[REVISION THR] Hip replacement revision DePuy hip

Oh dear! That's a bad thing to happen but at least you've got it sorted.

Welcome to BoneSmart.

Rossetta, Welcome to BoneSmart. So glad you got your hip sorted and can get on with life.

Please don't worry about the swelling. It's all part of the healing process. Do use ice and elevate when you can. Here's a thread about this from the Library Elevating your leg to control swelling and pain. Do spend some time in the Library. Lots of good information for you.

Happy Healing!

This is the latest from NHS Evidence site on metal-on-metal.

Failure rates of stemmed metal-on-metal hip replacements
Overview: Almost 70,000 primary total hip replacements were performed in England and Wales during 2010 (National Joint Registry for England and Wales, 2011).
About 7% of hip replacements are revised within 7 years due to prosthesis failure.
However, this figure is likely to underestimate failure rates, because many hips with poor function and pain are not revised (Wylde and Blom, 2011).

Stemmed metal-on-metal hip implants became popular because assessment in simulated tests showed them to be highly resistant to wear, with a reduced likelihood of dislocation. More than 40,000 people in the UK have a stemmed metal hip implant, although in recent years the use of metal-on-metal prostheses in England and Wales has declined.

Current advice: NICE guidance issued in 2002 recommends metal-on-metal hip resurfacing arthroplasty as one option for people with advanced hip disease who would otherwise receive and are likely to outlive a conventional primary total hip replacement. However, it states that less is known about the medium- to long-term safety and reliability of these devices or the likely outcome of revision surgery than for conventional total hip replacements.

NICE plans to review its guidance with the potential remit 'to appraise the clinical and cost effectiveness of total hip replacement and surface replacement within its licensed indication for the treatment of pain resulting from end stage arthritis of the hip'. The updated remit will be subject to a formal referral from Ministers.

This year the Medicines and Healthcare products Regulatory Agency advised that people who have received stemmed metal-on-metal hip replacements should be monitored annually for the life of the hip replacement. This replaces advice from 2010, that people with this type of hip implant need only be monitored for a minimum of 5 years after their operation.

New evidence: The National Joint Registry of England and Wales was established in 2003 and is the largest arthroplasty database in the world. An analysis of data held by the registry included more than 400,000 hip replacements (of which 31,171 were metal-on-metal) undertaken between 2003 and 2011 and tracked for up to 7 years after surgery (Smith et al. 2012). The researchers estimated failure rates for stemmed metal-on-metal implants based on different head sizes and compared them with implants made from ceramic and polythene.

The results show that stemmed metal-on-metal implants failed much more quickly than implants with other types of bearing surface, with a 5-year revision rate of 6.2%. Failure is related to head size, with larger heads failing earlier, corresponding to a 2% increase in the risk of failure for each 1mm increase in head size. By contrast, ceramic-on-ceramic implants do better with larger head sizes.

In women, failure rates for stemmed metal-on-metal implants are up to 4 times higher than those of other bearing surfaces, and are also higher compared with men even with the same head size.

Based on this evidence the authors recommend that metal-on-metal bearing surfaces are not used in stemmed total hip replacements. They add that all patients with these bearings should be carefully monitored, particularly young women implanted with large diameter heads.

Commentary: "The National Joint Registry was set up to detect early failure of joint replacements, and this study of large diameter head stemmed metal-on-metal hip replacements is a clear demonstration of its usefulness. The MHRA has advised that patients with these devices should be monitored indefinitely, but currently does not go so far as to say that they should not be used.

"The failure of stemmed metal-on-metal hip replacements shows that the complex interactions between host, implants and the products of wear are poorly understood by orthopaedic surgeons, device manufacturers and the regulatory authorities. However, it must be remembered that hip replacement remains one of the best operations in the history of surgery, and the search for better materials and implants will continue regardless. All of those involved in the development, regulation and implantation of new devices should take note of and learn from what has happened with stemmed metal-on-metal hip replacements so that similar mistakes are avoided in the future." - Jeremy Latham, Consultant Orthopaedic Surgeon at Southampton University Hospitals NHS Trust.