MOM HIPS: BANNED IN BRITAIN (Orthopedics This Week)
The United Kingdom has banned metal-on-metal hips.
The UK’s National Health Service (NHS), following new guidelines issued by the country’s National Institute for Health and Care Excellence (NICE) has banned most metal-on-metal hip implants in all hospitals funded by NHS. Few of the implants would meet the new standards set by NICE. The ban will affect nearly all manufacturers of the devices.
The UK’s public health system is fully funded by the NHS, so every hospital falls under the ban.
The new standards, according to The Telegraph, say the NHS should stop using any hip implant with a failure rate higher than 5% at five years. It means that almost every type of metal-on-metal hip implant—including five more devices still used—should no longer be fitted in patients. An audit of all hip surgery in England, Wales and Northern Ireland found that most types of metal-on-metal hip devices in use had failure levels below the standards NICE deems acceptable.
The Telegraph reported in October that the metal-on-metal resurfacing models found to have the high failure rates are: the Adept; Cormet 2000; Durom; Recap Magnum; and Conserve Plus. A sixth device, the Corail/Pinnacle full hip replacement using ceramic-on-metal, also failed to meet the standard.
Just two types of metal-on-metal devices in current use fall within the proposed national standard.
Stephen Cannon, honorary consultant surgeon at the Royal National Orthopaedic Hospital, said “The figures speak for themselves—even the best metal-on-metals have four times the failure rate of the rest. This is really a significant problem, because these were given to an awful lot of people.” He added, “I think there is a question about whether it goes far enough, but this is definitely a step in the right direction—it amounts to a ban on most of them.”
The devices continue to be sold in the U.S., but demand has dropped significantly after British and Australian surgeon societies first began reporting unusually high levels of failures of the devices. Johnson & Johnson, parent of DePuySynthes, just announced a $2.5 billion settlement for a vast majority of lawsuits filed by patients with failed revision hips. Other lawsuits continue to work their way towards settlements or trials for the other manufacturers.