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Over one-million patients worldwide have received metal-on-metal (MoM) hip arthroplasties with a significant proportion requiring revision surgery in the short-term for adverse reaction to metal debris (ARMD). Worldwide authorities have subsequently issued follow-up guidance for MoM hip patients. This article compares follow-up guidelines for MoM hips published by five worldwide authorities, analyses these protocols in relation to published evidence, and assesses the financial implications of these guidelines. A number of major differences exist between authorities regarding patient follow-up, with vast cost differences between protocols (£84 to £988/patient/year for stemmed MoM hips and £0 to £988/patient/year for hip resurfacing). Current worldwide guidance is neither evidence-based nor financially sustainable with most protocols lacking the sensitivity to detect asymptomatic ARMD lesions.

Original publication

DOI

10.1016/j.arth.2015.03.009

Type

Journal article

Journal

The Journal of arthroplasty

Publication Date

08/2015

Volume

30

Pages

1317 - 1323

Addresses

Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom, OX3 7LD.

Keywords

Humans, Prosthesis Failure, Device Removal, Arthroplasty, Replacement, Hip, Reoperation, Hip Prosthesis, Internationality, Cost-Benefit Analysis, Continuity of Patient Care, Practice Guidelines as Topic, Metal-on-Metal Joint Prostheses