Monday, April 8, 2013

Metal-on-metal management: Are you prepared?

The Advisory Board

on April 3, 2013  |  Permalink

Sam Gold

There is little doubt that metal-on-metal (MoM) hip implant technology is problematic for both patients and the clinicians who treat them. Orthopedic leaders are shifting their focus to figure out how to best manage the health of patients who have received this technology.
Because over a million MoM devices have been implanted since 1996, this is an issue that will affect most systems across the country. Patient concerns will continue to increase as further detrimental findings come to light.

It is expected that more and more patients who received MoM implants will seek a physician’s consultation, placing a premium on accurate and timely delivery of information. With news of catastrophic failures and pseudotumors circulating, patients may ask for intensive treatments such as complete implant removals that may not be medically necessary.

Setting an internal standard of care

So how do hospitals plan for unforeseen complications and an influx of patient demands? First, orthopedic departments should get ahead of the problem by contacting patients with MoM implants to monitor functional outcomes and provide evaluations. For patients the adverse effects of MoM hips, the frequency of follow-up visits should be accelerated depending on the severity of the condition. In a bundled payment environment, this level of diligence may reduce the risk of severe adverse effects associated with MoM devices.

At the recent AAOS conference in Chicago, presenters discussed best practices for MoM clinical and operational management. Evaluation can take a number of different forms: routine clinical evaluation, radiographic imaging, blood tests, and biopsies for detecting metal ion levels and potential tissue damage.  Clinical studies have yet to create universal care protocols for patients with MoM hips, so it is important that orthopedic departments collaborate with radiologists, staff handling patient outreach, and the hospital to develop standard protocols.

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Has your department instituted protocols for MoM management?

Understanding the financial impact

Unfortunately, management of MoM hips is a complex and expensive endeavor. In a study presented at AAOS, the researchers determined that costs of surgery, surveillance, and revision surgery for MoM patients at 10 and 30 years are $39,961 and $107,059, respectively (more than two and four times the associated costs with highly cross-linked polyethylene implants).

Hospitals need to size their patient base with MoM implants in order to best account for future care provision, especially in a bundled payment or ACO environment. These potential expenditures may also prompt orthopedic leaders to more conservatively manage implant devices, choosing to continue using implants with proven track records. 

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