Metallosis is a formal poisoning caused by exposure to metal that is often a side effect that occurs after a metal joint replacement device has been implanted during hip or knee replacement surgery. These include metal-on-metal knee and hip joint implants. The devices are manufactured from blended metals that could include titanium, nickel, cobalt, chromium, and molybdenum. The rubbing action of metal-on-metal when the joint moves can release microscopic particles of metals that enter the bloodstream and body tissue.
Metal poisoning is often the result of a buildup of metal toxins in the body causing damage to bone, tissue, and nerves. Some individuals develop metallosis from ongoing exposure to elevated levels of metal particles consumed in their diet or absorbed from the environment. Counterfeit prescription drugs and natural supplements sold to the public often contains harmful metals including uranium, lead, mercury, or aluminum.
Doctors and scientists classify metal poisoning (metallosis) as:
- Adverse local tissue reaction
- Aseptic lymphocytic vasculitis-associated lesions
- Adverse reaction to metal debris
- Metal ion poisoning
- Metal debris injury
- Metal poisoning
Allergic reactions to some metals, especially nickel, are the leading cause of metallosis. Many individuals undergo revision surgery after metal particles are released from their metal-on-metal implant causing inflammation and toxic reactions that lead to organ damage, tissue and bone death, and eventual failure of the implant.
Who Is a Risk for Metallosis?
Study results supplied by the American Academy of Orthopedic Surgery revealed that smokers who have undergone a metal-on-metal implant surgical procedure have the greatest risk of developing metallosis. However, many individuals with elevated levels of metal ions in the bloodstream never display symptoms or experienced difficulties caused by metallosis.
Many doctors recommend their patients undergo needle aspiration in the hip or knee joint when accumulated fluid needs to be removed due to a metallosis reaction. Some patients have undergone reconstructive surgery to repair damage caused to the pelvis when the bone and tissue reacts to metal debris. The surgical procedures often require bone grafts.
To date, there is no medical or research proof of any correlation between metallosis and the development of cancer. However, the International Agency for Research on Cancer under the World Health Organization lists cobalt and chromium-associated trivalent as being potentially carcinogenic.
Risk factors that increased the potential risk of developing metal poisoning from a hip or knee replacement device involve:
- Body Type – Individuals who are overweight or obese have a greater potential risk of experiencing negative reactions caused by metal ions released in the bloodstream.
- Gender – Females are more likely to suffer from metal poisoning compared to males.
- Medical Conditions – Individuals that show evidence of renal insufficiency might have developed a suppressed immune system caused by an adverse reaction to the metal ions
- Malfunctioning Implants – If the components of the implant device are not optimally aligned, it can cause additional wear and tear, releasing an excessive amount of metal debris into the bloodstream and surrounding tissue.
The Food and Drug Administration has said that metal-on-metal joint implants pose a significant risk to individuals compared to those who have joint implants made from ceramics and other materials. The federal agency has warned patients that the metal ions can loosen the implant and cause serious illness, extensive pain and damage to other parts of the body. The FDA also advises patients who are not currently experiencing symptoms to see their doctor at least once every year or two.
Common Metallosis Symptoms
The type of symptoms the individual experiences during the development of metal poisoning vary greatly between patients. Some individuals never experienced symptoms that all. Research indicates that the most common metallosis symptoms that identify damage to specific organs involve:
- Damage to the heart that causes chest pain and shortness of breath (dyspnea)
- Damage to the kidneys that cause significant changes in urination
- Damage to the thyroid that causes unexpected weight gain, fatigue in the sense of being cold
- Damage to the nervous system that causes changes in hearing, vision, weakness, and numbness
While there may be no immediate physical indicators that the body is suffering from metal poisoning, they may experience serious metallosis symptoms that include:
- Difficulty in walking
- Cardiomyopathy involving heart failure
- Swollen areas surrounding the affected joint
- Bone, muscle, and tissue death (necrosis)
- Cognitive impairment
- Genetic mutations (DNA)
- Reproductive issues
- Elevated risks of developing cancer's
- Impaired liver function
- Pulmonary problems
- Kidney failure
- Thyroid issues
- Skin disorders
- Nerve damage (neuropathy)
- Gastrointestinal issues
- Depression and anxiety
- Loosening of a hip or knee implant
In severe cases of metallosis, some patients have experienced pain in the groin area, serious skin rashes, restlessness, hearing loss, headaches caused by vertigo and mental confusion. Metal poisoning caused by exposure to toxic metal debris in the bloodstream from a metal-on-metal or ceramic on metal implant device can take time to develop. Because of that, diagnosing the condition during the initial stages of metal poisoning development may not be accurate.
Diagnosing and Treating Metallosis
Typically, doctors can diagnose metal poisoning in the body through a comprehensive personal medical history and physical examination. Usually, the patient is suffering constant pain at and/or around the affected joint. The doctor will typically inspect the area of tenderness or information to look for any early indicators of metallosis were information occurs at the implant site and surrounding tissue.
Some patients suffering from metallosis will have infection that can be detected through blood samples and biopsies. The patient might also have visual deterioration or their eyesight has become affected by the poisoning. Additionally, the implant may be uncomfortable or malfunctions because it has become loose. The patient may be displaying signs of heart failure other heart issues including chest pain or difficulty in breathing.
Any individual who has undergone a metal-on-metal knee or hip replacement surgical procedure should consult their doctor to undergo an examination to see if metal poisoning can be detected. Unfortunately, there are only a few options for treating metallosis. The doctor can prescribe and effective medical treatment that might require revision or reconstructive surgery.Revision or Reconstructive Surgery
Removing the old device and implanting a new one is not without risks. The Food and Drug Administration (FDA) warns patients undergoing reconstruction surgery that they could experience severe problems not associated with the first surgery that includes a reaction to the anesthesia, greater potential of developing blood clots, susceptibility to infection, and uncontrollable bleeding.Chelation Therapy
Doctors can use chelating agents to treat metal poisoning. Excessive levels of metallic debris in the body can be removed when metal ions bind to the chelating agents that are given orally, intramuscularly, or intravenously. However, the treatment is ineffective if the metal poisoning is caused by cobalt ions which do not bind to chelating agents. Typically, the only other option left to a patient suffering injury caused by cobalt poisoning is revision surgery.
The most successful outcomes to metallosis caused by implant devices are early detection followed by a quick and effective treatment involving chelation or surgery. This is because delaying treatment can produce undesirable side effects including bone fractures, infections, and tissue death in the affected area that could cause a challenging recovery.