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DePuy, Zimmer and other companies and doctors have said that most patients who received metal hips have done well.
Given the large number of people who have received metal devices, that could mean thousands of patients in the United States.
Enhanced metal ion concentrations have been reported widely from hair, blood and urine samples of patients who received metal hip replacements and in isolated cases when abnormally high levels have caused adverse local tissue reactions.
In one study, one out of three older patients undergoing hip surgery received metal on metal hip implants.
14 Concerns regarding the effects of metal ions have been noted after a landmark paper by MacDonald et al 36 that noted a 5.3-fold increase in erythrocyte cobalt, a 35-fold increase in urinary cobalt, and a 17-fold increase in urinary chromium concentrations in patients who received metal on metal hip replacements compared with those who received metal on polyethylene.
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A high proportion of our patients received metal-on-metal bearing surfaces, and this may bias towards worse outcomes (Smith et al. 2012).
22 23 The metal-on-metal cohort included all patients who had received metal-on-metal hip resurfacings and large diameter head metal-on-metal total hip designs that had been used at least 20 times from 2001 to 2010.
For this reason, we restricted our study to patients operated on from 1990 onwards, meaning that long-term follow-up is somewhat limited, especially for the cohort operated on most recently who are more likely to have received metal-on-metal prostheses.
There was also evidence from one trial that patients receiving metal on metal implants have a lower quality of life (functional component) than patients receiving metal on polyethylene bearing.
Disease specific functional outcomes and general quality of life scores were no different or they favoured patients receiving metal on polyethylene rather than metal on metal in the trials.
Surface water receives metals from natural and anthropogenic sources in natural condition.
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