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Metal on Metal warning (old but ongoing news)

Discussion in 'Hip Replacement Pre-Op Area' started by Dingbat7, Jan 28, 2012.

  1. bottomshollow

    bottomshollow Moderator

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    We'll have to tag Josephine for this one.
     
  2. Josephine

    Josephine NURSE DIRECTOR, BONESMART Administrator

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    Interestingly there is a considerable disparity in this context. I heard Derek McMinn (BHR expert on both sides of the Atlantic) at the Solving The Uncertainties Dec 2011 conference in London and again later in the year at another conference, declaring that he personally had zero cases of metallosis though the Joint Registry had trawled a number of BHR cases from elsewhere around the UK. It would also appear that Derek is a profound expert on this procedure and I am sure this has a great deal to do with it.

    I've said it again and again, this issue may have corrosion of the devices at its root but the real root cause is the skill of the surgeon. In some recovered MoM hips, it was found a sleeve had been used to make a better fit between the trunion and the ball because the surgeon had used a stem and a ball from different companies. Now I've known since my infant days in orthopaedics that you don't ever - ever - mix metals that are going into the human body. Plates and screws, for instance, have to be from the same manufacturer else there will be corrosion. Here I am talking about the early 60s - 50+ years ago. Yet these surgeon knowingly used not only a stem and a ball from different manufacturers but also included a third item, the sleeve, into the mix. Work it out for yourself. I think the answer is pretty clear. BHR heads are one unit and don't require stems or sleeves or anything else.
     
  3. Bumpa

    Bumpa Sr Bonesmartie

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    pcal, this site may be useful to give you the latest details: Metal-on-metal hip implants : MHRA (admin edit: this article has been archived and therefore unavailable)

    Best wishes
    Bob
     
  4. pcal

    pcal New Member

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    thanks you bumpa for that liink, they too seem to be concentrating on the full hip rather then the resurface so from everything I can find I am going ahead with the bhr if my surgeon still uses the device
     
  5. Josephine

    Josephine NURSE DIRECTOR, BONESMART Administrator

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    pcal did you read my post - was it helpful?
     
  6. pcal

    pcal New Member

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    yes josephine and thank you so much for that information...it seems to reinforce my confidence in a secon bhr, I'll keep everyone up to date as I get closer to the operation, and of course I'll monitor this board to see if there are any developments

    right hip bhr +/-2010, surgeon dr ron light long island jewish
    left hip bhr scheduled for june 27 2013
     
  7. Bumpa

    Bumpa Sr Bonesmartie

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    This is an abstract from an article in the latest Bone and Joint Journal (UK):

    The popularity of cementless total hip replacement (THR) has surpassed cemented THR in England and Wales. This retrospective cohort study records survival time to revision following primary cementless THR with the most common combination (accounting for almost a third of all cementless THRs), and explores risk factors independently associated with failure, using data from the National Joint Registry for England and Wales.

    Patients with osteoarthritis who had a DePuy Corail/Pinnacle THR implanted between the establishment of the registry in 2003 and 31 December 2010 were included within analyses. There were 35,386 procedures.

    Cox proportional hazard models were used to analyse the extent to which the risk of revision was related to patient, surgeon and implant covariates. The overall rate of revision at five years was 2.4%. In the final adjusted model, we found that the risk of revision was significantly higher in patients receiving metal-on-metal and ceramic-on-ceramic bearings compared with the best performing bearing (metal-on-polyethylene).

    The risk of revision was also greater for smaller femoral stems compared with mid-range sizes.

    In a secondary analysis of only patients where body mass index (BMI) data were available BMI above 30 kg/m2 significantly increased the risk of revision.

    The influence of the bearing on the risk of revision remained significant (MoM: HR 2.19; CoC: HR 2.09). The risk of revision was independent of age, gender, head size and offset, shell, liner and stem type, and surgeon characteristics.

    We found significant differences in failure between bearing surfaces and femoral stem size after adjustment for a range of covariates in a large cohort of single-brand cementless THRs. In this study of procedures performed since 2003, hard bearings had significantly higher rates of revision, but we found no evidence that head size had an effect.

    Patient characteristics, such as BMI and American Society of Anesthesiologists grade, also influence the survival of cementless components.

    Cite this article: Bone Joint J 2013;95-B:747–57.
     
  8. Josephine

    Josephine NURSE DIRECTOR, BONESMART Administrator

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    pcal I've added you surgery details into your signature so you don't have to keep adding them to the end of your posts any more!
     
  9. pcal

    pcal New Member

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    thanks for that josephine!
     
  10. Bumpa

    Bumpa Sr Bonesmartie

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    Thanks Josephine for highlighting the important bits!

    Bob:angel:
     
  11. Josephine

    Josephine NURSE DIRECTOR, BONESMART Administrator

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    Oh - you noticed! :blush:
     
  12. Bumpa

    Bumpa Sr Bonesmartie

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  13. Butterfly

    Butterfly Post-Grad

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    What is ASR? I get lost in all the acronyms.
     
  14. Bumpa

    Bumpa Sr Bonesmartie

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    Butterfly, no worry, ASR is a proprietary (trademark) name and is not an acronym of DePuy (J&J) and should always be followed by a superscript (denoting copywrite and registered name).
     
  15. Bumpa

    Bumpa Sr Bonesmartie

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    The Bone and Joint Journal reports another metal-on-metal hip replacement failure (Metasul).
    High rate of revision and a high incidence of radiolucent lines around Metasul metal-on-metal total hip replacements

    Results from a randomised controlled trial of three bearings after seven years

    A total of 397 hips were randomised to receive Metasul metal-on-metal (MoM), metal-on-conventional polyethylene (MoP) or ceramic-on-polyethylene (CoP) bearings using a cemented triple-tapered polished femoral component (MS-30). There were 129 MoM hips in 123 patients (39 male and 84 female, mean age 63.3 years (40.7 to 72.9)), 137 MoP hips in 127 patients (39 male and 88 female, mean age 62.8 years (24.5 to 72.7)) and 131 CoP hips in 124 patients (51 male and 73 female, mean age 63.9 years (30.6 to 73.8)). All acetabular components were cemented Weber polyethylene components with the appropriate inlay for the MoM articulation. Clinical evaluation was undertaken using the Harris hip score (HHS) and radiological assessments were made at two, five and seven years. The HHS and radiological analysis were available for 341 hips after seven years. The MoM group had the lowest mean HHS (p = 0.124), a higher rate of revision (p < 0.001) and a higher incidence of radiolucent lines in unrevised hips (p < 0.001). In all, 12 revisions had been performed in 12 patients: eight in the MoM group (four for infection, four for aseptic loosening, three in the MoP group (one each of infection, dislocation and pain) and one in the CoP group (infection).
    Our findings reveal no advantage to the MoM bearing and identified a higher revision rate and a greater incidence of radiolucent lines than with the other articulations. We recommend that patients with a 28 mm Metasul MoM bearing be followed carefully.
    Cite this article: Bone Joint J 2013;95-B:881–6.
     
  16. Bumpa

    Bumpa Sr Bonesmartie

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    More caution with regard to metal-on-metal devices:
    Researchers find ‘mixed health effects’ of MoM hip resurfacing

    Prentice J. PLoS One. 2013. doi:10.1371/journal.pone.0066186.


    • July 5, 2013
    In a cross-sectional study, researchers from the United Kingdom found higher total body bone mineral density but “potentially deleterious effects” in the left ventricular function of patients with a metal-on-metal hip resurfacing compared to patients with conventional hip replacements at mean of 8 years after surgery.
    See: http://www.healio.com/orthopedics/h...d-mixed-health-effects-of-MoM-hip-resurfacing
     
  17. pcal

    pcal New Member

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    I just went to the link and left the following comment, they moderate comments and it won't appear for a while;

    this study is not helpful unless the brand of resurfaces are documented, what is well documented is the fact that some resurface devices out perform others, what is also important is to analyse the device to make sure you are not measuring surgeon error before a general claim is made as to efficacy
     
    • Agree Agree x 1
  18. Bumpa

    Bumpa Sr Bonesmartie

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    pcal, you are quite right, there are many variables although the paper is useful. The only information I can see with regard to brands is the following:

    "In the MoMHR group 32 patients had received the Birmingham hip resurfacing prosthesis (Smith & Nephew Inc., Andover, MA; FDA approved 2006) and 3 the ASR prosthesis (DePuy Inc., Warsaw, IN; not FDA approved). In the THA group 17 patients received a metal-on-polyethylene bearing, 17 received a ceramic-on-ceramic bearing, and in one a ceramic-on-polyethylene bearing."
     
  19. Poppet

    Poppet Nutritional Advisor

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    I so enjoy reading this thread and your information Bumpa - thank you :)
     
  20. Pumpkln

    Pumpkln Forum Advisor

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