Tuesday, October 16, 2012

New Data and Lancet Analysis Trigger a Further Warning on Hip Resurfacing

Posted on : 02 October 2012
The BBC reports on a warning from doctors that due to the high failure rate of hip resurfacing, it should, in most cases, not be ised as an alternative to hip replacment. The advice comes as the Lancet issues its findings based on an analyisis of data from the National Joint Registry for England and Wales (read the Lancet summary here).

Hip resurfacing - where the damaged bone is capped rather than replaced - is often recommended for younger, active patients who will need more surgery as the joint continues to wear. Apparently, the UK's MHRA will look at the Lancet findings. They have already advised annual checks for people with large head metal-on-metal full hip replacements due to safety concerns. It is thought tiny pieces of metal can break off and leak into the blood.

The current study did not look at the safety of the metal resurfacing implants, although the researchers say there could be the same theoretical safety risk as with metal-on-metal hips. Instead it looked at failure rates with metal-on-metal resurfacing - where the socket and ball of the hip bone has a metal surface applied to it rather than being totally replaced.

The BBC article says that about 7 in every 100 hip patients go for resurfacing rather than a full hip replacement, although the rate has been decreasing in recent years. Some 32,000 people in England and Wales had this type of surgery between April 2003 and September 2011. The Bristol University team looked at the National Joint Registry data to see how many of these implants failed in the first seven years after surgery and how they compared with conventional full or "total" hip replacements.
In women, the resurfacing implants failed more quickly than total hip replacements. The five-year failure rate was about 5% on average compared with less than 2% for total hip replacement. The failure rate in women was so high - up to five times greater - that the researchers believe resurfacing implants should never be used in women. Similarly, they should not be recommended to men - the only exception is men with particularly large hip bones who appear to fare as well with resurfacing as with a total hip replacement, say the researchers.
The story includes a positive impact of hip resurfacing in that it is less invasive than a total hip replacement and leaves a patient with a greater range of movement after surgery. Plus, new, stronger materials for prosthetics are being developed that will allow longer wear and better joint mobility.
Source: BBC, 02 October 2012

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