The article in the Daily Telegraph today concerning metal on metal implants contained no new information and will only serve to worry patients. The use of the word Toxic is particularly unhelpful and is frightening for patients with well functioning metal hip implants who are being reviewed. There is little evidence for metal bearing hip implants causing toxicity.
The problems with some metal on metal implants have been widely publicised for years and, in collaboration with the MHRA, the British Hip Society and British Orthopaedic Association produced guidance for patients several years ago which was updated recently (http://www.mhra.gov.uk/Safetyinformation/Generalsafetyinformationandadvice/Product-specificinformationandadvice/Product-specificinformationandadvice–M–T/Metal-on-metalhipimplants/). Where appropriate, patients are already being followed up.
There has been a very significant reduction in the use of MoM devices over the last years and the worst performing implant (the ASR) was recalled 3 years ago. Other poorly performing devices have been withdrawn since.
The article in the Daily Telegraph further misleads since it is not made clear that some devices such as the Birmingham Hip Resurfacing have had good results and a low revision rate in certain population groups and that resurfacing in 55-year old males with a 54mm head has a revision rate of 3% at 7 years (NJR Annual Report 2013). A blanket ban on the use of all metal on metal implants, as inferred in the title of the Daily Telegraph publication, is not correct. In fact the NICE document is out to consultation and is not due to publish the final Document until February 2014.
Patients can be reassured that the advice previously published has not changed.
President British Hip Society
D.Phil (Oxon) FRCS (Ed)
President Elect BHS