Sunday, December 16, 2012

Metal-on-metal hip prostheses: where are we now?


Daniel Westacott, Specialist Registrar

Warwick Orthopaedics, University Hospital of Coventry and Warwickshire, CV2 2DX

Like many members of the orthopaedic community, I am grateful to the BMJ for the interest shown over recent months towards metal on metal bearings and the subsequent issues that have arisen around the regulation of orthopaedic implants. I hope Professor Wilkinson’s balanced and informative editorial will fuel further debate[1].

I must however request that the editorial staff are wary of misleading readers with ill-informed illustrations that accompany such articles in the print edition of the journal. This piece was set against a photograph of a small diameter metal on polyethylene hip replacement, arguably the polar opposite of the subject under scrutiny.

The illustration set into Professor Costa’s recent editorial on the regulation of orthopaedic devices inexplicably shows a periprosthetic femoral fracture[2].

The front cover of the 11th December 2011 issue seems to depict a ceramic bearing, above the banner “Adverse reactions to metal on metal hip implants”. The same digitally enhanced image is wheeled out twice more alongside articles on metal on metal bearings[3,4].

A news piece on the need for lifelong metal ion checks in patients with metal bearings above 36mm features a radiograph of bilateral small diameter bearings, at least one of which appears to be ceramic[5].
An extract on the FDA’s withdrawal of the DePuy ASR is illustrated with a radiograph of a small diameter cemented metal on polyethylene hip replacement[6].

Please avoid further clouding an already complicated issue.

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