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Public Health (09-10-2014)

Final opinion on the safety of Metal-on-Metal joint replacements with a particular focus on hip implants

Stiff joints, aching bones, painful movement – modern medicine has come up with solutions to alleviate some of the problems of old age. But can some forms of medical interventions like Metal-on-Metal hip and joint replacements actually do more harm than good?

Today, the European Commission and its non-food Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR), published the final opinion on “The safety of Metal-on-Metal (MoM) joint replacements with a particular focus on hip implants”.

The aim of this opinion is to assess whether there are any health concerns linked to the use of MoM implants in arthroplasty. It also seeks, where possible, to provide indications on design of the devices, on patient groups and to identify needs for further research.

A public consultation on the preliminary opinion took place between 13 March and 25 April 2014. The submissions received were carefully examined by the SCENIHR and, when relevant, taken into account in the final opinion.

The SCENIHR concludes that all types of MoM hip arthroplasties release metals. These, once in a person’s body fluids and tissues, may lead to local and/or systemic adverse health effects. MoM implants with large diameters (large-head) show the highest incidence of local reactions. In addition, this type of implant should be avoided in total hip arthroplasty on the basis of their high failure risk.

Due to the higher health risk when compared with alternative implants, the application of MoM hip arthroplasty should carefully be considered on a case-by case basis.

The SCENIHR endorses the strategy as outlined in the European Consensus Statement which recommends systematic follow-up for all patients and all implants, including clinical and radiographic investigation at intervals, depending on local protocols. In particular, metal ion determination is recommended for large-head MoM total hip arthroplasty on a routine basis and for hip resurfacing arthroplasty patients at least in the first postoperative years.