Q: Is there a risk of the metallic ion concentration after getting total hip replacement (THR)? If so, what are the alternates to THR?

A:In any THR, there is a possibility of release of metallic ions. The concentration of ions depends on the duration, wear characteristics of design, and the metal that is used in the prosthesis. Metal concentrations may increase 3 - 5 and at times even 8 times the normal. The long-term effect of these are a matter of considerable speculation but there are no clear guidelines. Therefore despite the theoretical risk in renal patients with conventional THR, there are no clear cut guidelines that I can tell you. However, we keep this at the back of our mind while doing regular THRs. If a THR can improve the quality of life in a patient with renal disease, we weigh the risks versus the benefits and take a calculated decision.