Scary hip resurfacing problems surface regarding what the makers knew! The hip replacement side effects train just keeps rolling. In fact, you just can’t seem to make this stuff up when it comes to hip resurfacing. Just a few years ago, I remember patients telling me that they were interested in a “minimally invasive” hip resurfacing surgery and curious about what I thought. At the time, it was known as the “Birmingham Hip”. The concept was that a much smaller device would be inserted into the hip (which was the minimally invasive part). I always thought this was interesting, as in other areas of medicine, minimally invasive refers to a needle or catheter based procedure (for example cardiac stenting instead of open heart surgery), but here it was referring to a smaller big surgery. Then problems began to surface with hip resurfacing. Then more problems were reported. Then it turns out that the devices really don’t help patients. Finally, yesterday the NY Times reported that Johnson and Johnson (Dupuy) knew that 40% of the hips they were making would fail in 5 years time! What’s interesting about that is that almost all the patients I spoke to were expecting 15 years in exchange for going with a smaller version of a very big surgery. Apparently the cracks in the metal on metal hip armor began to show when a UK registry began reporting early failures. This made sense, as some of the first uses of the hips were in England (hence the term “Birmingham Hip”). About 93,000 patients worldwide received this specific Dupuy implant, about one-third of them in the United States. The upshot? How many other devices out there have similar failure rates? I have blogged on the fact that none of the knee or hip devices have been designed to take the stresses of younger and active patients. More wear equals more wear particles, which have been shown to be a consistent problem. These wear particles end up in the patient’s blood stream and while they can be reduced, they can never be completely eliminated, it’s just simple physics.
More hip resurfacing problems? As I’ve blogged before, metal on metal hips for hip resurfacing have evolved as a huge problem. The basic issue is the same with all artificial joint prostheses-wear particles. Any piece of metal, plastic, or ceramic you insert in the body that is designed to undergo significant friction will wear out and those pieces that wear off have to go somewhere. Where do they go? Into you! They end up inside the joint capsule, with surgeons reporting that on re operation these Birmingham hip joints are black with the stuff. They go into your blood stream, with metal ions from artificial hips being detected in the blood. Some people are also allergic to the metals used in the hip and knee replacement device, causing a new set of tissue reaction problems. In addition, the more we push knee and hip replacements into younger and younger patients, the more of these wear particles you get, as these patients are more active and thus wear the prosthesis more. On the heels of all of this, this week yet another metal on metal hip was pulled for device failure. The upshot? No matter what we make, it wears down. If you aren’t a candidate for biologic therapies for your hip or knee arthritis, then consider going with very low wear particle prostheses. This past few years knee and hip replacement manufacturers have been trying to design devices that wear less and produce fewer particles. These include the Zimmer Nexgen system. Better yet, catch your arthritis early and try to avoid the replacement altogether!
So many Hip Resurfacing problems in recent studies! It’s amazing how the language we use to describe our surgeries shape how patients think about them. Most patients who hear the term, “hip resurfacing” think that it merely involves adding a small cap here and there and they’re done. Patients are drawn to this procedure because of a sense that it’s associated with a more rapid recovery than traditional hip replacement surgery. An internet search this morning shows several local advertisements that claim that these procedures are for younger and more active patients. I’ve blogged before on how the class of metal on metal hips used in resurfacing have been a disaster. These hips shed metal wear particles that are responsible for everything from local tissue irritation to nerve damage. A recent news story also highlighted the need for metal allergy testing with these devices, as metal allergies were surprisingly common. In addition, this news is among a background of negative reports on wear particles from just about all types of joint replacements and at least one large study suggested that knee joint implants are associated with an increased risk of cancer. The New York Times also recently reported on the alarming rate at which hip resurfacing implants were failing. Now a study out of an English registry this week shows that the type of metal of metal hips used in hip resurfacing wear out 2-3 times more quickly than other prosthesis types! Younger patients who were women had the highest chance of needing a hip surfacing revision surgery. In addition, a larger hip resurfacing joint increased the chance of prosthesis failure. The upshot? “Hip Resurfacing” is really just a smaller hip replacement surgery with a metal on metal prostheses. Given the problems with hip resurfacing, between the wear particles and the fact that this type of joint wears out faster, hip resurfacing appears to be too good to be true!
There is a troubling New York Times article this morning on how metal on metal hip replacement prostheses are causing patients to get sick and are wearing out only after a few years. What’s also concerning is the staggering health care costs associated with caring for these sick patients and taking out their failed hip replacement parts for a second joint replacement. The article describes how we will all bear these high costs in one way or another. I’ve blogged before on metal on metal hip replacement surgeries, the most prominent example of which is “hip resurfacing“. These hip resurfacing problems include the production of wear particles that not only irritate the surrounding tissue, but also get into the bloodstream, exposing the patient to a variety of systemic illnesses. The article highlights a gentleman who has more than $400,000 in medical expenses related to the removal of a metal hip and for the past 5 months has been left completely without a joint and is bedridden. Extrapolating from the number of patients in Europe who have needed their metal joints surgically removed and replaced, as many as tens of thousands of patients in the U.S. will need to have their metal hips prematurely removed. The companies that make these metal on metal joints are facing massive lawsuits that will likely break all records for medical device liability claims. The upshot? Don’t fall for “hip resurfacing” claims. The procedure is billed as “minimally invasive” when in fact it’s really just a mini hip replacement surgery using a prostheses that is metal on metal. In addition, the metal prostheses used will likely lead to wear particles which can make some patients very sick. We also don’t know the long-term consequences of metal ions in the blood stream, but I’d wager that it’s not a good thing.