Metal-on-metal Hip Resurfacing In India

Joint Replacement Surgery Hospital India offers highest quality bone and joint health care with attentiveness, care and compassion to meet the needs of the patients and their loved ones. The medical team includes board-certified orthopedic surgeons who are familiar with all the aspects of the musculoskeletal system. Our hospital uses the most advanced technologies available for the orthopaedic procedures and has a lower complication rate.

Yes, completely. A hip resurfacing has only two components, made of identical material. These two surfaces rub together in a bearing that has been used since the 1960s.

In a hip resurfacing, there are only two components, one resurfacing the femoral head, and one relining the acetabulum. These are made of identical material, cobalt chrome alloy. Hip replacements were made of exactly the same material back in the 1960s, using a design called the McKee-Farrar.

Depending on the type, there can be 2,3 or 4 parts.

• The acetabular component can be made of a single material – either plastic or cobalt chrome alloy or ceramic, or it could have an outer shell of titanium and a lining of plastic, cobalt chrome alloy, or ceramic.
• A hip replacement has a stem in the femur which can be made of titanium, cobalt-chrome alloy, or stainless steel. On top of this a femoral head is placed. Some systems provide the head and stem in one piece, called a monobloc, while most nowadays have heads of different sizes and lengths to allow the surgeon to make adjustments at the time.
• Femoral heads may be made of metal or ceramic. The exact type of metal is important, as some metals can corrode when placed against others.

All artificial bearings wear, but some wear faster than others. The rate of wear depends on how hard you use the hip, and the material and design of the bearing surfaces. In general, your bearing was chosen for you, to ensure that it lasted longer than you could expect to live, no matter how much exercise you do, so it is rather unlikely that any hip inserted in the last 15 years will actually wear out through overuse, no matter how long you live. In older hips, from the 1980s and earlier, this wasn’t the case, so we can expect to have to change the bearings in some of these.

The wear process caused by everyday life, produces small particles. In bearings with the same surfaces on each side, such as ceramic-on-ceramic or metal-on-metal, the particles may come from either surface, while bearings with a poly acetablular liner only generate particles of poly. The poly particles are so large that they cannot be digested easily. They tend to accumulate around the joint, and are associated with some hips loosening after many years because of a reaction to those wear particles.

Wear of metal on metal bearings should be extremely slow, so most hip resurfacings will never wear out in any human lifetime. They do produce wear particles, however, which are extremely small, and broken down into ‘ions’ or the single atoms of metal that are used in our body naturally. Cobalt ions are part of vitamin B12, while Chromium ions are in haemoglobin. The level of circulating cobalt and chromium in our blood stream is usually very low. After a hip resurfacing the levels rise, as the particles from the hip are dissolved into ions. These particles are then excreted by the kidneys into the urine. So a normal hip resurfacing actually is self-cleaning, with any wear particles eliminated from the body naturally every day.

Metal ions are essential for life, and cobalt and chromium are in every cell in our body naturally. Only excessive metal ions may be of concern.

If your hip is comfortable, then you almost certainly don’t have a problem. To reassure you and your doctor that all is well, a simple blood test to measure the levels may be helpful. A plain X-ray, or an MRI, or just an ultrasound may also be options to reassure that all is well. Only very occasionally does a blood test or scan throw up unexpected findings.

The measurement is not performed in every laboratory, and is best carried out on ‘whole blood’ not just the plasma. It is also best done in a laboratory that specializes in the test, so that the results are reliable. A technique called ‘mass spectroscopy’ is used. This requires a special and quite expensive instrument, which explains why many labs don’t do the measurement themselves.

Hips can only corrode if there are two different metals attached to each other. Even then, corrosion is unlikely, but it can happen, and is particularly likely if the stem is one metal, the femoral head another, and the acetabular shell still another. In these hips, the so called Large Diameter Metal-on-Metal Total Hip Arthroplasties (LDMoMTHA), corrosion has been a problem. The process has occurred at the junction between the stem and the femoral head. This process has produced many more wear particles and an entirely new problem. It is this problem that has caused all the fuss. The companies that supplied the heads and stems and sockets did not appreciate what a problem it would cause.

If you have a Large Diameter Metal-on-Metal Total Hip Arthroplasties (LDMoMTHA),, then you may have already been invited to come back for a review. If you have no problems, then the review will probably not yield anything. If you are having nagging pain, it might just be that some corrosion is happening, so it is worth going to see your surgeon.

If you have a LDMoMTHA, then the government recommendation is that you should have an annual check-up. However, if all is well, then it is exceeding unlikely that any harm will come if the gap between visits is lengthened to 5 or even 10 years.

We are working on a web based system, and in some circumstances a phone call may be sufficient. However, as surgeons who want to be sure that our patients are well, we would rather you were seen in person if at all possible, so that we don’t miss anything.

If all feels well, it is exceeding unlikely that any harm will come whatever. But if you do have any aches and pains, then it is worth having a check-up, in the same way that it is worth having your car reviewed regularly by the garage.

The surgeon who did the operation was trying to provide a stable hip that would last for a long time. Every bearing has its own problems, and at the time, the surgeon felt that the advantages of a large bearing, which would abolish any risk of dislocation, outweighed any risks.

By all means, you may call the hospital where you had the surgery, or your surgeon’s office and ask for a follow up. In the NHS, there are some rules about follow-up appointments that can make this difficult. To avoid a long wait on the phone, (which can be maddening), a short note to your GP will result in a referral that will make it all happen without any more effort from you. Unless you are in pain, there is no urgency, as the chances of any major problem developing are very small.

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