Metal-on-metal hip resurfacing: European concerns still exist
Metal-on-metal resurfacing in hip arthroplasty had a stormy introduction in Europe – mainly the result of advertisements lauding the benefits of the procedure. Surgeons throughout Europe are using the technique more frequently, particularly in the United Kingdom.
Some researchers have touted the benefits of resurfacing based on the results of several recent scientific papers (ie, anatomy preservation, a physiological loading pattern and improved propioception). The result has been an influx of younger patients approaching their orthopaedic surgeon about this “new” technique for their long-lasting hip replacement.
However, a growing number of European surgeons are concerned about the resurfacing technique in light of results from not only the Australian Hip Register, but also from newly published papers demonstrating an uneven, early high revision rate, mainly due to femoral neck fracture or varus compression of the neck. Moreover, the ever-present concern about the influence of the nano metal-debris has not subsided, although Finnish researchers comparing patients with a metal-on-metal implant with those in the general population could show no difference in the incidence of lymphomas and other malignancies.
In Denmark, we are seeing a dramatic increase in the number of metal resurfacing operations, some of which are performed by “low-volume” hip surgeons. Because of this new trend and concerns about the level of experience some surgeons have to perform the procedure, the Danish Society for Hip and Knee Replacement, together with the National Board of Health, stated that resurfacing in its present state is “experimental surgery” and should only be undertaken in a few clinics – and only under controlled conditions (ie, comparable studies).
European orthopaedic surgeons will continue to debate the merits and risks of metal-on-metal resurfacing, mainly because several patients in our outpatient clinics have heard about its “benefits,” but have never been informed about the known and potential risks. In my clinic, no patients have ever demanded to have a metal-on-metal resurfacing hip after becoming aware of the potential risks.
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- Per Kjaersgaard-Andersen, MD, is an assistant professor of orthopaedic surgery at Vejle Hospital, South Danish University, Odense, Denmark, and is an editor of Orthopaedics Today.