Follow-Up of Metal-on-Metal Hip Arthroplasty Patients Is Currently Not Evidence Based or Cost Effective

J Arthroplasty. 2015 Aug;30(8):1317-23. doi: 10.1016/j.arth.2015.03.009. Epub 2015 Mar 14.


Over one-million patients worldwide have received metal-on-metal (MoM) hip arthroplasties with a significant proportion requiring revision surgery in the short-term for adverse reaction to metal debris (ARMD). Worldwide authorities have subsequently issued follow-up guidance for MoM hip patients. This article compares follow-up guidelines for MoM hips published by five worldwide authorities, analyses these protocols in relation to published evidence, and assesses the financial implications of these guidelines. A number of major differences exist between authorities regarding patient follow-up, with vast cost differences between protocols (£84 to £988/patient/year for stemmed MoM hips and £0 to £988/patient/year for hip resurfacing). Current worldwide guidance is neither evidence-based nor financially sustainable with most protocols lacking the sensitivity to detect asymptomatic ARMD lesions.

Keywords: finance; follow-up; guidelines; hip resurfacing; metal-on-metal; total hip arthroplasty.

MeSH terms

  • Arthroplasty, Replacement, Hip / adverse effects*
  • Continuity of Patient Care / economics
  • Continuity of Patient Care / standards*
  • Cost-Benefit Analysis
  • Device Removal
  • Hip Prosthesis
  • Humans
  • Internationality
  • Metal-on-Metal Joint Prostheses / adverse effects*
  • Practice Guidelines as Topic / standards*
  • Prosthesis Failure
  • Reoperation