When you have a metal device in your body 

Hip replacement surgery, which is very common in the U.S., is a treatment to replace a broken joint with an “artificial joint,” which is a “device.” The purpose of the surgery is not to cure the original disease, but to support body weight with a pain-free joint using the power of the device and to regain a stable gait. For many elderly people, hip replacement is a landmark surgery to regain walking and mobility, and many are enjoying life to the fullest afterward. However, depending on the materials they use, the results could be fatal. 

When this technology was developed, artificial hip joints generally used a metal “ball” and a polyethylene (plastic) “socket. However, in 1966, a material called Metal-on-Metal (MOM) was introduced, which used an alloy containing cobalt and chromium for both the “ball” and “socket” of the hip joint. This MOM-made hip prosthesis was thought to have advantages over the metal and plastic joints used in the past, including less wear and durability, a larger femoral head (the “ball” of the ball and socket), which allows for greater stability and range of motion for the patient, and a lower chance of dislocation. 

However, friction resulting from normal wear and tear causes metal particles to spill out into the surrounding tissues and bloodstream. Accumulation of these particles increases blood levels of cobalt and carries a risk of serious clinical sequelae, including vision and hearing loss, peripheral neuropathy, hypothyroidism, and cardiomyopathy. Cobalt toxic patients may also have severe gastritis, lactic acidosis, and diabetic insipidus.  And since many people who undergo hip replacement surgery are elderly, the possibility of dementia or Alzheimer’s disease occurring years after the surgery remains unknown, and the possibility of being medicated is great. 

Dr. Stephen Tower, an Alaska resident, is an orthopedic surgeon specializing in complex hip replacements. He was very surprised when he, a physician specializing in this field, performed the same hip replacement surgery as a patient and subsequently developed unusual symptoms.  A few months after the surgery, he noticed a tremor in his hand. He started having tinnitus again, his thoughts were confused, and he started repeating myself. Then, while attending a medical conference, Dr. Tower had a psychotic breakdown and ransacked the hotel room where he was staying. Subsequent tests at the hospital revealed that the amount of cobalt in his blood was 100 times higher than normal.  Dr. Tower then underwent surgery again to replace the artificial hip device. The surgeon who performed the surgery said, “The tissue around [Dr. Tower’s] hip was black. The cobalt leaking from the ASR hip joint was causing a condition called metallosis, harming not only the surrounding muscles, tendons, and ligaments, but also Dr. Tower’s heart and brain.”. 

Dr. Tower subsequently conducted extensive research on cases similar to his own and named the series of neurological symptoms resulting from metal poisoning from cobalt-based hip prostheses “arthroplasty cobalt encephalopathy” (ACE). Of the patients diagnosed with ACE, the time between surgery and the onset of symptoms was about seven years, and ACE symptoms usually occurred one year before hip symptoms (pain, weakness, clicking, loosening, etc.). In addition, he looked at the cobalt levels in his own patients’ blood and found that those who had hip replacements with cobalt-chromium alloys, even if they did not have MOM, had high cobalt levels and some kind of symptoms. If you suspect “arthroplasty cobalt encephalopathy,” check your cobalt levels with a blood or urine test.  Generally, a cobalt level of 4 ppb or less is not cause for concern, and some surgeons may not order further testing until the cobalt level exceeds 7 ppb or even 10 ppb. However, according to Dr. Tower, he found that even a reading of 1 ppb could lead to serious neurological problems with cobalt. 

So, if you are recommended for hip replacement (as well as shoulder and knee), I recommend that you investigate other options without using cobalt-chrome alloy components in the body. Dr. Tower replaced cobalt’s hip with one with a plastic socket and ceramic head.  If replacement surgery seems difficult, consult with your doctor, as some physicians offer chelation therapy (“FDA approved” only for lead poisoning), which is an intravenous infusion of a chelating agent that binds to the heavy metal and allows it to be excreted as urine.



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