Joint replacement and metal sensitivity

Rushie

Rushie

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Rushie
My surgeon uses a titanium femoral stem and says it’s the most hypoallergenic material available but may still have trace amounts of nickel.

I’m interested in hearing from anyone with titanium parts AND an established nickel sensitivity. How are you doing?
 
I have no way of knowing if I have a nickel sensitivity. My two hip replacements work far better than what God gave me. Nothing but thumbs up from my perspective.
 
robin ardoin said:
I’ve installed a fair bit of titanium hardware in my career and never had a patient with signs or symptoms consistent with a sensitivity reaction. I have not seen any studies suggesting it is a risk neither.
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Have you ever heard of this guy and his "ceramic gold coating"? He's James Pritchett in Seattle.

The entire stem is coated, keeping the rough texture for bone ingrowth. Not sure what "ceramic gold" is. He claims he has had zero patients react to this, which may be true, but if zero patients react to regular titanium then this is just a gimmick.

If the CC were to be removed from this screenshot, you could see the entire stem is coated. I was concerned about the neck part that sticks out and comes in contact with regular tissue as opposed to the part inside bone which I assume won't push off ions as much but what do i know. The ball part will be ceramic in my case, the socket polyethylene I guess, with titanium backing of course.

He says titanium is "a little less reactive". A LITTLE less? I would think massively less than high nickel metals. But he claims patients still react to titanium. From what I can tell metal sensitivity to a joint replacement is a diagnosis of exclusion. Maybe he sees cases because he wants to.

Gold coating.JPG
 
@Rushie I can't speak about large joint prosthesis experience because I have only placed some ancient Cobalt/Chrome alloy and, later, Titanium alloy joints with UHMWPE fossa (cups) as a replacement for jaw joints. Titanium's great advantage is it's non-reactivity (almost zero and the documented cases are not exactly certain if it was the titanium alloy components or a contaminant) and the ability of bone the chemically bind the the surface. Unlike the original Stainless steel joints, which relied upon screws and methyl methacrylate bone 'cement' for initial as well as long term stabilization the Titanium prostheses will 'fuse' to the bone so any fixation screws become passive after 10-12 weeks. I practice Oral and Maxillofacial surgery and place Titanium plates and screws for trauma and reconstructive surgeries as well as place dental implants made of the same. The binding of bone to the surface is dependent of surface texture to some degree but also of the surface composition. All implanted devices that I have placed are made of Titanium/aluminum/vanadium alloys and it is the 'gold standard' (excuse the un-intentional pun as it related to the above video) for titanium implanted devices. I would be more concerned about the gold ceramic coating interfering with long term stability of the bone to implant bond although it may not be critical in an axially loaded hip prosthesis. I see it as a technology in search of a problem perhaps.
 
robin ardoin said:
@Rushie I can't speak about large joint prosthesis experience because I have only placed some ancient Cobalt/Chrome alloy and, later, Titanium alloy joints with UHMWPE fossa (cups) as a replacement for jaw joints. Titanium's great advantage is it's non-reactivity (almost zero and the documented cases are not exactly certain if it was the titanium alloy components or a contaminant) and the ability of bone the chemically bind the the surface. Unlike the original Stainless steel joints, which relied upon screws and methyl methacrylate bone 'cement' for initial as well as long term stabilization the Titanium prostheses will 'fuse' to the bone so any fixation screws become passive after 10-12 weeks. I practice Oral and Maxillofacial surgery and place Titanium plates and screws for trauma and reconstructive surgeries as well as place dental implants made of the same. The binding of bone to the surface is dependent of surface texture to some degree but also of the surface composition. All implanted devices that I have placed are made of Titanium/aluminum/vanadium alloys and it is the 'gold standard' (excuse the un-intentional pun as it related to the above video) for titanium implanted devices. I would be more concerned about the gold ceramic coating interfering with long term stability of the bone to implant bond although it may not be critical in an axially loaded hip prosthesis. I see it as a technology in search of a problem perhaps.
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Wow that’s all great to know. I have TMJ dysfunction too and never imagined it could get so bad and there was a replacement joint.

“I would be more concerned about the gold ceramic coating interfering with long term stability of the bone to implant bond although it may not be critical in an axially loaded hip prosthesis.”

I was wondering about that too.

To keep this aviation related I am also wondering how having major hardware inside you affects you going through TSA. Does the metal detector go off causing them to throw you to the floor and handcuff you?
 
Rushie said:
SNIP
To keep this aviation related I am also wondering how having major hardware inside you affects you going through TSA. Does the metal detector go off causing them to throw you to the floor and handcuff you?
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If you tell them, they generally pass you through the surface scanner or if you have to go through the metal detector, they scan the area that triggered, then pat it down. No biggie.
 
My hips set off the halo detector. My titanium pacer never did. I either request the body scanner or I get patted down. When I've triggered the halo type machines I've had the full body pat-down. That machine doesn't identify where the metal is. Especially prevalent in Europe. No body scanners there during my travels.
 
Rushie said:
To keep this aviation related I am also wondering how having major hardware inside you affects you going through TSA. Does the metal detector go off causing them to throw you to the floor and handcuff you?
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My Dad had both of his knees replaced decades ago. I've no idea what alloys were used then, but he had medical ID cards, one for each knee, to show when he went through airport security. They'd basically look at the cards, wave a wand over him to make sure only knees were causing an alert, and wave him through.
 
I’ll see if they give me a card. Big difference between having a knee patted down and the groin patted down. :mad3:
 
Just go to the big scanner. No problems. They don’t give a hoot about a card once a detector goes off. Otherwise every idiot terrorist would carry a medical card!
 
Had right hip done 4 ½ years ago and left one done YESTERDAY. They work great. No negative reactions. You’ll have to go through the scanner, then wand, maybe pat down (on the side not groin). Can’t go through the magnetometer even if you’ve got precheck. Just point to your hip as you approach the scanners. They send you the right way.

As I understand stand it, it’s the cobalt chrome in the head and socket that can contain higher levels of nickel not the titanium stem. The company that made my protheses uses a proprietary oxidized zirconium metal with <.0035% detectable nickel to avoid that sensitivity. That’s Smith & Nephew.
 
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Lance F said:
Had right hip done 4 ½ years ago and left one done YESTERDAY. They work great. No negative reactions. You’ll have to go through the scanner, then wand, maybe pat down (on the side not groin). Can’t go through the magnetometer even if you’ve got precheck. Just point to your hip as you approach the scanners. They send you the right way.

As I understand stand it, it’s the cobalt chrome in the head and socket that can contain higher levels of nickel not the titanium stem. The company that made my protheses uses a proprietary oxidized zirconium metal with <.0035% detectable nickel to avoid that sensitivity. That’s Smith & Nephew.
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Yesterday and it already works great? Thanks for the tip about Smith & Nephew, I’ll check it out.

I don’t know what a magnetometer is.
 
Stewartb said:
Just go to the big scanner. No problems. They don’t give a hoot about a card once a detector goes off. Otherwise every idiot terrorist would carry a medical card!
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Is the “big scanner” the Nude-O-Gram?
 
After my right (and left) knee replacements I have had to use the Nude-O-Scope. I just point at it and they run the scan. I have the cards stating replacements but never used them. After the scan they rarely wand my knees.

Actually its faster since most pax use the the old time magnetometer.

No clue what the parts are made of but after three plus years, no problems.

Cheers
 
Rushie said:
Yesterday and it already works great? Thanks for the tip about Smith & Nephew, I’ll check it out.

I don’t know what a magnetometer is.
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the new hip works fine immediately. The incision and trauma to get the new parts in take awhile to heal. There is some pain.
 
Anterior approach? Robot or free-hand? Mine were both anterior and robotic. I'm told it's way easier for recovery than the older posterior approach. I think the way the surgeon twists us is where most of the trauma comes from. I was up and walking within 4 hours of surgery both times, including up and down stairs. The marvel of modern medicine!

PS- for both of my hips day 3 was the hardest pain-wise. No pain meds after day 5 either time.
 
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Anterior absolutely. Free hand. My surgeon uses robotic for knees, but prefers free hand for hips. The most important thing is the surgeon’s experience however he does it. I remember day 3 as the worst last time. That’s tomorrow for this one ☹️
 
I went in convinced I wanted anterior but my surgeon said he only does posterior and listed the reasons why. He is very familiar with anterior and regularly attends them, says there’s nothing wrong with it but there are pros and cons of each.

He favors posterior because there is a lower risk of excessive bleeding, of infection, problems with wound healing and permanent damage to the cutaneous nerves to the outer thigh. These risks are really low anyway but he says they’re even lower in the posterior approach. But the biggest advantage is a better field, more accessibility and visibility especially if something goes wrong. If the femur fractures for example, he has more options. That was a big selling point.

However the posterior approach has a higher risk of dislocation and a longer recovery. Traditionally it also risked damage to the sciatic nerve. However it has been updated and refined and now has a smaller incision located away from the sciatic nerve, they cut less muscle, and the recovery period has been reduced to only about 5 days longer than the anterior method. (I still need to ask him if there are position restrictions with his posterior that you don’t get with the anterior. Some googling says yes, some says no.)

With the newer posterior approaches it’s even controversial whether there is a higher risk of dislocation. It seems the important part is the correct repair of all the soft tissue. That’s where the experience and skill of the surgeon comes in. Better repair, better healing, less risk of dislocation because it’s the muscles and tendons that hold the whole business together.

To me the anterior/posterior issue is almost irrelevant compared to the metal allergy problem. I am more about picking the best surgeon first then let him use the approach he’s good at and trust he knows what he’s doing.

I just need to make sure I can live with the metal.
 
Posterior easier for him. Anterior easier for you. To me that was an easy call. If nickel is your concern, I'm pretty sure that with the right prosthesis that could be easily solved.
 
Lance F said:
Posterior easier for him. Anterior easier for you. To me that was an easy call. If nickel is your concern, I'm pretty sure that with the right prosthesis that could be easily solved.
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Yep, if something goes wrong, I want it easier for him.

Don’t worry, I’m sure I’ll be cursing myself and saying you were right for several days after.
 
It is not uncommon for your knees to feel warm after total replacement...even years later.
 
Rushie said:
Yep, if something goes wrong, I want it easier for him.

Don’t worry, I’m sure I’ll be cursing myself and saying you were right for several days after.
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I hope you’re as happy with the result as I’ve been. Best wishes!
 
Rushie said:
Have you ever heard of this guy and his "ceramic gold coating"? He's James Pritchett in Seattle.

The entire stem is coated, keeping the rough texture for bone ingrowth. Not sure what "ceramic gold" is. He claims he has had zero patients react to this, which may be true, but if zero patients react to regular titanium then this is just a gimmick.

If the CC were to be removed from this screenshot, you could see the entire stem is coated. I was concerned about the neck part that sticks out and comes in contact with regular tissue as opposed to the part inside bone which I assume won't push off ions as much but what do i know. The ball part will be ceramic in my case, the socket polyethylene I guess, with titanium backing of course.

He says titanium is "a little less reactive". A LITTLE less? I would think massively less than high nickel metals. But he claims patients still react to titanium. From what I can tell metal sensitivity to a joint replacement is a diagnosis of exclusion. Maybe he sees cases because he wants to.

View attachment 109519
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Fer gawds sake don’t get that gold plated thang. Gold’s worth lotsa money. Think catalytic converters and that plutopaldium stuff.:D
 
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luvflyin said:
Fer gawds sake don’t get that gold plated thang. Gold’s worth lotsa money. Think catalytic converters and that plutopaldium stuff.:D
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I was trying to avoid coming out and saying “that manufacturer and surgeon found a way to make lots of money off patients who can be convinced they’re so allergic they need it.”

I don’t want to be that sucker, and I definitely don’t want to fly to Seattle for my surgery. I don’t even want to drive 3 hours to Houston. (My surgeon is 20 minutes away.) On the other hand that thing is going inside me with no good way to get it back out. I need to be 99% confident my system won’t reject it. Right now I’m only about 80%. But that’s way up from 0. You guys are helping.

I am highly allergic to nickel. I start reacting within an hour to skin contact with nickel containing metal. My guy gave me a titanium femoral stem to test. (He trusted me with it after a patient absconded with his other one, lol!) I taped it tightly to my arm for 24 hours and no reaction, other than the same faint pink outline that was left by the plastic object I used as a control. No rash, no itching.

But whether skin sensitivity correlates to reactions to implanted metal isn’t completely understood. So I’m persisting in looking for anecdotal stories (and trying to find studies) to see if reactions to titanium are really a concern.

Robin’s input is very reassuring. That plus my test got me up to 80%. I’m going to consult an allergist next week then talk to my surgeon again (and return his stem!) and we will see from there.

So thank you all for your responses, it really helps.
 
No metal issues here from my surgeries.

first hip done in 86
Hip revision in 2009
Left ankle fusion and plates 2017
Right leg, Plates, screws, and rods to fix the right leg after our engine out off airport “landing” in 2018.
 
GMascelli said:
No metal issues here from my surgeries.

first hip done in 86
Hip revision in 2009
Left ankle fusion and plates 2017
Right leg, Plates, screws, and rods to fix the right leg after our engine out off airport “landing” in 2018.
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I remember that! You are fully recovered?

So you had a hip that lasted 23 years, wow. I can’t wrap my head around revisions. Do they have to chip that thing out of your femur? Do they have like a little saw they stick down in there to separate the bone that grew into the stem? How do they get the socket part out of the pelvis? I know there’s one that you can just pop out the liner and replace it without removing the fused metal part. Do they just change the ball of top of the stem? I bet that’s how they do it. That wouldn’t help me if my body decides it doesn’t like the stem.
 
This doesn't specifically address your concerns, but for what it's worth, my hair dresser says that she has heard nothing but good about knee-replacement surgery. Besides what she has presumably heard from her clients, her mother had one knee done, and regrets not having the other one done. (Apparently it's now too late to do the other one now that she's in her nineties.)
 
I’m hurting some on day 3 of my (left anterior THA) recovery. So far only taken 2 Percosets though. I hope I’m over the hump. I’ve got to believe Rushie that if you don’t get any cobalt-chromium-molybdenum (CoCrMo) alloy parts you’ll avoid nickel problems. You’re a glutton for punishment though with your posterior choice. Did you get a second opinion?
 
Lance F said:
I’m hurting some on day 3 of my (left anterior THA) recovery. So far only taken 2 Percosets though. I hope I’m over the hump. I’ve got to believe Rushie that if you don’t get any cobalt-chromium-molybdenum (CoCrMo) alloy parts you’ll avoid nickel problems. You’re a glutton for punishment though with your posterior choice. Did you get a second opinion?
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No, but I know one of his patients. He had a great experience, a fast recovery and was back at work in three weeks, at a job where he’s on his feet all day. He also had the dilemma about whether to drive all the way to Houston for the anterior or go with this guy and he is real glad he went with this guy, he strongly recommends him. We’re talking about a minimally invasive posterior procedure, not the old one with a foot long incision.

I did talk with another surgeon in that practice and also a PA as well as my PCP who recommended them. There’s no question I need the THR even though 9 months ago I was told I didn’t. That’s how fast this thing progressed. I can feel it too, I wasn’t limping back then. What on earth did people do before these hip replacements, the S&W solution?

I’m glad you’re doing well on day 3. Hope it continues getting better!
 
Although it was two knees and not a hip, I waited too long for the first one. While I waited three more years for the second, it definitely was easy to tell when to have it done after the first experience.

All I can say is joint deterioration never gets better until its replaced.

Best to you.
 
X3 Skier said:
Although it was two knees and not a hip, I waited too long for the first one. While I waited three more years for the second, it definitely was easy to tell when to have it done after the first experience.

All I can say is joint deterioration never gets better until its replaced.

Best to you.
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Thanks. No, it won’t get better. I can’t say I waited too long because it went from not too bad to intolerable in less than a year. I have to do it, no choice, no matter how scared I am, cuz I can’t go on like this.

I got a surprise text from my son-in-law’s mother. My daughter blabbed to her I need a hip replacement. She got one, and had the posterior approach. She says the scar is 4” long. She is thrilled with the result and now wants to do the other one. AND…. She is highly nickel sensitive! She said they used titanium and she has had no problems. One more good data point.
 
Rushie said:
Wow that’s all great to know. I have TMJ dysfunction too and never imagined it could get so bad and there was a replacement joint.

“I would be more concerned about the gold ceramic coating interfering with long term stability of the bone to implant bond although it may not be critical in an axially loaded hip prosthesis.”

I was wondering about that too.

To keep this aviation related I am also wondering how having major hardware inside you affects you going through TSA. Does the metal detector go off causing them to throw you to the floor and handcuff you?
Click to expand...
TSA has a little form you can download and hand to them with specific details about the hardware, eg knee or hip, etc.
 
Is it possible to do a posterior procedure without cutting muscle? I believe that’s the advantage of anterior. No muscles cut. Simplified recovery. Better joint stability.
 
Hey you’ve done your homework, got a second opinion and even a referral. Sounds like your choice is sound. I wish you luck. Keep us advised.
 
Stewartb said:
Is it possible to do a posterior procedure without cutting muscle? I believe that’s the advantage of anterior. No muscles cut. Simplified recovery. Better joint stability.
Click to expand...

My understanding is no. But they cut it along the grain, not across it, which sounds a lot better to me. Disclaimer, I’m no doctor I’m going from googling drawings dumbed down for the masses so what do I know.
 
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