Woman's hip replacement disintegrates, causing metal poisoning | Hacker News Reader

Woman's hip replacement disintegrates, causing metal poisoning

arstechnica.com

53 pointsQem22 comments

I do not know who these Very Important Patients are, what sort of insurance they carry, what their social-credit ratings are, or what sort of providers they see, but this article reads to me like an episode of “House MD” or “Doc Martin”.

I can only vouch for my personal lived experience, as a mentally ill man living in poverty, on Medicaid and ACA plans. No provider would ever in a million years do this kind of diligence for any condition. Not in the Emergency Department for sure . They run standard tests: every test that insurance will pay for, every test that my credit rating will bear, and then they slap on the most common treatments and try to get me outta there ASAP.

I’ve long had alleged thyroid issues and alleged organ troubles that can be wicked mimics of myriad conditions, and Levothyroxine (Synthroid) in particular can engender some horrific psychiatric symptoms.

So bravo to the genius providers who evidently needed to apply for grants and/or needed to get monographs published in the JAMA, so much so that they went to considerable and unnecessary expense to figure out this lady’s issues.

There actually was an episode of House with this very diagnosis from a hip replacement, https://house.fandom.com/wiki/Family_Practice

My hottest policy take is that all physicians have to watch House all the way through.

lmao the reason he finally figured it out was because she didn't understand him sarcasm, so he figured she must have neurological issues? classic

It's a common and well-known consequence of hip replacements.

This paper from 2015 describes a similar case (quickly identified via X-ray by the deformation of the metal structure)

    "It has been well established in the literature that revision of a fractured ceramic total hip replacement with metallic components can result in metallosis. Several authors have reported symptomatic cobalt toxicity after revision of a failed ceramic head component to a metal-on-polyethylene articulation"

https://pmc.ncbi.nlm.nih.gov/articles/PMC4958112/

I share your cynicism based on my own experiences, but I think the technical answer to your question includes:

1. We don't know how many people had similar conditions that simply went untreated.

2. If you somehow manage to pique a doctor's curiosity, they might apply a similar effort for you.

You mention mentally ill - do you think that your mental illness could affect your human relationship with doctors?

- stupid question

- what set of conditions actually cause a person to get a hip replacement surgery apart from an accident?

Arthritis. Causes heaps of pain and reduced mobility which brings a whole lot of other medical complications. Hips replacement are super common past a certain age.

Osteoarthritis (or specifically, osteoarthrosis), not rheumatoid arthritis (swelling of the areas around the joint due to immunoresponse), it's when the cartilage on the femural head wears out so its just bone on bone. Doctors can inject hyaluronic acid for temporary lubrication but a replacement is pretty much the only long term treatment.

Cancer is an additional one. A friend of mine is going to have a hip replacement soon now that the cancer in her hip is gone.

Age. Hip replacement surgery is common among the elderly.

She had a hip replacement at age 37. That's not due to age.

The question (“what set of conditions actually cause a person to get a hip replacement surgery apart from an accident?”) wasn’t about her case. The article clearly indicates she had an accident (“Twenty years before, she had a hip replacement that stemmed from an injury she sustained in a car crash ten years before that”)

Hip impingement.

Ouch! I must say, she got lucky they diagnosed the cobalt poisoning in time.

Why do they use cobalt? For imaging?! I always assumed they used titanium or platinum :/

  Cobalt-chrome is the most commonly used metal for hip implants. Titanium is also used but is a softer metal with similar properties to bone.

~ https://practiceplusgroup.com/knowledge-hub/what-hip-replace...

with known risks:

Cobalt toxicity — an emerging clinical problem in patients (2011) - https://www.mja.com.au/journal/2011/194/12/cobalt-toxicity-e...

Cobalt-chromium toxicity following revision of total hip replacement (2024) - https://pmc.ncbi.nlm.nih.gov/articles/PMC11115421/

Because the human body is warm and wet and salty and so despite the forces being low when your criteria are "super long wearing" and "non-reactive" you wind up with kind of a shitty list of options.

It's "supposed" to remain in solid form.

I wonder if the same can happen from dental implants. While not subject to the same levels of mechanical stress, the mouth can be a very acidic environment which can be corrosive to metals.

In general, mercury amalgam fillings are being phased out, mostly because modern alternatives are superior.

The risk to the individual is actually really low, but cremation and general waste disposal introduces mercury as a pollutant to the environment.

https://www.optimaldentalhealth.co.uk/mercury-fillings-banne...

If you mean the 'screw in jawbone' style implants, those are generally made of titanium.

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