Doctors in Germany studied patients to determine the prevalence of sensitisation to chromium, cobalt, nickel, or a cement component in patients who received joint replacement surgery. When should I involve a Prolotherapist in my care? About 1 in 7 show declines across all brain networks. It is a very small part of our environment. In Portland, Dr. Tower researched the difficult problems that are occasionally encountered after hip or knee replacement. This went on for a couple of years. These elevated levels of serum cobalt and chromium are for real, so if you’ve had a joint replacement, getting them checked may be a good idea. Another Attune knee problem is the device fails earlier than expected. In addition to Cobalt leaching into the bloodstream, thousands of DePuy knee replacement patients have suffered the device deboning at the point where the tibia is inserted into the device's sleeve. Int Orthop. Titanium has two allotropes: alpha and beta. 22 patients with total knee arthroplasty and metal-on-metal hinge connecting mechanisms were studied for whole-blood chromium and cobalt levels at 6 months, 1 year, and at 2 years or less after surgery. It is only suggested after the patient has already exhausted all other options, including physical therapy and medication. High blood metal ion levels in 19 of 22 patients with metal-on-metal hinge knee replacements. In order to fill the space in between the tibia and the sleeve into which the bone is inserted, doctors were told to use "shims" much like a carpenter would when trying to level a set of shelves or a bookcase. Revision surgery was needed in 9.8 % of patients with sensitisation to one of the reviewed components. Because it turns out that anyone who submits to joint-replacement surgery is at risk for developing a condition called arthroplasty cobalt encephalopathy, or ACE, but they may not know it — because the symptoms mimic those of Parkinson’s and even dementia! Another complication that is causing DePuy knee patient's enough pain and suffering to require revision surgery is having a hypersensitivity to the Cobalt core of the DePuy knee. | 7/26/2018, The Journal of Knee Surgery Explains DePuy Knee Debonding | 7/24/2018, Tibial Baseplate Debonding Complicates Knee Replacement Recovery | 7/21/2018, High Number of Database Complaints about DePuy Knee Replacement System | 7/19/2018, Seniors requiring revision surgery also need to take a second, painful, lengthy rehabilitation period into account | 7/16/2018, Old Sports Injuries Degenerate Later in Life | 7/12/2018, Knee Replacement Recovery For Senior Citizens | 7/9/2018, DePuy Synthes Redesigned Knee Replacement | 7/6/2018, DePuy Knee Replacement Device Debonding | 6/30/2018, Senior Citizens Experience Knee Replacement Complications | 6/26/2018, The Revised DePuy Knee System Addresses Malfunctions in the Original Device | 6/21/2018, DePuy Tibial Baseplate Malfunction | 6/18/2018, DePuy Knee Patients May Require Many Years of Physical Rehabilitation | 6/12/2018, The Malfunctioning DePuy Knee System Was Untested | 6/7/2018, Senior Citizens Should Think Twice Before Having Knee Replacement Surgery | 6/4/2018, The DePuy Knee Replacement System Can Fail Prematurely | 5/31/2018, Doctors Perform Knee Surgery on Senior Citizens | 5/29/2018, Osteoarthritis is a Common Cause of Knee Replacement | 5/24/2018, The DePuy Revision Knee Replacement Device is an Admission the Original Was Faulty | 5/21/2018, The DePuy Knee Revision Device | 5/15/2018, Physical Therapy After a Knee Replacement | 5/11/2018, The Unacceptably High Failure Rate of DePuy Knee Replacement Device | 5/7/2018, Senior Citizens Get Most DePuy Knee Replacements | 5/4/2018, FDA Recalls of DePuy Knee Replacement System | 4/27/2018, DePuy Knee Replacement Systems and Tibial Loosening | 4/23/2018, The Realities of Knee Replacement Surgery | 4/20/2018, DePuy Knee Replacement Fails to Live Up To Expectations | 4/16/2018, The FDA Recalls Depuy's LPS Diaphyseal Sleeve | 4/13/2018, DePuy Knee Replacement Complications | 4/9/2018, Knee Replacement Surgery Can Be More Painful Than You Think | 4/6/2018, DePuy Knee Replacement for Senior Citizens | 4/2/2018, Johnson & Johnson's History of Product Recalls | 3/23/2018, DePuy Knee Replacement Lockups and Infections | 3/19/2018, Knee Replace Can Cause Detrimental Life Changes | 3/12/2018, Symptoms to Look For That Indicate a Failing DePuy Artificial Knee | 3/5/2018, Doctors Perform Unnecessary Knee Replacement Surgeries Any further gaps between the bone and the device were filled with glue. Within weeks, her skin broke out in boils. Many metal hip replacements were constructed using a hard metal called cobalt in order to extend the life of the hip replacement. The most common causes are dental or surgical procedures, urinary tract infections and skin infections. As hip replacements fail and metal flakes enter the body, patients can suffer from cobalt toxicity (elevated cobalt levels). If you have an allergy, imagine carrying that around in your knee. The pragmatic approach adopted by most contact dermatologists for patients known to be allergic to nickel, cobalt or chromium and who require joint replacement is to recommend prostheses made of titanium-based alloys. Cobalt is a naturally occurring element used to make metal alloys and other metal compounds, such as military and industrial equipment, and rechargeable batteries. Never think about my knee. Tibial base loosening is the primary reason so many DePuy knee come painfully undone, unstable and twists and turn when one walks. Blood levels. 2016 Feb;40(2):239-44. doi: 10.1007/s00264-015-3001-6. Monday, August 13, 2018 - Cobalt poisoning could result from metal to metal or metal to plastic friction in the DePuy Knee Replacement System. Titanium and titanium alloys used in hip and knee replacements. | 3/1/2018, Candidates for Knee Replacement | 12/29/2017, Knee Replacement Device Failures | 12/22/2017, Knee Replacement Failure Can Be Life Changing | 12/18/2017, Depuy Knee Replacement Side Effects | 12/15/2017, Johnson and Johnson Past Product Failures | 12/11/2017, People Describe Their Knee Replacement Ordeals | 12/8/2017, The Market For Knee Replacement Devices | 12/4/2017, Arthritis and Knee Replacements | 12/1/2017, What Are The Signs Of Knee Replacement Failure | 9/29/2017, DePuy Knee Replacement Lawyer Handling Claims in All Fifty States | 9/22/2017, DePuy Synthes Targets Senior Citizens for Knee Replacement | 9/15/2017, Knee Replacement Patients Need To Know What Is Wrong With Their Implanted Device | 9/7/2017, DePuy Knee Replacements Fail to Solve Knee Pain | 9/1/2017, Johnson & Johnson's History of Knee Replacement Recalls | 7/31/2017, Do I Need a DePuy Knee Replacement Lawyer? If you or a loved suffered from DePuy knee problems including instability, pain, bone damage, and the need for revision surgery due to a defective DePuy knee, you may be entitled to damages. These are associated with a range of potential health problems including cancer, neurological difficulties and thyroid and heart disease. "Total Knee Arthroplasty (TKA) and Unicompartmental Knee Replacement are intended to provide increased patient mobility and reduce pain by replacing the damaged knee joint articulation in patients where there is evidence of sufficient sound bone to seat and support the components." While tibial loosening causes wobbliness, pain, instability, and a decreased range of motion, metal hypersensitivity results in migraine headaches, body aches, nausea, infection and auto-immune disorders and severe psychological complications. A study has found that almost 1 in 4 of knee replacement patients who are 60 or older show a decline in activity in at least one brain region 48 hours after surgery. And the devices may also loosen or develop other problems, causing pain and affecting a person's ability to walk. Symptoms include: … Patch testing continues to be a useful tool as laboratory investigations for metal hypersensitivity continue to emerge. We are an out-of-network provider. Cobalt chromium poisoning is a risk for anyone with a metal on metal (MoM) hip replacement. In this curious study, the doctors “selected patients with a pre-operative known sensitisation to chromium, cobalt, nickel, or a cement component for a post-operative allergic reaction. How long are titanium cobalt knee replacement suppose to last? Knee Replacement Surgery Carries Incredible Risks | 7/29/2019, Senior Women May Need 25 Percent Fewer Knee Replacement Surgeries If They Take This Drug | 7/22/2019, Cemented Knee Replacement Devices Fail at a Higher Rate in Obese Patients | 7/2/2019, Senior Citizens Can Treat an Arthritic Knee By Eating Properly | 6/10/2019, Too Many Are Opting For Knee Replacements Too Early In Life | 6/4/2019, Knee Replacement Patients Need Honest Objective Advice | 5/28/2019, Knee Replacement Surgery Makes Little Sense | 5/22/2019, Senior Knee Replacement Patients Are Peddling To a Healthier and Longer Life | 5/9/2019, It Is Recommended That Osteoarthritis Patients Try The Mediterranean Diet Before Rushing Into Knee Replacement Surgery | 4/30/2019, DePuy Knee Replacement Doctors May Be Failing To Follow The Written Product Warnings | 4/23/2019, Study Finds Plain Cement As Effective As Antibiotic-loaded in Limiting Knee Replacement Surgeries | 4/16/2019, Several More Lifestyle Changes To Help Alleviate Osteoarthritis Knee Pain | 4/10/2019, Holistic Herbs And Supplements Can Help Reduce Arthritis Knee Pain | 4/1/2019, Cobalt Poisoning From a Hip or Knee Replacement Could Drive One to Suicide | 3/28/2019, Artificial Knee Joint Infections Require Painful and Debilitating Revision Surgery | 3/26/2019, DePuy Knee Replacement Requires Artifical Spacers Packed With Antibiotics | 3/9/2019, Total Knee Replacement Devices May Last But Patients Are Dissatisfied With The Result | 3/5/2019, Stem Cell Recruitment Therapy Offers an Alternative to Knee Replacement Surgery | 3/1/2019, Clinical Trials For Treating Knee Osteoarthritis Are Underway | 2/25/2019, Knee Replacement Patient Dissatisfaction May Be As High as 20% | 2/19/2019, The New and Improved DePuy Revision Knee Replacement Device May Lead to More Bonding Failures and Tibia and Femur Fractures | 2/13/2019, DePuy Knee and Hip Failures Are Similar and Lead to Class Action Lawsuits | 2/8/2019, DePuy Knee Glue Failure Prompts Lawsuits | 2/6/2019, Knee Replacement Failure is Starting To Get The Attention It Deserves | 1/30/2019, Gene Therapy Could Treat Osteoarthritis And Eliminate The Need For Knee Replacement Surgery It’s caused when the metal wears and introduces cobalt into the bloodstream. We provide free no-obligation DePuy knee lawsuit case review. The knee replacement implant material used may differ from patient to patient, on the basis of their condition, actual requirement, and also the choice made by the surgeon. Another Attune knee problem is the device fails earlier than expected. Then with present day technology they do a revision. Along with titanium, cobalt chrome is one of the most widely used metals in knee implants. Attorneys representing DePuy knee cases expect to consult with more patients that have suffered from the complications due to a DePuy knee replacement surgery. This blog post provides general information to help the reader better understand regenerative medicine, musculoskeletal health, and related subjects. Fast forward to age 59. Did it, did the follow up therapy and have been happy ever since. This is a known risk with metal-on-metal implants, but newer data are showing that it is also a risk with metal-on-polyethylene implants. Take the Quiz! The most common metal ions found in knee replacement implants that can cause hypersensitivity include nickel, cobalt, and chromium. He had a terrible time. The effects of cobalt toxicity on the brain are evident. My surgeon assured me at least 20 years. 2.3. ELEVATED BLOOD COBALT LEVELS IN A PATIENT WITH BILATERAL METAL-ON-METAL HIP PROSTHESES . Metal on metal contact of the DePuy knee can cause metal Cobalt shavings that are quickly absorbed into the bloodstream. Another complication that is causing DePuy knee patient's enough pain and suffering to require revision surgery is having a hypersensitivity to the Cobalt core of the DePuy knee. Monday, August 13, 2018 - Cobalt poisoning could result from metal to metal or metal to plastic friction in the DePuy Knee Replacement System. Infection can occur years after knee replacement surgery, when bacteria enter the bloodstream and infect the surgical site, according to MayoClinic.com 1. Ross Hauser, MD Doctors in Finland have released a new troubling study on the release of metal debris from knee replacement hardware. The doctor chose to use a new type of devise for the replacement. This can cause serious reactions in patients who undergo total knee replacement surgery because some knee replacements are made of cobalt chrome that contains around 1 percent of nickel. It happens when there’s friction between metal surfaces. Frances was 39 when she had cobalt alloy hips implanted. Cobalt poisoning can result in nervous system disorders beginning with tremors in the hand, ringing in the ears, and eventually dementia. Had my knee done in 2002, age 59. This warning virtually never makes it to a knee replacement consumer, 90% of whom are senior citizens suffering from osteoporosis and osteoarthritis, the exact bone deteriorating conditions surgeons are warned to avoid in patients. Material fundamentals of titanium and cobalt–chromium alloys used in hip and knee replacement 2.3.1. There is little information available concerning the prevalence of and risk factors for these adverse reactions in knee replacements … [Pubmed], 2 Guenther D, Thomas P, Kendoff D, Omar M, Gehrke T, Haasper C. Allergic reactions in arthroplasty: myth or serious problem? Celebrating 28 years of service to those in pain. Some people are concerned about developing an allergic reaction to metal implants. … *It does not include vitamin B-12, because cobalt in this essential nutrient is bound to protein and does not release cobalt ions. The friction releases tiny metal particles into your bloodstream that could trigger a hypersensitive immune response in your body. Infection is a severe complication, and it needs immediate medical attention. (The Finnish researchers) determined the levels of metal ions in the blood of 22 patients with metal-on-metal hinge total knee arthroplasty. The results clearly show that the metal-on-metal hinge knee replacement carries a high risk of increased levels of systemic metal ions and also local adverse patient reactions to metal debris, leading to complicated knee revisions. cobalt and chromium) from the metal implant or from the metal particles will enter the bloodstream. Health Problems from Metal Ions: Metal-on-metal hips have raised other concerns, including potential harm from cobalt and chromium ions released into the bloodstream. Dr. Steven Tower, an orthopedic surgeon in Alaska, recently gave a fascinating (and alarming) talk about the many neurological problems he has observed in hip patients with elevated cobalt levels in the body. We do not charge attorney fees unless you receive compensation and you are under no obligation after your initial consultation. We report two Australian patients with possible cobalt toxicity related to metal-on-metal total hip replacements. Get our FREE 4th Edition Prolotherapy e-book! Potential allergens were strictly avoided in the replaced prosthesis. Because no two patients have exactly the same tibial bone size or density, the company has updated the information on its website instructing DePuy doctors to rule out potential patients with insufficient tibial bone strength. Here is a list of the different knee replacement implant materials and their pros and cons. It would seem logical to simply monitor knee replacement patients for raised metal levels, but this is not as simple as it seems. Possible adverse patient’s reactions to metal debris were investigated by MRI. The patient described in the preceding clinical vignette is an excellent example of a concerning medical topic emerging in the current news. Alpha phase titanium has a hexagonal closed-packed (hcp) crystal structure and exists at room temperature. Knee replacement surgery — also known as knee arthroplasty (ARTH-row-plas-tee) — can help relieve pain and restore function in severely diseased knee joints. Longevity depends on many factors including the implant but also on such things how well it is implanted (go to 23 percent of participants who had knee replacement surgery showed large declines in brain connectivity. This work won the Alonzo Nuffield Award for the best submitted research paper to the 1992 annual meeting of the Western Orthopedic Association and was published soon thereafter. Acta Orthop. All patients who received revision surgery because of a potential allergic reaction were followed up post revision surgery.”, November 3, 2016: (National Institute of Health) Seven substances added to 14th Report on Carcinogens. They note: If you are looking to avoid knee surgery, see our main page Prolotherapy for knee pain for an alternative to surgery. Treatments discussed on this site may or may not work for your specific condition. and the rate of revision (repair surgery) due to adverse patient’s reactions to metal debris in patients treated with metal-on-metal hinge total knee arthroplasty. However, one problem that can happen with plastic implants is an immune reaction triggered by tiny particles that wear away from the spacer. DePuy knee Cobalt poisoning most often affects one's ability to think and remember things and misdiagnosed in senior citizens as Alzheimer's disease. Metal-on-plastic is the least expensive type of implant and has the longest track record for safety and implant life span. Throughout my 20's through 50's they put off replacement because I was too young and knees lasted only 8-10 years. Cobalt is used throughout the industrial world because of its extreme hardness. There has been increasing alarm regarding metal-on-metal joint replacements leading to elevated levels of metal ions and adverse patient’s reactions to metal debris. | 1/28/2019, Orthopedic Surgeons Recommend Knee Replacements When a Little Exercise May Be All That is Needed | 1/22/2019, Artificial Knee Manufacturers Battle With Patient Knee Infections | 1/17/2019, Knee Replacement Infections May Necessitate Amputation | 1/14/2019, Overweight Knee Replacement Candidates Should Consider Other Options | 1/9/2019, The DePuy Revision Knee Can Come Unglued Just as Easily as the Original Device | 1/7/2019, DePuy Knee Replacement Can Be Complicated by Osteoporosis | 1/3/2019, Knee Replacement Patient Should Lower Their Expectations | 12/18/2018, Medical Device Sales Representatives Are Present In Knee Replacement Operating Rooms | 12/13/2018, Knee Pain Patients Are Urged To Investigate Stem Cell Therapy Before Agreeing To Knee Replacement Surgery | 12/10/2018, The Risk of Infection May Outweigh the Benefits of the DePuy Knee Replacement Device | 11/29/2018, The FDA Failed to Adequately Test The DePuy Knee Replacement Device | 11/26/2018, DePuy Knee Patients Should Know When Enough is Enough | 11/9/2018, Senior Citizens Should Seek a Second Opinion for a Doctors Knee Replacement Advice | 11/2/2018, Senior Citizens With Osteoporosis May Want To Avoid Knee Replacement | 10/30/2018, DePuy Synthes Addressed the Failed DePuy Knee Due to Infections | 10/29/2018, Knee Replacement Market Estimated to Reach $10 billion Annually by 2024 | 10/24/2018, DePuy Targets Older Senior Citizens With The Revision Knee | 10/18/2018, Failed Knee Replacements Can Lead to Leg Amputation | 10/12/2018, Arthritis Knee Pain and Total Knee Replacement Surgery | 10/10/2018, Debonding, Infections, and Metal Hyper-Sensitivity Can Require DePuy Knee Replacement Revision Surgery | 10/1/2018, DePuy Blames Glue For Knee Replacement Device Failures | 9/28/2018, Arthritis Sufferers Should Think Twice Before Jumping Into Knee Replacement | 9/27/2018, The Meager Benefits of the DePuy Revision Knee Replacement Device | 9/25/2018, Lawsuit Alleged DePuy Failed to Recall the Knee Replacement Device | 9/22/2018, Alternatives to Knee Replacement Surgery for Senior Citizens | 9/19/2018, Blood Test Results May Be An Early Warning That An Artificial Knee Is About To Fail | 9/17/2018, The New DePuy Revision Knee Replacement System | 9/13/2018, Doctors May Be Overselling The Benefits of Knee Replacement Surgery | 9/10/2018, Total Knee Replacement Questions and Answers | 8/31/2018, Medical Device Studies Are Looking More Like Infomercials | 8/27/2018, Metal Hypersensitivity Can Cause DePuy Knee Failure | 8/24/2018, DePuy Knee Replacement System is sold primarily to senior citizens in spite of the product's age warning | 8/17/2018, Tibial Fractures and Loosening Cause DePuy Knee Failure | 8/15/2018, Report DePuy Knee Replacement Malfunctions Using The FDA's MAUDE System | 8/8/2018, A Physically Active Generation Demands More Knee Replacement Surgeries | 8/6/2018, Senior Citizens Will Require More From The DePuy Knee Replacement Device Than Merely Playing With The Grandkids | 8/2/2018, Setting the DePuy Revision Knee Terminology Straight | 7/30/2018, Senior Citizens Are Urged To Put Off DePuy Knee Surgery Unless Absolutely Necessary DePuy Attune knee replacement patients report tibial loosening. Background: Oxidized zirconium (Oxinium) was introduced as an alternative bearing surface to cobalt-chromium (CoCr) in an attempt to reduce polyethylene wear and decrease aseptic mechanical failure of total knee replacements. ... Metal Attune knee components are made from a Cobalt-Chromium-Molybdenum alloy. Because the knee is required to bears a person's full weight on every step, the tibial-knee device joint was inadequate causing the glue to debone and causing further painful bone loss. DISCUSSION. Some patients sued. Cobalt poisoning can occur when you are exposed to large amounts of it. Replacement knee and hip joints wear out and produce debris that can enter the bloodstream and make a person very sick Thursday, March 28, 2019 - One of the focuses of the Netflix documentary, The Bleeding Edge, is the negative health consequences of "cobalt poisoning" that occurs in metal on metal artificial joints manufactured by DePuy Synthesis. For years the focus following hip replacement surgeries has been on the physical condition of the hip itself. Finally the doctor replaced the devise with one that had already proven reliable. Some of the metal ions (e.g. Had major knee problems from the age of 6. | 7/24/2017, The Global Market For Knee Replacement | 7/17/2017, Product Failures at Johnson & Johnson | 7/10/2017, Depuy Knee Replacement Side Effects | 7/3/2017, Over 4 Million Knee Replacements in US Alone | 6/19/2017, How Joint Replacement Surgeries Have Become More Dangerous | 6/12/2017, High Demand for Joint Replacement Systems Lead to Defective Products | 6/5/2017, DePuy Knee Replacement System Failures | 6/1/2017. October 2, 2014 — A man who had an allergic reaction to cobalt and nickel in the Stryker Triathlon knee replacement has filed a lawsuit in Colorado. - Hi! Knee replacement surgery is the last option available to people suffering from debilitating osteoarthritis and painful knee injuries. Dr. Tower returned to Anchorage in 1992. Dermatitis on the knee following knee replacement: a minority of cases show contact allergy to chromate, cobalt or nickel but a causal association is unproven. We, therefore, discourage the use of metal-on-metal hinge knee replacements. They note: There has been increasing alarm regarding metal-on-metal joint replacements leading to elevated levels of metal ions and adverse patient’s reactions to metal debris. Patients suffering from the symptoms of metal hypersensitive demonstrate higher than normal levels of Cobalt in their bloodstream. Very small amounts are needed for animals and humans to stay healthy. CONCLUSION: The allergic patient should be thoroughly informed about potential reactions resulting from implant choice, Cobalt and cobalt compounds that release cobalt ions. The DePuy knee is made from a combination of metal and plastic parts including a Cobalt-Chromium-Molybdenum alloy. Cobalt is a naturally occurring element in the earth's crust. FINAL DIAGNOSIS. Doctors in Finland have released a new troubling study on the release of metal debris from knee replacement hardware. Of course technology continues to improve. Is this possible, and could it be a cause of pain or irritation after surgery? Epub 2015 Nov 2.[Pubmed]. The biggest culprit for toxicity seems to be cobalt-chrome but there is no generally accepted threshold beyond which serum or blood concentrations of cobalt and chromium are known to be toxic8. According to Healthline’s analysis of … Are you a chronic pain expert? Cobalt Chromium Metal Poisoning from Hip Replacements. Metal implants are used in a variety of orthopedic surgical settings, including fracture repair and joint replacement surgery. 2017 Jan 26:1-6. doi: 10.1080/17453674.2017.1283846. A good, close friend had hip replacement a few years back. The reason for most tibial loosening is the fact that the original DePuy knee is "one size fits all," and fits very few patients perfectly. 1 Laitinen M, Nieminen J, Reito A, et al. The metals commonly used include cobalt-chromium, titanium, zirconium, and nickel. There is no consensus as to which material is better and more suitable. These metals are known to cause skin sensitivity in the general public; about 15 percent of people have nickel sensitivity. Infections are rare after knee replacement surgery, but they can occur. The lawsuit (PDF) was allowed to move forward based on failure-to-warn and negligence claims, according to HarrisMartin. Cobalt is a component of vitamin B12, which supports the production of red blood cells. Although the percentage of patients having allergic reactions related to the use of cobalt-chromium alloys to is very low, one area of concern is the issue of tiny particles (metal ions) that may be released into the body as a result of joint movement. Within months, she faced effects ranging from memory loss and visual disturbances to severe tinnitus and PTSD-like rage/anxiety attacks. Others symptoms of Cobalt poisoning are reduced vision and amnesia. Best thing I ever did. Also for cost of knee replacement Both patients were treated for osteoarthritis with a DePuy ASR (articular surface replacement) XL Acetabular Hip System prosthesis, which contains cobalt and chromium, and which has recently been recalled from the market. When a person walks with the DePuy knee they are experiencing the metal-on-metal contact of the Cobalt-Chromium alloy. The devise dislocated at will several times and he developed cobalt poisoning. Cobalt Toxicity. There is little information available concerning the prevalence of and risk factors for these adverse reactions in knee replacements as opposed to the widely studied metal-on-metal hip joint replacements. Possible, and nickel or may not work for your specific condition patients. 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