Ceramic and plastic implants to the fore following safety concerns

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MORE than 80,000 hip operations were carried out in England and Wales in 2011, mainly on people suffering problems linked to arthritis.

Most had implants using ceramic or plastic components following a dramatic fall in the use of metal-on-metal (MoM) devices.

Metal implants became more popular in the 1990s, with experts believing that they were particularly suitable for younger, more active patients due to lower wear.

At their peak in 2008, more than 9,000 operations were carried out using MoM implants but safety concerns had already been raised in Australia.

In 2010, a worldwide alert was issued over implants made by manufacturer DePuy which had the highest rates of failure, although some surgeons had already stopped using them – among them specialists in Bradford who called a halt in 2008 after picking up their own concerns.

All hip implants wear down over time and patients may need surgery to remove or replace components. This is known as revision – accounting for about 10 per cent of hip operations carried out each year.

Many patients need further surgery even after having their original MoM implant replaced.

In its alert last year, the Medicines and Healthcare products Regulatory Agency (MHRA) said 49,000 patients with metal hip replacements would need annual check-ups for signs of wear and for dangerously high levels of toxic metals. Those with symptoms of damage would need MRI scans, while 10,000 with DePuy implants would need both checks.

Latest figures from the National Joint Registry for 2003-11 point to “unacceptably high” failure rates from MoM hip replacements.

It estimated one in eight patients would need revision surgery after eight years, compared with only per cent for some other types of implant and four per cent overall.

In a confidential paper obtained by the Yorkshire Post for NHS Rotherham’s clinical commissioning group committee last May, officials said the growth in MoM implants was due to “the development and marketing efforts of several manufacturers...rather than response to a genuine clinical need”.

The MHRA says most patients with MoM hips have well functioning implants and are at low risk of serious problems.

Patients with MoM implants who develop pain, swelling or a limp are being advised to contact their doctor for referral for expert help.

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