title: A multinational assessment of metal-on-metal bearings in hip replacement.
abstract: There is emerging evidence that many metal-on-metal (MoM) bearings, when used with large femoral heads in conventional hip replacement and some resurfacing prostheses, are associated with increased rates of revision arthroplasty. Registries are the main sources of data on MoM prostheses. At the recent International Consortium of Orthopaedic Registries (ICOR) meeting, data were presented from the Australian, England and Wales, and New Zealand registries. All registries reported an increased rate of revision for large femoral head MoM prostheses when prostheses were aggregated compared with the aggregated data of hip prostheses with other bearing surfaces. There was also evidence, however, that the outcome varied, depending on the type of prostheses used, in both large femoral head MoM conventional hip replacement as well as resurfacing hip replacement.The relevance of the recent isolated case reports on systemic metal toxicity was also discussed at the ICOR meeting. Although systemic metal toxicity appears to be a rare occurrence, there is a need to undertake appropriately designed studies to define the true prevalence of this phenomenon. There may be advantages in nesting these studies within registries. The ICOR meeting highlighted the implications of the MoM experience for the orthopaedic industry, regulators, and surgeons.
authors.affiliation: Australian Orthopaedic Association National Joint Replacement Registry, Discipline of Public Health University of Adelaide, MDP DX650 511, Adelaide SA 5005, Australia. segraves@aoanjrr.org.au
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Graves
authors.forename: Alastair
authors.initials: A
authors.lastname: Rothwell
authors.forename: Keith
authors.initials: K
authors.lastname: Tucker
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Jacobs
authors.forename: Art
authors.initials: A
authors.lastname: Sedrakyan
mesh_terms: D000368:Aged; D001315:Australia / Q000453:epidemiology; D019544:Equipment Failure Analysis; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D006967:Hypersensitivity / Q000453:epidemiology* / Q000209:etiology; D007391:International Cooperation; D008297:Male; D008670:Metals / Q000009:adverse effects*; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D015207:Osteoarthritis, Hip / Q000601:surgery; D011041:Poisoning / Q000453:epidemiology* / Q000209:etiology; D011358:Product Surveillance, Postmarketing / Q000706:statistics & numerical data; D012042:Registries / Q000706:statistics & numerical data; D012086:Reoperation / Q000706:statistics & numerical data; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D008670:Metals