Hip Replacement Surgery Alternatives | Update
Ross Hauser, MD
In this article Ross Hauser MD discusses seeing the patient following hip replacement who had surgical complications, alternatives to hip replacement surgery, and the use of Prolotherapy, Platelet Rich Plasma Therapy and Stem Cell Therapy for degenerative hip arthritis.
A 2006 article in Pain Physician Journal featured a case study of successful cartilage regeneration using stem cell therapy1. This case involved a 64-year-old man with a 20-year history of hip pain. He was a candidate for hip replacement as his MRI showed severe degeneration, decreased joint space, bone spurs and cysts.
This man underwent a stem cell transfer in an effort to regenerate cartilage in his hip. Bone marrow was extracted from this patient, processed and injected into the affected hip. After the first stem cell treatment the patient reported some improvements in his hip although the MRI showed no change.
One month later a second treatment was done and resulted in increased joint space and increased range of motion. The patient reported that he was able to stand for longer periods of time, enjoyed travel and recreation and was able to walk further and sit with less pain. The researchers concluded that this man did in fact have cartilage regeneration and that bone marrow therapies hold great promise for joint degeneration.
Stem Cell Therapy for Chronic Hip Pain
We are discovering study after study that proves the benefit of bone marrow in treating chronic pain. In our experience, we have seen excellent results using bone marrow as a proliferant for healing. Stem cell injection therapy is just one treatment option that we offer sports injuries, chronic pain and arthritis of the hip.
Pain and complications after hip replacement
In this section we will discuss issues of hip replacement complications.
Metal-on-metal total hip replacements have shown a number of adverse effects.1-3 Some recipients of these hip replacements have complained of severe pain and immobility after tiny metal fragments have chipped off and damaged surrounding tissue. As a result, many who receive metal-on-metal hip replacements have elevated blood levels of chromium and cobalt, two metals used in these hip replacements.1 There has also been a greater need for revision surgery, a procedure where surgeons must re-open the hip for repair.3 Another hip arthritis treatment is hip resurfacing. Instead of completely replacing the hip joint, metal “caps” are placed on the articular surfaces of the femur and pelvic socket.
Numerous reports continue to pour in about the adverse effects of metal-on-metal hip replacements. We’ve written before about the dangers of hip replacements and the complications associated with all-metal hip replacements. Recent articles are further revealing the trouble with metal-on-metal hip replacements (2, 3):
- Heavy metal leaching into the blood
- Friction of the metal destroying bone and muscle.
- Residual pain and disability
- High incidence of revision surgery or early removal of artificial hip
- Necessity of regular MRI scans to assess the status of the artificial hip.
Recent research including that appearing in the British Medical Journal, found that 7 to 23% of patients who had hip replacement continued to have long term unresolved pain. . . There is an urgent need to improve general awareness of this possibility and to address determinants of good and bad outcomes.” 4
Concerns with pseudo tumor development after Hip Replacements
A surgeon in the Netherlands recently published an article discussing new concerns of pseudo-tumors developing around the hip replacement or resurfaced site5. They are caused by an adverse reaction to metal debris, as in a local metal allergy or sensitivity. Patients who present with pseudo-tumors experience:
- soft tissue masses in the groin, pain,
- swelling and discomfort in the leg and groin and compression of the neurovascular bundle (nerves, arteries, veins and lymphatics that travel together).
The development of pseudo-tumors has caused some surface replacement to be recalled from the markets and medical registries in England, Wales, New Zealand and Australia have all seen increases in rates of revision arthroplasties. Both the British Orthopaedic Association and the Dutch Orthopeadic Association have issued strong warning on the metal treatments for hip arthritis, with the Dutch recommending a complete cessation of using hip resurfacing and hip replacements.5
Chromium and Cobalt Poisoning from Hip Replacements
One danger in joint replacement is the wearing away of the all-metal joints that lead to heavy metals leaking into the blood. We recently had a client whose blood chromium level was 25 times the normal range and whose blood cobalt level was 13 times the normal level. His doctor thought these were from some of his joint replacements. We did some further investigation and found that heavy metal toxicity is common among joint replacement recipients.
The Journal of Orthopaedic Research published a four-year study of cobalt and chromium blood levels in 259 patients with one of two types of all-metal hip replacements. All the patients had higher cobalt and chromium levels compared to the control group. And even worse than our patient mentioned above, this study showed cobalt concentrations up to 50 times higher and chromium concentrations up to 100 times higher than the control group 6.
Danger of Heavy Metal Toxicity
Heavy Metal Toxicity causes a whole host of serious problems – visual impairment, cardiomyopathy, cognitive impairment, hearing impairment, hypothyroidism, peripheral neuropathy, and rashes.Some cases of cobalt poisoning have reported blindness, deafness, heart failure, peripheral neuropathy, rashes, and hypothyroidism 7.
Joint replacements can be avoided with Prolotherapy, an injection therapy that stimulates healing in the body to regenerate cartilage and soft tissue. It is our belief that it is harmful to put unnatural substances in the body. Metal is an unnatural substance and now metal-on-metal joint replacements are causing people much harm. If you have been given a joint replacement recommendation we urge you to get a second opinion and consider Prolotherapy.
Doctors warn each other that they must make the patients aware of hip replacement complications
In another study, doctors warned each other that they must make the patients aware of complications that could include “fracture, neurovascular damage, leg length discrepancy, (surgery) failure, premature loosening, death, medical complications, ongoing pain, stiffness, wound healing problems.”8
Alternatives to Hip Replacement Surgery
Often patients seek a doctor’s opinion after having had a hip arthroscopy. While some have experienced temporary relief of pain and symptoms, others continue to experience the same problems following surgery. It is unfortunate that these individuals were not offered Prolotherapy, Platelet Rich Plasma Therapy, or Stem Cell Therapy first, instead of surgery. The unfavorable long-term results of joint arthroscopy should not be surprising. Removing tissue from joints may provide a temporary pain-relieving benefit, but long-term, the patient is left with a weaker joint, more susceptible to degeneration.
Are you a candidate for Prolotherapy, Platelet Rich Plasma Therapy, or Stem Cell Therapy?
In our research published in the Journal of Prolotherapy we sought to show how Prolotherapy could provide high levels of patient satisfaction while avoiding hip surgery. Here is what was reported:
- We examined sixty-one patients, representing 94 hips, who had been in pain an average of 63 months.
- We treated these patients quarterly with Prolotherapy. Included in this patient group was twenty patients who were told by their doctors that there were no other treatment options for their pain and eight patients who were told by their doctor that surgery was their only option.
Results: In these 94 hips,
- 89% experienced more than 50% of pain relief with Prolotherapy; more than 84% showed improvements in walking and exercise ability, anxiety, depression and overall disability; 54% were able to completely stop taking pain medications.9
Prolotherapy and Hip Pain
1. Centeno CJ, Kisiday J, Freeman M, Schultz JR. Partial Regeneration of the Human Hip Via Autologous Bone Marrow Nucleated Cell Transfer: A Case Study. Pain Physician. 2006;9:253-256. Regenexx study
2. Knoix, R. Prone To Failure, Some All-Metal Hip Implants Need To Be Removed Early. http://www.npr.org/blogs/health/2012/03/19/148769073/prone-to-failure-some-all-metal-hip-implants-need-to-be-removed-early. Accessed 3/7/2012.
3. Bates, C. Hope, J. Toxic metal hip implants ‘could affect thousands more people than PIP breast scandal’. http://www.dailymail.co.uk/health/article-2107640/Toxic-metal-hip-implants-affect-thousands-people-PIP-breast-scandal.html. Accessed 3/7/2012
4. Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open. 2012 Feb 22;2(1):e000435.Print 2012.
5. Van Raay JJ. Metal-on-Metal Total Hip Arthroplasty: Known and Unknown Side Effects. Orthopedics. 2012: 35 (6).
6 Lhotka, C., Szekeres, T., Steffan, I., Zhuber, K. and Zweym BCllerK. (2003), Four-year study of cobalt and chromium blood levels in patients managed with two different metal-on-metal total
7 Smith IC, Carson BL. Volume 6-Cobalt An Appraisal of Environmental Exposure. 1st ed. Ann Arbor: Ann Arbor Science; 1981.
8. Isherwood J, Dean B, Pandit H. Documenting informed consent in elective hip replacement surgery: a simple change in practice. Br J Hosp Med (Lond). 2013 Apr;74(4):224-7.
9. Hauser R, Hauser M. A retrospective study on Hackett-Hemwall dextrose Prolotherapy for chronic hip pain at an outpatient charity clinic in rural Illinois. Journal of Prolotherapy. 2009;2:76-88.