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Joint registry report finds metal-on-metal hip replacements more prone to revision

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Elaine Young

Metal-on-metal hip replacement device failure is still a cause for concern, particularly in women, according to the recently released 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 revision subset carried revision rates of 11.81%, with those in the MoM subset displaying rates as high as 13.61%.

The registry found that non-MoM hip prosthesis types displayed revision rates ranging from 3.31% to 4.94%. According to the 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 carried out 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

“These results, along with all the other analysis in the annual report, again illustrate how the National Joint Registry is fundamental in informing clinical practice,” Healthcare Quality Improvement Partnership National Development Lead, Elaine Young, stated in a release.

“Our work regarding metal-on-metal is ongoing, with an in-depth study commissioned via one of our research fellows and our involvement with the joint working group metal-on-metal, alongside the government’s Medicines and Healthcare products Regulatory Agency and the British Orthopaedic Association.”

Furthermore, the year-on-year revision rate increase for prostheses in the MoM categories was labeled in the press release about the report as “dramatic,” with non-MoM prostheses types displaying a less than a 1% increase in revision rates. Resurfacing devices displayed an increase of 1.93% and MoM device revision rates increased 4.11%.

Gender differences

Gender-based statistics were also analyzed in the NJR, and 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 rate of 7.34% for general metal-on-metal devices. The same statistics for men were reported as 7.06% and 5.48%, respectively.

Five-year revision rates for non-MoM devices for women in the same age range varied from 2.02% to 3.19%.

The use of MoM devices, according to the report, has declined. Statistics from 2006 and 2007 showed the devices used in 15% of procedures in the NJR. This fell to 10% in 2009 and 5% in the most recent report, covering statistics from 2010.

Reference:

• www.njrcentre.org.uk

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