Metal on Metal Hip Replacement
My Story

Metal on metal? Or Ceramic on Polyethylene? To be frank, not a decision I ever expected to have to take!

I thought it would be helpful, as part of the context for this site, for me to share my story which, with the benefit of hindsight, so far appears to have a happy ending.

I also include this page so you can appreciate that I do have some relevant personal experience - some 'skin in the game'. I know what it is like to go through a total hip replacement. And as part of that I needed to make my own decision about whether to have a metal on metal implant.

I am fortunate in that the hip implant that I have has not been recalled, but I can very well appreciate the distress and worry that a person would feel if they have a hip implant that is thought to be faulty, or has a higher than anticipated risk of failure.

Here is my story.

A Bolt out of the Blue

I'm just a regular guy based in the UK. I was age 47 when quite unexpectedly I received a diagnosis of advanced Osteoarthritis of the hip.

To that point throughout my whole life I had been very fortunate in that I had enjoyed good health and reasonably high levels of physical fitness.

In the two years prior to the diagnosis I was 'as fit as a flea' and remember thinking that I had never felt physically stronger in years. I was cycling over 60 miles (90km) per week on average back and forth to my work and I was using light free weights at home to help with general strength and muscle toning. I was no serious athlete, but I was a fairly fit guy.

In addition, I was relatively young to receive this diagnosis at 47 years. I am 1.8 m tall and weigh just under 70kg - so, a fairly trim - many would say 'skinny' frame.

The Root Cause… maybe

In February of that year I picked up a nasty virus, most likely from the office, which knocked me out for a week. I had all the classic symptoms of Influenza - weakness; high temperatures; extreme night sweats. This was unusual for me - I rarely succumb to colds and flu.

The pain in my right hip started soon after - in March / April of that year just as I was recovering from the virus. My normal approach to aches and pains, probably in common with a lot of men, is to ignore and tried to simply work through it in the expectation that I will somehow shake it off, or, if I improve my fitness or posture then the problem will most likely disappear as mysteriously as it appeared.

Mid April we went away on a one week cycling holiday to celebrate my birthday. We cycled most days despite my pain getting progressively worse. I was having difficulty walking without a limp and sleeping on my right side had become too painful. I was busily taking the common supplements that are held out as being important for joint health including chondroitin, glucosamine and concentrated fish oils. The pain continued to worsen.

In late April I yielded and went to see my doctor (general practitioner). I made three visits to the doctor and following the third visit my condition was diagnosed:

  • Initially the advice was 'wait and see' - it may just disappear of its own accord…. Thanks doc!
  • On my second visit a few weeks later, extensive blood tests were initiated, the results of which came back 'all clear' - no evidence of inflammation (which seemed to rule out rheumatoid arthritis) At this point in the timeline I had 'graduated' from walking with just a stick, to needing crutches just to get around the house and the office.
  • Having drawn a blank with the blood tests I was booked for an X-ray… Bingo! The image of my pelvis and hips revealed an almost complete absence of cartilage remaining in my right hip joint - a classic indication of advanced osteoarthritis. Effectively the bone at the top of my femur was rubbing and bumping direct on the bone of my pelvis / acetabulum - QED and Ouch!…

Best consensus between my General Practitioner and the Hip Consultant on the root cause, was that my body, in the process of fighting the flu virus, released antibodies which clustered & concentrated in my right hip, attacking the cartilage within the joint. This condition is referred to as reactive arthritis. It is relatively uncommon, but it can and does happen. Bummer.

No, must be a mistake. This only happens to Old People, right?

I vividly remember the doctor giving me his diagnosis and I can't deny - I was shocked. First of all I only had a peripheral and sketchy knowledge of what arthritis actually is, and I was thinking "No- only Old people get arthritis - surely? Not me at only 47?" I asked whether there was any doubt and the doctor assured me that no, it was pretty much certain.

Of course I immediately asked: "OK, so what are my options?". This was his killer punch… he said "Well Richard, you really have just two options:

  • Either you have a hip replacement (crowd gasps…)
  • Or you accept a life of quite severe long-term disability. The pain will continue and possibly worsen, and the problems you currently have with walking and sleeping may also worsen. The difficulty that you will have with walking may well cause secondary complications with other joints and / or aspects of posture & mobility"

He said he was sorry to be giving the bad news and immediately recommended that I make an appointment with a consultant orthopaedic surgeon to explore the option of hip replacement.

Vain? Who, me?

I must admit, perhaps to my shame, that I immediately suffered a 'Vanity attack' - I simply did not want to tell people, other than my very close family and one close friend, that I had this condition and that I was seriously contemplating having a hip replacement operation. I had it fixed in my mind that only 'very old' people have hip replacement operations.

I now know, having done some research over the months, that this is clearly not true. That people of all ages can suffer with osteoarthritis; some need to have joint replacement surgery, even at a young age - teens or twenties. Despite this, my choice has been to keep my condition and the fact that I have now had a hip replacement secret. This is the reason that I do not publish my surname on this site.

All Credit to my Orthopaedic Surgeon

The consultant orthopedic surgeon to whom I was referred has proved to be absolutely outstanding in managing every aspect of my care, and ultimately the surgery which he personally performed.

He carefully explained to me my two main hip replacement options which very simply were as follows:

  • Either a Total Hip Replacement (THR)
  • Or, a metal on metal hip 'resurfacing'

The characteristics, advantages and risks of the two options were very carefully explained to me, and based on this, for me there was only ever one clear choice. I elected for the 'Exeter' (link: degradation timeline of hip implant) Total Hip Replacement option. The differences were explained to me as follows:

'Exeter' Total Hip Replacement

This approach is the tried, tested and well proven option. The Exteter, so called because the specialists who pioneered the technique were largely working out of the University and hospitals in the City of Exeter in the southwest of England, has been developed and refined over many decades and there have been hundreds of thousands of successful procedures completed.

In simple terms the replacement joint I have is comprised of:

  • a metal stem that is, in my case, cemented in to the femur
  • a ceramic head or 'ball' placed on top of the stem
  • a metal cup with a polyethylene (plastic) lining cemented in to the hip socket

So, in essence, what I have fitted is referred to 'in the trade' as a 'ceramic on plastic articulation'; this is proven to be smooth, stable and very hard wearing.

Metal on metal resurfacing

I was also offered another option which was a metal on metal hip resurfacing procedure. My best understanding of this option is that:

  • The top of my femur would have been shaved & shaped, and a convex metal cap would have been fixed to it
  • A metal cup would have been inserted in my hip socket

The net result would have been a metal on metal articulation - in essence, two smooth metal surfaces in contact with each other, allowing my hip joint to move freely.

Pros & Cons - in My Case

My consultant outlined to me the relative features, advantages & disadvantages between the 'Exeter' THR and metal on metal resurfacing as follows:

'Exeter' Total Hip Replacement (THR)

Metal on metal resurfacing

 

Analogy

 

The 'High quality German sedan' of hip replacements.

Mainstream; reliable; very robust; refined over decades.

The 'Formula 1 racing car' of hip replacements.

Higher performance and slightly more 'exotic'.

 

Advantages

 

Proven over many decades and hundreds of thousands of instances.

Ceramic on polyethylene gives a very smooth & hard wearing articulation.

More predictable lifespan of joint (could be up to 20 years before revision is required - if I look after it).

Less bone loss.

More robust; the joint can potentially withstand higher impacts.

Would allow me to participate in more 'aggressive' sports such as running or long distance cycling.

 

Disadvantages

 

More bone loss compared with a resurfacing procedure.

Less suitable for extreme / higher impact sports - for example, running is not recommended.

Surprisingly, and contrary to common belief, resurfacing surgery may be slightly more invasive relative to THR surgery (depending on approach taken).

 

Risks

 

(see note 1.)

Metal on metal contact and friction may, through time, release tiny metal particles in to the surrounding tissue and in to the blood stream. These particles may be harmful.

 

Summary

 

Compared to Metal on Metal resurfacing:

Slightly lower performance capability, but proven to be successful more often and avoids the risk of metal on metal wear / particle release.

Lower performance; lower risk.

Compared to THR:

Slightly higher performance capability, but less frequently used. More 'avant-garde'. Introduces the risk of metal on metal surface wear and particle release.

Higher performance; higher risk.

Note 1.: In the table above I have simply attempted to summarise the relative differences between the two options that were presented to me, comparing 'Exeter' Total Hip Replacement with Metal on metal resurfacing. For the avoidance of doubt, I have not included a note of the numerous more general risks typically associated with all hip surgery such as blood clots, infection, unequal leg length and so on.


My Decision - and the Plan of Attack

I was very easily able to make my decision. By nature and especially with respect to my health, I am risk averse and I opted for the more mainstream 'Exeter' Total Hip Replacement rather than the metal on metal resurfacing.

We set the date for the operation as 1st August; there seemed little point in delaying and I was keen to get on with it and start my recovery as soon as possible - and end the pain.

Through June and July I continued with a basic program of exercise in order that I was as fit and strong as possible going in to the operation, this of course was subject to the limitations imposed by the pain that my hip problem was causing.

We had another cycling holiday in July, and then I had a couple of weeks at home to make final preparations and to rest prior to the surgery.

The big day came - 1 August. In summary the operation was very straightforward. I was in a hospital for a total of four days, including the day of the operation.

My recovery followed a very standard and predictable course, with my priority in weeks 1-6 being to balance managing the pain and the wound; with getting mobile (walking) and regularly doing the basic exercises as recommended by my physio.

In weeks 7-12 I did more of the same routine, but walking longer distances and adopting a more ambitious and stretching regime of physiotherapy.

By Christmas I was just starting back cycling (tentatively), and my walking and sleep patterns were pretty much back to normal.

I was looking forward to what I hoped would be a more normal New Year!

Another perspective on metal on metal hip replacements

In my family we have one other experience directly related to metal on metal implants. A close relative (age mid 70s) has suffered from very bad osteoarthritis of the hip for many years. She has endured severe pain, but despite this has been unwilling to investigate or progress hip replacement surgery. This is largely due to her fear, whipped up by reports in the press & media of faulty and recalled metal on metal hip implants, and the adverse health effects that some people have experienced.

I am hopeful that based on my relatively positive experience she will be encouraged, and will soon get whatever treatment is best for her.

In Conclusion

Paying it Back; Paying it Forward

In many ways, this site for me is a labour of love, and building it has been part of my path to recovery. I hope that in some way visitors benefit from this content and from my sharing some of my experiences.

I have been blessed beyond words and in so many ways, not least:

  • living in a country where high quality health care is readily available
  • having been referred to a truly outstanding consultant, anaesthetist and supporting hospital team. For their skill, dedication and commitment I will be forever grateful
  • The love and support of my partner, my family and the small group of close friends who carried me through a difficult period. You know who you are.

Richard

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