The risk of cardiac failure following metal-on-metal hip arthroplasty

Sabah, Shiraz A.; Moon, James; Jenkins‐Jones, Sara; Morgan, C. Ll.; Currie, Craig John; Wilkinson, JM; Porter, Martyn; Captur, Gabriella; Henckel, Johann; Chaturvedi, Nishi; Kay, PR; Skinner, John; Hart, Alister; Manisty, Charlotte

doi:10.1302/0301-620x.100b1.bjj-2017-1065.r1

Cited by 31 publications

(23 citation statements)

References 34 publications

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“…What should we as cardiologists take from this work? As with several other clinical/ large-scaIe population studies, [4][5][6] this work failed to detect a strong signal for heart failure risk with MoM hips. Indeed one study from the largest joint registry (including data from greater than 500,000 patients) suggested lower heart failure risk in MoM patients.…”

supporting

confidence: 63%

“…Indeed one study from the largest joint registry (including data from greater than 500,000 patients) suggested lower heart failure risk in MoM patients. [5] One smaller epidemiological study found potentially higher risks of heart failure but only in a small subgroup of elderly men with one particular high risk prosthesis. [7] Currently, there is no evidence to advise routine cardiac screening of MoM patients and we think that patients should be reassured unless their blood levels are very high.…”

mentioning

confidence: 99%

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Metal-on-metal hips and heart failure – Can we relax?

Manisty

Skinner

Moon

2019

International Journal of Cardiology

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supporting

confidence: 63%

mentioning

confidence: 99%

Metal-on-metal hips and heart failure – Can we relax?

Manisty

Skinner

Moon

2019

International Journal of Cardiology

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“…However, a larger study using National Joint Registry (NJR) data from England and Wales demonstrated that MoMHA patients were not at increased risk of heart failure compared with non-MoMHA patients (Sabah et al. 2018 ), with the same authors reporting that MoMHA patients with high blood metal ion concentrations undergoing comprehensive cardiac investigations had no detectable heart pathology (Berber et al. 2017 ).…”

Section: Threshold For Armd Revision Surgerymentioning

confidence: 99%

Revision surgery of metal-on-metal hip arthroplasties for adverse reactions to metal debris

et al. 2018

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Background and purposeThe initial outcomes following metal-on-metal hip arthroplasty (MoMHA) revision surgery performed for adverse reactions to metal debris (ARMD) were poor. Furthermore, robust thresholds for performing ARMD revision are lacking. This article is the second of 2. The first article considered the various investigative modalities used during MoMHA patient surveillance (Matharu et al. 2018a). The present article aims to provide a clinical update regarding ARMD revision surgery in MoMHA patients (hip resurfacing and large-diameter MoM total hip arthroplasty), with specific focus on the threshold for performing ARMD revision, the surgical strategy, and the outcomes following revision.Results and interpretationThe outcomes following ARMD revision surgery appear to have improved with time for several reasons, among them the introduction of regular patient surveillance and lowering of the threshold for performing revision. Furthermore, registry data suggest that outcomes following ARMD revision are influenced by modifiable factors (type of revision procedure and bearing surface implanted), meaning surgeons could potentially reduce failure rates. However, additional large multi-center studies are needed to develop robust thresholds for performing ARMD revision surgery, which will guide surgeons’ treatment of MoMHA patients. The long-term systemic effects of metal ion exposure in patients with these implants must also be investigated, which will help establish whether there are any systemic reasons to recommend revision of MoMHAs

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“…This more intensive follow-up may reflect the MHRA’s continued and serious concerns about the long-term systemic effects of ions released from MoM hip replacements, which are largely unknown [ 11 , 12 ]. Other large cohort studies have shown no association between MoM hip replacements and the risk of cardiac disease in the medium term, another potential deleterious effect of metal ion release [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

The risk of developing cancer following metal-on-metal hip replacement compared with non metal-on-metal hip bearings: Findings from a prospective national registry “The National Joint Registry of England, Wales, Northern Ireland and the Isle of Man”

et al. 2018

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Background and purposeOver 1 million metal-on-metal hip replacements were implanted. Even well-functioning implants produce wear debris that can cause tissue damage, disseminate and cause DNA damage. We aimed to establish if there was an association between metal-on-metal hip replacement and the risk of subsequently developing cancer compared with alternative hip replacements.MethodsWe performed a population based prospective longitudinal cohort study using data from the National Joint Registry linked to Hospital Episode Statistics (n = 403,881 patients). We examined the incidence of a new diagnosis of cancer in patients who received a metal-on-metal bearing in comparison with those who received a non metal-on-metal bearing. Kaplan-Meier estimates of time to first cancer diagnosis were used with Cox proportional hazards regression models to assess the effect on the time to cancer diagnosis for all cancer types, haematological, malignant melanoma, urinary tract cancers or prostate cancer in men.ResultsThe maximum follow up available was 11.8 years with 25% of patients followed up for more than 6.8 years (mean follow up 4.6 years; median 4.3; IQR 2.1–6.8; range 0.01–11.8). Analyses by gender that adjusted for age at primary and presence or absence of linked Welsh (PEDW) records showed no increase in the risk of developing cancer according to the bearing surface implanted for all cancers, haematological cancers, malignant melanoma, urinary tract cancers or prostate cancer in men. For patients receiving a second hip replacement, there was also no difference.ConclusionWe have demonstrated that there is currently no evidence of an increase in the risk of cancer following primary hip replacement according to the type of bearing material used. Although the risk of revision in metal-on-metal bearing hip replacements is higher, it is reassuring that the risk of a new diagnosis of cancer is not currently increased. Despite the long term follow up available in this study, the latency period for some cancers is very long and therefore continued monitoring is required to ensure no new patterns emerge that may indicate need for universal screening.

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The risk of cardiac failure following metal-on-metal hip arthroplasty

Cited by 31 publications

References 34 publications

Metal-on-metal hips and heart failure – Can we relax?

Metal-on-metal hips and heart failure – Can we relax?

Revision surgery of metal-on-metal hip arthroplasties for adverse reactions to metal debris

The risk of developing cancer following metal-on-metal hip replacement compared with non metal-on-metal hip bearings: Findings from a prospective national registry “The National Joint Registry of England, Wales, Northern Ireland and the Isle of Man”

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