title: Follow-Up of Metal-on-Metal Hip Arthroplasty Patients Is Currently Not Evidence Based or Cost Effective.
abstract: 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.
authors: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom, OX3 7LD.
authors: Gulraj S
authors: GS
authors: Matharu
authors: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom, OX3 7LD.
authors: Stephen J
authors: SJ
authors: Mellon
authors: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom, OX3 7LD.
authors: David W
authors: DW
authors: Murray
authors: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom, OX3 7LD.
authors: Hemant G
authors: HG
authors: Pandit
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D003266:Continuity of Patient Care / Q000191:economics / Q000592:standards*; D003362:Cost-Benefit Analysis; D020878:Device Removal; D006622:Hip Prosthesis; D006801:Humans; D038622:Internationality; D061825:Metal-on-Metal Joint Prostheses / Q000009:adverse effects*; D017410:Practice Guidelines as Topic / Q000592:standards*; D011475:Prosthesis Failure; D012086:Reoperation
keywords: finance; follow-up; guidelines; hip resurfacing; metal-on-metal; total hip arthroplasty