Some Surgeons Reconsider Use of Metal-on-Metal Hip Implants

It looks like some orthopedic surgeons are souring on metal-on-metal hip implants. In a recent survey of some surgeons, a significant number said they planned to reduce their use of the devices.

In the U.S., metal-on-metal hip implants are used in one third – roughly 250,000 – of all hip replacements every year. They are also used in hip resurfacing procedures. The implants, whose ball-and-socket joints are made from metals like cobalt and chromium, were thought to be more durable than earlier devices.

Recently, metal-on-metal hip implants have received some bad press. Hip implants should last about 15 years. But a New York Times investigation published earlier this year found that in many cases, metal-on-metal hip implants require replacement surgery within a year or two.

According to the report, studies indicate that hip implants can quickly begin to wear, generating high volumes of metallic debris that is absorbed into a patient’s body. This can cause soft-tissue destruction and destruction of bone. The Times said that roughly 1 to 3 percent of implant recipients could be affected by the problem, which translates to thousands of patients.

In March, concerns over one such device, the ASR artificial hip implant, prompted DePuy Orthopedics to warn that the implant appears to have a high early failure rate in some patients. According to a letter to doctors, patients of small stature, a group that typically includes women and patients with weak bones, faced the highest risk. According to records from the U.S. Food & Drug Administration (FDA), since the beginning of 2008, the agency has received about 300 complaints on the ASR involving patients in the U.S.

Such devices have also raised concerns outside of the U.S. In April, European regulators announced they would be conducting a review of 40,000 metal-on-metal hip replacements over fears that the devices could cause non-cancerous tumors and tissue damage. At the time, officials with the United Kingdom’s Medicines and Healthcare Products Regulatory Agency (MHRA) said anyone considered at risk would be given tests to establish whether there are high levels of metal compounds in the blood.

Now, a survey of 150 U.S. orthopedic surgeons conducted by the Millennium Research Group found that the negative buzz surrounding these devices might be affecting physician decisions about what implants to use. The survey found that a “significant” minority – 25 percent – of surgeons plan to reduce their use of metal hip implants over the next year.

According to a press release detailing the survey, most of those surgeons will likely turn to alternatives such as ceramic-on-polyethylene hip implants.

The survey appears in Physician Forum, a publication of the Millennium Research Group.