Do Heavy Metals from Metal-on-Metal Hip Implants Cause COPD and Other Respiratory Problems?

Thursday, April 25, 2013

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Some of the clients we are representing in hip implant cases against manufacturers DePuy (owned by Johnson & Johnson) and Howmedica Osteonics Corporations (n/k/a Stryker Corporation), d/b/a Stryker Orthopaedics, have signs and symptoms of respiratory illnesses similar to chronic obstructive pulmonary disease (COPD) and other illnesses.

Signs of this include general fatigue, persistent coughing, shortness of breath (dyspnea), wheezing and a history of colds or acute bronchitis. For other symptoms of COPD, click here to read an article on MD Guidelines.

One of our patients has fibroids growing in the lungs and has lost forty percent (40%) of lung capacity.

Medical Literature Provides a Link Between Heavy Metals and Respiratory Illnesses.

Although we haven’t seen any medical literature linking respiratory illnesses directly to hip implants, we are aware of medical literature linking them to exposure to heavy metals that are in some hip implants, predominantly cobalt.

Patients with metal-on-metal hip implants, specifically the ones recalled by manufacturers DePuy and Stryker, have demonstrated elevated levels of cobalt and chromium in laboratory test results.

There is an abundance of medical literature linking cobalt to respiratory illnesses. See, for example: Heavy Metals and COPD from MD Junction, Chronic Obstructive Pulmonary Disease (COPD) Fact Sheet from the American Lung Association, Chronic Obstructive Pulmonary Disease from MD Guidelines, and Urinary Heavy Metals and Chronic Obstructive Pulmonary Disease (COPD) from the American Public Health Association.

What to do if You Have Metal-on-Metal Hip Implants and Respiratory Problems.

1.  Obtain an immediate blood test for heavy metals. This can be ordered by your internal medicine physician, your gerontologist, your family practice physician, your pulmonologist or your orthopedic surgeon.

2.  Consult with a pulmonologist immediately. A pulmonologist is a medical doctor who specializes in the treatment of lung diseases.

3.  Tell your pulmonologist if you have been exposed to heavy metals such as chromium or cobalt, especially if you suspect your hip implants.

4.  Request your pulmonologist order x-rays and other diagnostic tests to attempt to determine the cause of your respiratory problems.

5.  Consult an attorney if you have metal-on-metal hip implants. Most attorneys do not charge for such consultations.

6.  Do not talk with or deal with Broadspire Services, Inc., or its representatives. Broadspire is representing the manufacturers of hip implants. They do not have your best interests at heart.

Summary of Recent Studies.

Results of a recent study may help guide the future treatment of patients with chronic obstructive pulmonary disease (COPD). Two analyses of a cross-section of more than 8,000 Americans have shed light on the pathogenesis of the disease. The researchers found that high levels of cadmium and cobalt in the urine and blood serum may significantly increase the risk for developing COPD. The findings were presented at the 2011, annual meeting of the Society of Critical Care Medicine.

“Interventions may ultimately target heavy metal concentrations, but at present all we can do to minimize the effects of these metals is reduce industrial exposure and emphasize the role these metals play in first-and secondhand smoke–related COPD,” said Brian Carlin, MD, assistant professor of critical care and pulmonology at Drexel University College of Medicine, in Philadelphia. Dr. Carlin was not involved in the study. “The findings are based on one of the largest databases around and add another piece of the puzzle being put together on the effects of heavy metals on lung function.”

Cadmium and cobalt are constituents of tobacco smoke. Shikhar Agarwal, MD, a resident in the Department of Internal Medicine at the Cleveland Clinic, in Ohio, and a colleague, conducted the two analyses. They examined heavy metal concentrations in the urine of 612 patients with COPD and 7,570 subjects without COPD. The subjects were registered in the National Health and Nutrition Examination Survey database, representing a cross-section of the U.S. population.

In their initial analysis, the researchers looked for statistical associations between COPD and urine concentrations of more than a dozen heavy metals. They controlled for the presence of known COPD risk factors, including age, gender, race, hypertension, hyperlipidemia, diabetes, body mass index, C-reactive protein, cardiovascular disease and chronic kidney disease.

The researchers found that for every 10-fold increase in the concentration of cadmium in the urine, the risk for COPD nearly tripled. The presence of a high level of cobalt also increased the odds of developing COPD, but to a lesser extent. A high cadmium level was associated with an increased risk for both emphysema and chronic bronchitis, whereas cobalt was associated only with a higher incidence of chronic bronchitis.

In a second analysis, Dr. Agarwal and his colleague examined lead and cadmium levels in serum for a possible correlation with development of COPD in 5,709 active smokers (of whom 597 had been diagnosed with COPD), 6,833 former smokers (of whom 725 had COPD) and 13,657 never-smokers (of whom 638 had COPD). Similar to the first analysis, known COPD risk factors were controlled, as well as the presence of high cadmium and lead levels.

As expected, current smokers were 2.4 times more likely to have COPD than never-smokers. However, after controlling for high cadmium levels, they found that the odds of developing COPD dropped to 1.72 times among smokers compared with never-smokers, which suggested that the relationship between smoking and COPD was mediated by cadmium.

It also was determined that serum concentrations of cadmium above 0.5 mcg/L increased the risk for emphysema and cadmium levels higher than 0.74 mcg/L were associated with a higher risk for chronic bronchitis. Statistical adjustment for the presence of lead did not affect the risk for COPD.

In an interview with Anesthesiology News, Dr. Agarwal emphasized the study was not a controlled, interventional trial and the findings only generate hypotheses. “The results provide a platform other investigators can use to conduct further research in order to better understand the effects of heavy metal exposure,” he said. “Future research may ultimately lead to the development of direct interventions, like antioxidant therapy, that may help reduce or mitigate the effects of heavy metals.”

Click here to read the entire study.

Contact an Attorney Experienced in Products Liability Litigation.
Although The Health Law Firm represents predominantly physicians and other health care providers, we are involved in products liability litigation. At the request of our clients, we have agreed to take on and prosecute a number of hip implant cases against their manufacturers for the patients. We currently are representing several plaintiff patients with DePuy hip implants and several plaintiff patients with Stryker hip implants.

We are able to combine our knowledge of the health care industry with our litigation experience for the benefit of patients. If you received a DePuy, Stryker or any metal hip replacement and have experienced pain, swelling, high levels of metal in your blood, a corrective revision surgery, or other complications, we may be able to help you. To learn more about your legal rights, contact The Health Law Firm for a consultation today.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at


Hope, Thomas. “Heavy Metals and COPD.” MD Junction. (August 8, 2013). From:

MD Guidelines. “Chronic Obstructive Pulmonary Disease.” MD Guidelines. From:

"Chronic Obstructive Pulmonary Disease (COPD) Fact Sheet." American Lung Association. (July 29, 2009). From:

“Urinary heavy metals and chronic obstructive pulmonary disease (COPD): Results from National Health and Nutrition Examination survey (NHANES) 1999-2008." American Public Health Association. (November 1, 2011). From:

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.

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