Friday, May 25, 2012

Don't rely on one single investigative tool to make clinical decisions.

 I so agree with this thesis:
 
J Arthroplasty. 2012 May 17. [Epub ahead of print]

Evidence-Based Understanding of Management Perils for Metal-on-Metal Hip Arthroplasty Patients.

Source

Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

Abstract

Adverse biological reactions causing failures of metal-on-metal (MoM) hip arthroplasty can be local or systemic. Both dose-dependent cytotoxicity of wear debris leading to subsequent necrosis of periprosthetic soft tissues and adaptive immunity may play an important role in pathogenesis in susceptible patients. There appears to be a spectrum of clinical presentations of adverse soft tissue reactions, reflecting a complex interplay of implant, surgical, and patient factors. A systematic treatment approach is helpful in optimizing evidence-based management of MoM patients. Although specialized tests such as metal ion levels are a useful diagnostic tool for evaluating MoM hip arthroplasty patients, overreliance on any single investigative tool in clinical decision-making process should be avoided. Future research focusing on diagnostic tools for detecting adverse periprosthetic soft tissue necrosis as well as optimization of MoM bearings and modular connections to further diminish wear and corrosion is warranted.

xxx

very important message for patients!  things to avoid in my opinion:

Cr and Co levels are high, remove the hip.  Maybe a mistake.
No pain, no action required.....big mistake
moderate pain, postpone a comprehensive look at the issue...big mistake

Your surgeon should have a comprehensive look at the issues in 100% of all cases.  like the authors say, over reliance on a single investigative too in clinical decision making process should be avoided.

What might constitute comprehensive testing:
MRI (Mavrik protocol)
Blood levels taken periodically
Sonogram

There are others but these are the most common and the results should be viewed in the totality of the patent's history.

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