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Are
there steps that can be taken to reduce the metal ion concentration?
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Dr.
Antoniou: Some have associated a transient increase in metal ion levels with
vigorous increased activity or with vertically positioned acetabular components.
These associations are tenuous for now and there are no non-invasive steps that
a patient can take to reduce metal ion levels.
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Would
the presence of metal ions affect my reproductive health?
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Dr.
Antoniou: It is unknown whether metal ions directly affect reproductive health.
To date, there is no evidence that it will.
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What
risks might metal ions pose to my health?
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Dr.
Antoniou: For now, it is unclear whether these ions have any negative impact
on a patient’s health. A great deal of ongoing research is being performed looking
at this exact question (including our own).
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What
is known about metal ions from implant debris, their concentration and elimination?
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Dr.
Antoniou: There is a
great deal of ongoing research looking at metal ion levels in patients with metal
on metal articulations (of which resurfacing is one). We are performing this
type of research in our institution on all of our metal on metal arthroplasty
patients. It is widely accepted that the metal ion levels are elevated compared
to people without a prosthesis or to those with a metal on polyethylene prosthesis.
The implication of these increased ion levels is unknown but the elimination
of these ions is through the kidneys. Thus, people with renal failure are not
considered ideal candidates for this procedure.
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Are metal ion increases enough to warrant avoiding chromium in vitamins?
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Dr. Antoniou: There is no question that metal ions
are elevated in patients with hip resurfacing (any brand). This includes elevation
in chromium. It wouldnot seem logical to take additional chromium with that in
mind, but there is no evidence one way or the other regarding the impact of chromium
taken by mouth or released from the joint.
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Any effect by metal ions on sperm or reproduction effectiveness?
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Dr. Antoniou: here is no good information on this topic. We know from sporadic
observations that metal ions can cross the placenta to a fetus, but that has
not been linked to any negative impact on a fetus. I am not aware of any analysis
of metal ions affecting sperm or ova.
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What is the path forward for an individual that developed a metal allergy after
surgery?
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Dr. Antoniou: A true, symptomatic metal allergy that causes a soft tissue reaction
or pain may ultimately require revision to a total hip with an alternate bearing
such as ceramic.
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