A year and a half after DePuy’s massive hip replacement recall, the United Kingdom’s counterpart to the FDA (called the “MHRA”) has issued updated guidelines for the treatment of patients with any kind of metal-on-metal hip implant.
The MHRA recommend that patients who have any large-diameter metal-on-metal hip implant (such as the DePuy Pinnacle 36mm or 40mm metal-on-metal implant) receive essentially the same treatment as patients who have the recalled ASR hip implant.
Among other things, the MHRA recommends that:
Both symptomatic and unsymptomatic patients should receive annual blood tests to check for the level of cobalt and chromium.
If the a blood test shows a level of cobalt or chromium of 7 parts per billion or more, then another blood test should be done in 3 months.
All symptomatic patients should receive a MARS MRI or an ultrasound.
All unsymptomatic patients should receive a MARS MRI or an ultrasound if thei level of cobalt or chromium in their blood is rising.
The MHRA recommends that doctors should consider a revision surgery if (1) MRI or ultrasound images show abnormal results, or (2) if the level of cobalt or chromium in the blood is rising.
Dr. Susanne Ludgate, Clinical Director of the MHRA, said in a statement:
As a precautionary measure, we have today issued updated patient management and monitoring advice to surgeons and doctors that they should annually monitor patients for the lifetime of their metal-on-metal total hip replacements that are sized 36 millimetres or more because this particular type of hip replacement has a small risk of causing complications in patients.
This updates previous advice that patients with this type of hip replacement need only be monitored for a minimum of five years after their operation.