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Letter to the Editor, October 2, 2011
Remedy is Elusive as Metallic Hips Fail at a Fast Rate", Barry Meier, Sept 30, 2011
I feel compelled to respond to Mr. Meier’s latest installment in his series highlighting the problems arising in metal-on-metal (MOM) joint replacements to provide readers and recipients of such joints with some perspective. In the article, Mr. Meier describes a growing phenomenon of “silent tissue destruction…with no obvious symptoms”; this type of sensationalistic journalism may sell newspapers but does no favors for the patients who have these types of joints.
This phenomenon of tissue destruction with MOM joint replacement is extremely rare; a recently published study in the Journal of Bone and Joint Surgery found that the incidence in a series of over 3400 hip resurfacings was 0.10% at an average of 3.4 years postoperative! Furthermore, Mr. Meier neglects to report that MOM hip resurfacing has been used internationally for over 10 years with excellent results, a fact confirmed by the 2011 statistics from the Australian National Joint Registry.
The above letter was submitted on October 2, 2011 and is limited to 150 words.I would have liked to provide additional statistics from the 2011 Australian National Joint Registry, which is available at http://www.dmac.adelaide.edu.au/aoanjrr/
This report, which encompasses results from Sept 1 1999 to Dec 31 2010, continues to show superior results of hip resurfacing as compared to total hip replacement, in select patients.For men under the age of 65, the revision rate of hip resurfacing at 7 years is 4.3%, whereas the revision rate of total hip replacement is 4.9% (see Tables HT72, page 94 and HT20, page 50).For women aged 55-64, the revision rate of hip resurfacing is 10.6% at 7 years, and for total hip replacement, it is 4.6%.
Another interesting statistic in support of hip resurfacing is that the re-revision rate of a hip resurfacing (that is, the chance of a repeat revision surgery after hip resurfacing) is lower than the re-revision rate of a total hip replacement.At 7 years, the re-revision rate of a failed hip resurfacing is 16.3%, as opposed to the 18.9% re-revision rate of a failed total hip replacement (see Table R4, page 146 and Table R8, page 148).
Finally, the Australian Registry continues to highlight the importance of implant selection.The Birmingham Hip Resurfacing is the best performing implant, with a cumulative 5% revision rate at 7 years, as compared to the ASR’s 13% revision rate (page 89).
These statistics, gathered from a national joint registry with multiple surgeons, continue to give support to the practice of hip resurfacing.I do recognize that there is more work to be done in identifying the best patients for the procedure, as metal-on-metal joints DO have unique problems.But for young, active patients who want to preserve as much bone as possible, I continue to offer this excellent alternative to total hip replacement.
Dr. Su responds to recent New York Times article about hip implants
Many of you have contacted my office regarding the recent NY Times article by Barry Meier, entitled “Hip Implant Complaints Surge, Even as the Dangers are Studied”, dated August 23, 2011. I would like to reassure all of my patients that I am aware of the article and have been following the media attention given to metal on metal hip implants.
This article, as well as the series of articles published previously by Mr. Meier (“Hip Implants Show that new is not always Improved” - June 26, 2011 and “Studies Ordered for Makers of Artificial Hips” – May 11, 2011), are primarily focused upon certain brands of metal-on-metal hip implants that have been recalled, namely the Johnson & Johnson ASR and Zimmer Durom. As we have learned more about metal-on-metal implants, we have found that these particular implants have design flaws that have caused them to fail at alarmingly high rates in the short term.
Fortunately, I have never used either of these hip implants. I have primarily used the Smith and Nephew Birmingham Hip Resurfacing (BHR), which has the longest track record of any metal-on-metal hip resurfacing device. There was extensive use of the BHR in patients for about 7 years in the UK prior to its approval in the United States. As part of the FDA approval of the BHR, a post-market approval study was designed to monitor safety of the device, and I am an investigator in this study. To date, with over 4 years of monitoring of patients in this study, the success rate remains high, with a very low complication rate.
To summarize the series of articles, a metal-on-metal hip implant is a high performance design. As with any high-performance equipment, there is little room for error. It is important that both patients and surgeons recognize the importance of routine followup of the hip implants. Please be reassured that I continue to research this topic to ensure optimal results for my patients. The articles have not changed my opinion of hip resurfacing, and I continue to believe that in the right patients, with the right implant, it is an excellent treatment for hip arthritis.
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