Metal Resurfacing of Hips
There remains concerns in the press and scientific literature about metal on metal total hip joint replacement bearing surfaces. Hip replacements/ hip resurfacing with metal-on-metal hip bearings became very popular in the late 1990’s and early 2000’s with implant companies, the popular press, patients and some surgeons being a driving force. In the late 2000’s, however, it became apparent there was a much higher failure rate (5-6x that of standard hip replacements in some patient groups) with these bearing surfaces. There were also incidences of significant soft tissue damage being caused by metal wear debris, so called pseudo-tumours. NHSScotland is aware of these concerns and takes patient safety seriously. There are currently no total hip joint replacements using metal on metal bearings being performed in NHSScotland. Hip resurfacing procedures are not routinely offered in the majority of health boards in Scotland and there are only a small number of specialist centres performing the procedure under close follow up. However, there may be a limited place for metal resurfacings procedures. The belief that it is easier to revise a hip resurfacing than a hip replacement is misplaced.
This note sets out NHSScotland position with regard to hip resurfacing with metal bearings.
Choice
Patients should have the option to consider a range of choices to improve their quality of life when they have significant pain or lack of mobility due to damage to a hip joint.
Cohort
The group of patients to whom a metal hip resurfacing procedure is a potential option tend to be male, young, with good bone quality and with large diameter hips
Consent
There must be additional informed and recorded consent agreed with the patient that currently a resurfacing procedure does involve the use of a metal bearing and that there may be a risk of early failure and soft tissue damage due to metallosis. The patient must agree, and the surgeon must ensure that more intensive follow-up is in place than is routine following standard total hip replacement surgery so any development of metallosis will be found early and managed properly in line with current guidelines for metal hip bearings from the MHRA. This follow up may involve yearly review and x-rays together with blood tests to monitor metal levels that can become elevated.
Surgeon
The surgeon must have significant experience in hip resurfacing procedures, record specific consent for the procedure and ensure follow up according to MHRA guidance
Device
The device chosen must be one with a minimum 10A Orthopaedic Data Evaluation Panel (ODEP) rating Bor be part of a registered research trial.
Patients and surgeons should ensure that the advice from the British Orthopaedic Association and British Hip Society is followed.
Mr Edward Dunstan
Consultant Orthopaedic Surgeon
Chair – Scottish Committee for Orthopaedics & Trauma