After watching the documentary film “The Bleeding Edge” on Netflix I thought I should weigh in as a patient who has had both of my hips resurfaced, meaning my hip joints are metal on metal ball and sockets.
The film is a very well done documentary that examines the $400bn medical device industry that reviews five products that have exhibited significant failures including the broad review of cobalt based hip implants. This is an important documentary that does expose the weakness of our regulation of the medical implant industry and sounds a needed alarm to those patients who may now be at risk.
I am focusing on hip resurfacing which was lumped into the broad exposure of any metal joints made from Cobalt. The greatest concern comes from these devices that actually operate with a metal on metal joint, and hips are probably the most common. My hips are made of a Cobalt-chrome alloy that is used because it creates one of the hardest and strongest metals known to man. These features are critical for a successful and enduring joint replacement. The premise for using a metal on metal hip as in my case is that the body naturally encapsulates and provides lubrication for the joint movement. The Co-Cr alloys show high resistance to corrosion due to the spontaneous formation of a protective passive film composed of mostly Cr2O3. The minor amounts of cobalt and other metal oxides on the surface appear to be contained by the body’s encapsulation. The documentary does not spell this out in sufficient detail, instead it broadly classifies any device made from cobalt as dangerous.
My History: My family has shown a propensity toward the development of an arthritis that creates some bone deposits in our hips. For me this has been accelerated by a life of sports activity, most notably basketball, that allowed this arthritic condition to wear away the natural lining of my hip joint. Once I understood this back in 2006 when I was 52 years old and in constant pain I had to figure out a solution. I had heard that hip replacements were good for 15-20 years which did not seem to match well with my age. I remember hearing about hip resurfacing in a 60 Minutes type segment on Americans traveling to India for this surgery. So I started investigating this alternative procedure. The allure for me was the fact that you could remain active and if needed down the road I could still get a hip replacement. Fortunate for me there was an orthopedic surgeon in Salem, Oregon, who was allowed to perform this surgery probably due to the FDA’s 510(k) pathway for approving medical devices as mentioned in the documentary. My first hip was his 439th hip resurfacing. I do believe that my second hip done in 2010 was from the same design and stock of the Cobalt-chrome implant.
I guess the point of my post is to let it be known that hip resurfacing can be very positive. So why have I not experienced any cobalt poisoning related medical issues? Obviously the surgery can be positive, however, it is true that many have experienced serious problems. Depuy, owned by Johnson & Johnson, was referenced in the documentary, however, there has been recall activity on cobalt based joints from Stryker and Smith Nephew. My theory for my success is based on the fact that the hips that were used for me were created in the early pre FDA approval period. I have asked who made my hips and I never got an real answer. They appear to be similar to the Smith Nephew BHR and the Wright Conserve systems. Maybe those early test hip parts were done with more attention given to the metallurgy involved. Possibly my success has to due with my lifestyle. I have learned that I cannot participate in physical activity that is based on radical lateral movement such as basketball or handball. What I can do is walk or backpack which I have done to the tune of about 2000 miles since my second hip surgery. So overall I am extremely thankful for this medical hip resurfacing technology.
I do hope that the FDA is able to improve the overall approval process for medical device technologies and it is good that documentaries are made to help bring attention to these needs. But we must also caution against blanket assumptions made to help sensationalize a documentary, such as all devices made with cobalt are bad for you.
The first ski day is always hard on the body. Generally you try to make it into the afternoon before the screaming pain in your thighs finally does you in. This is only amplified as you get older so I thought I would reflect on how my 62-year-old body with 2 artificial hips handled this awesome first day of skiing here at Mt. Baker Ski Area which is really on Mt. Shuksan. The most critical requirement for skiing at my age is believing that I can. Then I think it is critical to insure that you choose a day with optimal conditions. So when the snow began piling up on the North Cascades I started watching for that perfect ski day. Bang, Tuesday had no important meetings, it was supposed to be sunny and only 20 degrees on the mountain. The fact that there was not any wind was a pure bonus. So you commit and then float some suggestions to your friends that you plan on doing this. However, you have to balance skiing with someone who might hold you back with the advantage of someone who knows the mountain. I was totally prepared to ski it alone, but if you do that it is likely that your actual skiing experience will suffer. Luckily I scored a ski companion (one of my employees) who was also a local ski instructor which translated into the ultimate ski experience.
It is about an hour and half drive from Bellingham to the Mt. Baker Ski area and we arrived near opening which gained us an excellent parking spot and confirmation that skiing on a Tuesday was not going to be crowded. I have skied most of my life but I have never been a die-hard skier. Yes, I lived in Steamboat Springs for many years, but even then I only skied when conditions were perfect, maybe 5-6 times a year. That is partly because I devoted equal time to cross-country skiing. Skiing for me is not about a commitment to the craft but instead about the glorious experience of gliding on snow while observing some of the most beautiful scenery in the world. Dealing with cold and fatigue is just part of the price for the chance to experience yet another epic day in God’s glorious kingdom.
How about that view, wow, you come off the lift and take this in before every run. This was so cool because I had a tour guide who could tell the names of all those mountains and help me understand where I have been hiking through my many outings up here at the Mt Baker Wilderness earlier this Fall.
I want to call attention to the photo on the right showing Mt Herman and the saddle over to Table Mountain, location of my first hikes in this area. Now, back to the skiing. Conditions were perfect and I did feel comfortable cruising along on blue runs. I did try to hit some bumps and powder, but age does create limitations. I have mentioned that I have 2 artificial hips which are wonderful, however, the muscles around those hips have never been as strong probably due to being filleted open for the surgery. Combine weaker muscles with the reality that you do not want to crash and dislocate one of those hips and I wisely avoided straying to far from the safe cruising runs. Overall, I was very pleased with my body on this first day out. My transition to hiking and backpacking and raising a dog with incredible amount of energy has prepared me well for this ski day. I really felt great and was able to push myself almost to closing. The beer in the lodge at the end of the day was perfect as well.