Cost of failed implants nears £3m

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WHEN regulators last year ordered a dramatic scaling-up in monitoring of patients fitted with metal-on-metal hip replacements, it was the culmination of mounting concern over the safety of the devices given to 65,000 patients in the UK.

Experts advised annual check-ups for 49,000 of the patients given the implants and further surgery for those whose artificial hips had failed.

But investigations by the Yorkshire Post indicate the decision risks putting further pressure on NHS budgets as taxpayers foot the bill for the battery of tests and operations.

Around 10,000 patients nationwide had been given implants by DePuy which were withdrawn in 2010 owing to high failure rates. The remainder had been given other types of implants which typically are also more likely to fail although they have not been subject to the same level of concerns.

One analysis by NHS officials in Rotherham warns more than 600 patients in the area need surveillance. In 2013-14, it estimates they will require nearly 1,000 blood tests, 370 MRI scans and up to 218 revision operations.

Overall costs could hit nearly £3m in the next three years and it warned of uncertainty over rates of revision and local capacity to investigate and treat patients. Further clarity was also needed over therapy services to support patients undergoing revision.

The impact in Rotherham is likely to be greater since the town’s hospital was named last year by the National Joint Registry as one of eight NHS and private units in England and Wales, also including the Clifton Park NHS Treatment Centre in York, which have higher-than-expected rates of revision surgery on patients following hip replacements, mainly owing to their high usage of metal-on-metal implants.

Between 2003 and 2011, 43 per cent of all hip work in Rotherham involved metal implants, compared with 22 per cent at Clifton Park, which opened in 2006 to treat patients mainly from North Yorkshire and the East Riding.

The privately-operated York centre said its surgeons had carried out 347 hip replacements using DePuy hips and another 147 using other MoM implants in its first four years. Some 120 revision operations had been carried out so far including patients who did not have their initial surgery there.

In others parts of the region, the costs of surveillance and revision surgery remain unclear.

In Hull, hospital managers estimate the annual cost of surveillance where nearly 200 patients received metal-on-metal implants at £110 per patient for life. So far cost of revision work on 30 patients has been £300,000.

NHS officials said the cost of outpatient appointments and diagnostics was being met by primary care trusts, with treatment costs falling on the supplier of the implant if it had caused the problem.

In northern Lincolnshire, where more than 430 patients have been given MoM implants, talks with manufacturers have yet to begin but surveillance costs, put by hospital officials at £120,000 a year, were being met by the NHS.

In Sheffield’s hospitals, 220 patients were given the implants and 24 revision operations have so far been carried out. Managers are negotiating with DePuy to cover surveillance and revision costs but prior to 2012-13 the costs had been borne by the NHS.

At the Calderdale and Huddersfield NHS trust, managers say the vast bulk of costs are being met by manufacturers.

Ian Carmichael, clinical director at Rotherham’s hospital, said patients were part of a regular review process in line with national recommendations.

Since concerns about the use of MoM hip replacements had been raised, their use had been reduced.

A Clifton Park spokesman said all patients with DePuy implants had been assessed following the initial 2010 alert and following further guidance last year surveillance had commenced of the remaining patients.