Wednesday, December 8, 2010

Nice metal-on-metal round table discussion with 4 orthopedic surgeons: Pros and cons discussed.

Excerpts from that discussion.  The full discussion can be found here:  
Five questions were asked by the moderator:
(1)    What are the advantages of MOM (metal on metal) bearing use for both total hip and surface replacement?
(2)    What are your patient’s indications and contraindication is considering the use of the MOM bearings?
(3)    Are there particular design caveats which the orthopedic surgeons should be aware of?
(4)    In your practice, what is the current percentage of  MoM use in THA procedures and if applicable, surface replacement?
(5)    The overall percentage use of the MoM bearings has diminished in the US over the past 3 years.  Has this occurred in your practice and for what reasons?

Things I found of interest:
·         MoM is most often used by this group for resurfacing rather than implants. 
·         Contraindications of MoM  implants:  
o   Patients with metal sensitivity
o   Woman of childbearing age
o   Patients with significant renal impairment because the kidney is the primary pathway for ion excretion
o   Woman in general are at greater risk for hypersensitivity reactions to the MoM bearing.
·         Indications:
o   Primarily young active males
o   High demand male patients
·         Design caveats the surgeon should be aware of:
o   Proper positioning of the implant is critical to minimizing wear and tear
o   Even if placed properly, some of these components if placed correctly at a 45 degree angle function with large variances
o   Selection of the implant should be  based on designs that have been shown to work well for at least 5 and preferably 10 years.
o   Not all MoM implants are created equal.
·         The percentage of patients in their practice that are given the MoM implant (4 surgeons):
o   5%-10%
o   25%
o   Use to be 95% now he dropped it down to 2%
o   Only on young , fit, active men with normal hip anatomy
·         They all have reduced the use of metal in their practice now.


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