FOLLOW-UP OF METAL-ON-METAL HIP REPLACEMENT PATIENTS IS CURRENTLY NOT EVIDENCE-BASED OR COST EFFECTIVE

IntroductionThis study aimed to: (1) compare published follow-up guidelines for metal-on-metal (MoM) hip patients and analyse protocols in relation to current evidence, and (2) assess the financial implications of these guidelines.MethodsFollow-up guidance for MoM hips from five national authorities (MHRA in the UK; EFORT; United States FDA; Therapeutic Goods Administration of Australia; Health Canada) were contrasted and critically appraised. Using National Joint Registry (NJR) data (67,363 MoM hips implanted) the cost of annual surveillance for all MoM hips recorded in the NJR was calculated for each protocol.ResultsSignificant differences existed between recommended guidance, with protocols not reflecting the best available evidence. These include not stratifying patients according to implant type (total hip replacement (THR) or hip resurfacing (HR)) or adverse reaction to metal debris (ARMD) risk factors, using symptoms to decide patient follow-up, and using suboptimal blood metal ion thresholds to id...