In U.K., Annual Check-Ups For Metal Hip Implant Patients

August 7, 2012 — A U.K. health agency responsible for regulating medical devices is recommending that people who have “large head” metal-on-metal hip implants should get annual check-ups. This recommendation is an update to one that was issued in 2010, which advised five-year check-ups. The agency is concerned about recent research that has linked “large head” metal hip implants to a high risk of wear, corrosion, tissue damage, bone damage, toxic metal particles in the body, pain, and other complications that cause failure of the hip implant.

The advice concerns only “large head” metal hip implants, so-named because the femoral head of the device is 36-mm or greater. It is estimated that nearly 50,000 people in the U.K. are currently implanted with these devices. Although the risk of severe complications is small, research suggests that complications are higher for large-head metal-on-metal hip implants, compared to plastic, ceramic, or smaller-size hip implants.

When the patients go in for a check-up, the health agency is recommending that they undergo blood tests to check the concentration of metal ions in the bloodstream. An annual check will be able to monitor if the metal ion level is changing, and at what rate, which should give the doctor a better idea of how quickly the hip implant is wearing out.

If the patient is suffering from symptoms of hip implant failure (pain, swelling, inflammation, decreased mobility, or changes in gait), then an MRI or ultrasound is warranted. Patients without symptoms should also have blood tests to check for signs of rising metal ion levels.

A major problem with the metal-on-metal hip implants (and not with the plastic or ceramic devices) is that the metal parts can grind together and shed metal debris into the body. This debris can irritate the hip joint, dissolve bone, and cause tissue damage. In severe cases, the patient may need revision surgery to remove the device.

Although researchers do not understand the long-term effects of metal nano-particles in the body, there have been a few rare cases where metal hip implants caused very high levels of metal debris in the bloodstream, which caused life-threatening metal poisoning.

The U.K. health agency and the U.S. Food and Drug Administration (FDA) are continuing to monitor the safety of metal hip implants and issue warnings when safety risks are identified. At this point, patients are advised to immediately contact a physician if they suffer any of the following symptoms:

• Pain in the hip joint, groin, or leg
• Swelling in the hip
• Limp, changes in gait, or decreased walking ability
• Chest pain, shortness of breath
• Numbness or weakness
• Changes in vision, hearing, or other senses
• Fatigue
• Feeling cold
• Weight gain
• Changes in bowel or bladder habits
• Changes in consciousness

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