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Joint registry report finds metal-on-metal hip replacement more prone to revision
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Joint registry report finds metal-on-metal hip replacement more prone to revision
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Metal-on-metal hip replacement device failure is still a cause for concern, particularly in women, according to the 2011 National Joint Registry of England and Wales Annual Report.
According to the report, revision rates among hip devices are “by far the highest” in the two main categories of metal-on-metal (MoM) devices — resurfacing devices — and those known simply as “metal-on-metal.” Devices in the resurfacing subset carried revision rates of 11.81%, while those in the MoM subset had rates as high as 13.61%.
The registry found non-MoM prosthesis revision rates of 3.31% to 4.94%. According to a press release, these figures reflect performance on the registry data at 1-year, 3-year and 5-year intervals up to December 2010.
The National Joint Registry (NJR) of England and Wales is the largest database of its kind, encompassing 1.1 million records of hip, knee and ankle joint procedures performed since 2003 in those countries. The latest report included the largest number of single year submissions (179,450) and the highest patient consent rate (88.6%).
Resurfacing, MoM devices
Regarding revision rates being higher in MoM devices, Paul Gregg, MD, FRCS, NJR Steering Committee vice chairman, said, “it is not possible to be precise, but a combination of factors are likely to affect the higher revision rates including, but not necessarily limited to, the materials used in [MoM] devices, the designs used by the different brands in their individual products, the size of the cup used in the device, the patient’s individual characteristics, and the surgical technique used.”
“The NJR has commissioned an in-depth study ahead of the next Annual Report to explore MoM in greater depth,” he added. “This … will also include study into MoM resurfacing statistics, results involving the smaller 28-mm MoM devices, as well as subanalysis of different types of implants and fixation.”
In the press release, the year-on-year revision rate increase for prostheses in the MoM categories was labeled “dramatic,” with non-MoM prostheses displaying a less than 1% increase in revision rates. Resurfacing devices showed an increase of 1.93% and MoM device revision rates increased 4.11%.
Gender differences
Gender-based NJR statistics demonstrated that women were at higher risk for MoM device failure. According to the release, the revision rate at 5 years for women aged 60 years to 69 years with a resurfacing device is 12.01%, with a 7.34% revision rate for general MoM devices vs. 7.06% and 5.48%, respectively, for men.
Five-year revision rates for non-MoM devices for women in the same age range varied from 2.02% to 3.19%.
From 2006 to 2007 statistics showed the MoM devices were used in 15% of procedures in the NJR that fell to 10% in 2009 and 5% in the latest 2010 data.
“I would expect this trend to continue until the current uncertainty surrounding [MoM] is resolved or made clearer,” Gregg said. – by Robert Press
Reference:
- Paul J. Gregg, MD, FRCS, can be reached at The James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, United Kingdom; +44-1642-854403; email: prof.gregg@btinternet.com.
- Disclosure: Gregg has no relevant financial disclosures.