title: Lessons learnt from metal-on-metal hip arthroplasties will lead to safer innovation for all medical devices.
abstract: Metal-on-metal bearings were re-popularised in the late 1990s with the introduction of modern hip resurfacing. Large diameter (LD) metal-on-metal (MoM) hips became more prevalent and have been the least successful group of hip implants ever used. They were rapidly adopted from 2004 until the British Hip Society stopped their use in 2012. Well functioning MoM hip results (including the BHR and Metasul) are hidden in the mire of poor results from the group of all MoM bearings.We have reviewed what happened and we make 3 observations. Firstly, collaboration between surgeons and then between surgeons and other disciplines, first identified and then solved the clinical management problems. Secondly, the problems with MoM hips occurred because hip simulation was inadequate at predicting performance in patients. They gave no indications of the biological effects of wear in the human environment. Lastly, retrieval of failed implants was essential to understanding why failure occurred.These lessons must never be forgotten and must form the basis by which new or altered implants are introduced and how they should be monitored. This will enable safer innovation for patients, surgeons and manufacturers. The problems with MoM hips will not have been in vain.
authors.affiliation: Royal National Orthopaedic Hospital, Stanmore - UK.
authors.forename: Alister J
authors.initials: AJ
authors.lastname: Hart
authors.forename: Shiraz A
authors.initials: SA
authors.lastname: Sabah
authors.forename: Johann
authors.initials: J
authors.lastname: Henckel
authors.forename: Gwynneth
authors.initials: G
authors.lastname: Lloyd
authors.forename: John A
authors.initials: JA
authors.lastname: Skinner
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D006621:Hip Joint / Q000601:surgery*; D006622:Hip Prosthesis / Q000639:trends*; D006801:Humans; D061825:Metal-on-Metal Joint Prostheses / Q000639:trends*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation