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MRIs May Spot Early Tissue Damage Caused by Metal-on-Metal Hip Implants

Mar 19, 2013

Magnetic Resonance Imaging (MRI) can serve as an early warning system for people who possess a failing, or potentially failing, metal-on-metal (MoM) hip implant, thereby signaling that revision surgery may be required. So proclaimed a new study presented yesterday at the 2013 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) in Chicago.

The early detection of a failing MoM implant is significant in that it can help to prevent the implant recipient from experiencing greater suffering caused by extended tissue damage, coupled with a possibly rising level of pain. Some patients who are not informed of issues through early detection of potential problems with their MoM hip implant may eventually find themselves with a failed total hip replacement (THR), which can cause significant loss of the proximal femoral bone, proximal migration of the greater trochanter, and breakage of multiple screws distally from the previous interlocking device.

Considering that in the past several years, hip implants that were made by major manufacturers have been associated with serious safety problems, an early warning system would certainly be a welcomed gadget for the implant surgeon’s toolkit. The MRI, for example, could potentially serve as one possible solution for the thousands of people across the U.S. who were implanted with the DePuy Orthopaedic defective ASR hip replacement system between 2005 and 2010, when it was recalled. Some patients experienced premature failure of their DePuy hip implants – sometimes within a mere few years following their initial MoM hip implant surgery.

Researchers scrutinized MRI images of 70 patients – all of whom eventually underwent required revision surgery resulting from botched MoM implants. In surveying the various images, the researchers focused on finding telltale indications of tissue damage and swelling, among other signs of a possibly budding implant problem.

As noted by the study, an MRI is capable of identifying tissue damage in MoM THR patients by means of the device’s inherent “highly sensitive and specific” capabilities.

The 2013 AAOS annual meeting also included an educational panel, titled “Optimizing Management of Patients with Metal-on-metal Hips,” that featured seven orthopaedic experts engaging in discussion regarding how to identify and treat MoM hip failure.

In December of last year, the AAOS issued a statement that recommended swifter evaluations of patients with MoM hip implants. This is because "early recognition and diagnosis will facilitate the initiation of appropriate treatment prior to significant adverse biological reactions," according to the statement, which in addition served up a comprehensive synopsis of the diverse range of diagnostic and treatment methods available to address discomfort in these patients. The statement also highlighted when treatment should promptly be sought -- as well as revision surgery, when necessary.

The potential market for MoM and other types of hip implants is huge: According to the AAOS statement, more than one in four Americans is now dealing with bone- or joint-related problems. These health-related tribulations, in fact, are responsible for “the greatest cause of lost work days in the U.S.,” the statement said.

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