U.K. Doctors Given Additional Guidance for Metal-on-Metal Hip Implant PatientsJun 25, 2012 | Parker Waichman LLP
Doctors in the U.K. are again being advised to follow-up with patients who have been fitted with metal-on-metal hip replacement devices, especially those who have received a recalled DePuy ASR hip implant device, or an implant with a femoral head diameter ≥36mm. The new guidance from the Medicines and Healthcare products Regulatory Agency (MHRA) incorporates updated advice on the duration of follow-up for symptomatic patients implanted with metal-on-metal hip implants in resurfacing (no stem) procedures, as well as those who received devices with the smaller femoral head (<36mm).
Patients who have undergone resurfacing with all-metal hip implants, or devices with femoral head diameter <36mm, should be followed up for the life of their implant if they exhibit symptoms, according to the MHRA. Imaging tests and an initial blood test should be administered to all of these patients. A repeat blood test should be administered in three months for patients who have metal ion levels greater than 7ppb.
Patients with a larger femoral head device (≥36mm) or any DePuy ASR device should be followed up annually, regardless of symptom presentation. Imaging tests, including MARs, MRIs or ultrasound, are recommended for any patient showing symptoms. All patients, with a larger diameter implants or any type of DePuy ASR hip replacement device, regardless of symptom presentation, should undergo an initial blood ion test. These patients should also be retested in three months if they are found to have a blood ion level greater >7ppb.
According to the MHRA, revision surgery should be considered patients in any of these groups when their imaging appears abnormal, or blood test indicates their ion levels are rising.