title: International metal-on-metal multidisciplinary teams: do we manage patients with metal-on-metal hip arthroplasty in the same way? An analysis from the International Specialist Centre Collaboration on MOM Hips (ISCCoMH).
abstract: OBJECTIVE
  There are many guidelines that help direct the management of patients with metal-on-metal (MOM) hip arthroplasties. We have undertaken a study to compare the management of patients with MOM hip arthroplasties in different countries.
  
  
  METHODS
  Six international tertiary referral orthopaedic centres were invited to participate by organising a multi-disciplinary team (MDT) meeting, consisting of two or more revision hip arthroplasty surgeons and a musculoskeletal radiologist. A full clinical dataset including history, blood tests and imaging for ten patients was sent to each unit, for discussion and treatment planning. Differences in the interpretation of findings, management decisions and rationale for decisions were compared using quantitative and qualitative methods.
  
  
  RESULTS
  Overall agreement between the orthopaedic centres and the recommended treatment plans for the ten patients with MOM hip implants was moderate (kappa = 0.6). Full agreement was seen in a third of cases, however split decisions were also seen in a third of cases. Units differed in their interpretation of the significance of the investigation findings and put varying emphasis on serial changes, in the presence of symptoms.
  
  
  CONCLUSIONS
  In conclusion, the management of raised or rising blood metal ions, cystic pseudotumours and peri-acetabular osteolysis led to inconsistency in the agreement between centres. Coordinated international guidance and MDT panel discussions are recommended to improve consensus in decision making.
  
  
  CONCLUSIONS
  A lack of evidence and the subsequent variation in regulator guidance leads to differences in opinions, the clinical impact of which can be reduced through a multi-disciplinary team approach to managing patients with MOM hip implants. Cite this article: Bone Joint J 2016;98-B:179-86.
authors: Royal National Orthopaedic Hospital, Brockley Hill, Stanmore Middlesex, HA7 4LP, UK.
authors: R
authors: R
authors: Berber
authors: Royal National Orthopaedic Hospital, Brockley Hill, Stanmore Middlesex, HA7 4LP, UK.
authors: J
authors: J
authors: Skinner
authors: Wrightington Hospital, Hall Lane, Appley Bridge, Wrightington, Lancashire, WN6 9EP, UK.
authors: T
authors: T
authors: Board
authors: ENDOKLINIK, HELIOS Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin.
authors: D
authors: D
authors: Kendoff
authors: COXA Hospital for Joint Replacement, PL 652, 33101 Tampere, Finland.
authors: A
authors: A
authors: Eskelinen
authors: Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02114, USA.
authors: Y-M
authors: YM
authors: Kwon
authors: Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA.
authors: D E
authors: DE
authors: Padgett
authors: Royal National Orthopaedic Hospital, Brockley Hill, Stanmore Middlesex, HA7 4LP, UK.
authors: A
authors: A
authors: Hart
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation* / Q000379:methods; D015415:Biomarkers / Q000378:metabolism; D005260:Female; D006104:Granuloma, Plasma Cell / Q000628:therapy; D006622:Hip Prosthesis; D006801:Humans; D007400:Interprofessional Relations; D007477:Ions / Q000378:metabolism; D008297:Male; D061825:Metal-on-Metal Joint Prostheses; D008670:Metals / Q000378:metabolism; D008875:Middle Aged; D015588:Observer Variation; D010014:Osteolysis / Q000628:therapy; D010348:Patient Care Team; D011183:Postoperative Complications / Q000628:therapy; D016059:Range of Motion, Articular / Q000502:physiology; D012086:Reoperation
chemical_list: D015415:Biomarkers; D007477:Ions; D008670:Metals
keywords: Metal-on-Metal hip; Multi-disciplinary Team; Revision