knee this condition is usually related to a previous knee replacement in which the polyethylene components have worn down and inadvertently allowed metal components to come into contact where they normally would not. In particular it is often the polyethylene part of the metal-backed patella that is at fault, where the polyethylene breaks down and allows the back of the patellar component to make friction contact with the metal femoral component2. Metal-backed patellar components are no longer in frequent use but of course there are still many patients who had had this type of implant done in previous years. Mechanisms of failure of the polyethylene include polyethylene wear, fracture of the polyethylene or the underlying bone, and dissociation of the polyethylene from its metal backing.
The condition is more frequently recognised in hip replacements. Although rare in the knee, metallosis is a diagnosis must be thought of when investigating a patient whose knee is not settling after a knee replacement
Frequently Asked Questionsabout Hip And Knee Replacement Materials
Once An Athlete, Always An Athlete – William Best
I’ve been an athlete all my life, but at age 69 was beginning to find it hard to do some of the activities I had grown fond of doing. These included skiing, horseback riding and golf. Osteoarthritis in my hip had begun to restrict my ability to twist. I decided to meet with Dr. Rafael Sierra at Mayo Rochester to discuss the possibilities of a hip replacement. During our meeting, we discussed in detail the anterior versus posterior approach to the procedure. The anterior approach seems to be the most preferred procedure these days, but with that, there’s the possiblity of causing damage to the nerve bundle located near the incision. This was a concern for me. To read more, .
I Feel 10 Years Younger – Greg Bland
My doctor had recommended total knee replacement in 2017, but I was under the belief that I was too young and that the replacement wouldnt last very long. When the viscosupplementation finally wore off I couldnt walk even one block before intense pain kicked in. Because of COVID-19 related delays, it took five months before I could get elective surgery. To read more, .
Expectations and Advocacy from a Well-Known Bioethics Professor – Dr. Arthur Caplan
Years of Damage, Repaired in Hours – Rachael Epling
It’s all about “Work Mode” – Michelle Menconi
The Grateful Golfer – Rev. Dr. George B. Wirth
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