ARE METAL ON METAL HIP IMPLANTS TOXIC?

Over the weekend, it was reported in the newspapers that The Medicines Healthcare Regulatory Authority is planning on beefing up the advice that they have previously given in relation to the management of metal on metal hip implants. 

 

The current advice is that there should be close monitoring of patients who have received the implants over a five year period with blood testing and ultrasound scans, if merited, to test for signs of metal toxicity.

 

The current concern is that many patients have not been notified of this advice and that the advice does not go far enough to ensure that signs of metal toxicity are identified as early as possible so that appropriate action can be taken.

 

Whilst I welcome all efforts to raise awareness of these problems, it concerns me that a group of patients are still being overlooked.  Much of the focus is on patients who have had the DePuy ASR hip implant which has been recalled however, there are other metal on metal implants on the market and those patients are rarely discussed. 

 

I have been instructed by several clients who have been given the Birmingham Hip Resurfacing (BHR) implant which is manufactured by Smith and Nephew. 

 

All exhibit virtually identical symptoms to those who have had the DePuy implant  i.e. pain, inflammation and/or elevated metal ions in their blood stream.  Many however have not received correspondence from their treating consultants inviting them for a review as advised by the MHRA. 

 

The current thinking appears to be that these implants are not problematical because they do not exhibit the same failure rates as the DePuy hips.  It is true that the design of the two implants is different and as such the wear points are not the same.  ASR hips fail more frequently, however, both hip types are linked with elevated metals in the blood stream which seems to be an issue with metal on metal hips as a whole.

 

This was the conclusion of The London Implant Retrieval Centre which is an independent body set up by two leading orthopaedic consultants, but funded by several of the leading hip manufacturers, to analyse explanted metal on metal hips and failure rates.

 

They reported in July last year that, “both implants suffer high wear when malpositioned and both have examples of “unexplained” failures of low wearing well positioned cups.”

 

An earlier study in the Journal of Bone Joint Surgery in March 2011 (Matthies et al) also concluded that there were similar levels of elevated metals in the blood of two groups of failed metal hip implants (one of which included the BHR implants).  They concluded that the design did not make a significant difference when it came to the level of metal ions in the blood in patients who have had a metal on metal implant which has failed.

 

So, why are there little or no voiced concerns over the non-DePuy hips at the moment?  Are the MHRA looking to broaden their recall to include other hips too?  Is there a generally unacceptable failure rate for all metal on metal hip implants?

 

No one can say for sure at the moment and studies are ongoing.  What is important, is that these patients must not be allowed to fall through the net.  The absence of a hip being recalled should not mean that clinical signs and symptoms go unnoticed and each patient must receive the consideration and treatment they deserve. 

 

The general mood that only the DePuy hips are problematical, may be proven not to be that case and therefore, until then, my views is that all patients should be treated in the same way.

 

Christian Beadell is an associate clinical negligence solicitor at Goodmans Law. You can e-mail Christian at cab@goodmanslaw.co.uk

 

The team have many years experience of claims of this nature and are always happy to help and advise.

 

For more information please contact us on 0800 073 0385 (0151 257 6000) or by email at FRT@goodmanslaw.co.uk

 

Our First Response Team is available from 8am to 8pm every business day.
 

Goodmans Law are specialists in dealing with clinical negligence and personal injury claims.
 

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