Links

See below for links relating to hip replacements.

Please see also the tabs to the left providing links to articles from MRHA, TGA, News coverage, Knee replacements and Papers.

Please note we are not responsible for the content of external websites.

Articles and videos ::: UK Organisations

Articles and videos

Questionnaire for people with metal-on-metal hip replacement

Questionnaire about people's experiences with metal-on-metal hip implants.

MHRA Updates Alert on Metal-on-Metal Hip Implants

The UK's Medicines and Healthcare products Regulatory Agency (MHRA) issued an alert to healthcare professionals with updated recommendations for long-term follow-up for patients with metal-on-metal hip replacements.

BOA/BHS joint statement: MoM hip implants – update from the Medicines and Healthcare products Regulatory Agency (MHRA)

The British Orthopaedic Association (BOA) and British Hip Society (BHS) welcome the update issued by the Medicine and Healthcare Devices Regulatory Authority (MHRA) regarding the metal-on-metal hip implants.  

Smith & Nephew recalls Modular SMF, Modular Redapt hip implants

Smith & Nephew recently recalled its Modular SMF and Modular Redapt hip implants “due to a higher than anticipated complaint and adverse event trend” with the modular necks used in the devices.

How you can maintain bone health as you age

Article published by OrthoInfo

Medical devices face tougher premarket testing under new EU laws

BMJ: The European Parliament has passed new legislation to tighten regulation of medical devices that will require high risk devices, such as hip implants, to undergo more premarket testing and assessment.

Getting active for better musculoskeletal health

Article on gov.uk discussing the need to change how we view musculoskeletal conditions with a focus on prevention, early detection and treatment using the life course whole systems approach.

Investigation of Taper Failure in a Contemporary Metal-on-Metal Hip Arthroplasty System Through Examination of Unused and Explanted Prostheses.

A paper published in JBJS.

Explant analysis of the Biomet Magnum/ReCap metal-on-metal hip joint

Our paper open-access paper published in BJR.

Northern Retrieval Registry Inaugural Conference 3 May 2017 at The Baltic, Gateshead-Newcastle

Examination of explanted medical devices can identify factors associated with their clinical success or failure.  This conference brings together a number of recognised experts in the fields of surgery, medicine and bioengineering to discuss how explant analysis can improve patient healthcare.

Registration open now. 

Regarding medical implants, "What you can do now to meet new EU regulations"

New European regulations covering medical devices will be final in June.  This article discusses an interview with the Director for Regulations and Industrial Policy at the industry association MedTech Europe in Brussels, John Brennan, about how the new rules will hit orthopedics and implant manufacturers.

Early Lessons From a Worldwide, Multicenter, Followup Study of the Recalled Articular Surface Replacement Hip System

A Clinical Orthopaedics and Related Research article.

Recall of the ASR XL Head and Hip Resurfacing Systems

In the future, closer monitoring of new implants is needed to prevent high failure rates, as seen with the ASR design.  This article was published in Orthopedics.

The Age of OrthoInfo: A Randomized Controlled Trial Evaluating Patient Comprehension of Informed Consent

Article published in The Journal of Bone and Joint Surgery.

Smith & Nephew Issues Recalls for Hip Implants

FDA report that Smith & Nephew has recalled its Modular SMF and Modular Redapt hip implants due to an unprecedented complaint and adverse event trend with the modular necks used in the devices.

Complications of Wear or Corrosion of Chrome-Cobalt Hip Implants

Presentation given by Stephen Tower.

MHRA Devices Safety

Reporting suspected side effects makes medicines safer.

2016 Australian Orthopaedic Association National Joint Replacement Registry

The 2016 Australian Orthopedic Association registry is now available.

Don’t Take Osteoarthritis Lying Down

Article published in the New York Times discussing osteoarthritis.

Patients should be more involved in decisions about their care, says NICE

A new collaborative, made up of the UK’s leading health care organisations including NICE, has set out plans that will help get patients more involved in decisions about their care.

NJR poster

Summary of the key facts about joint replacement (2015/2016).

NJR report published

NJR's 13th Annual Report has been published.

NHS: Health apps to inform patient records

BBC article.  Data from approved health apps will feed directly into personal health records, Health Secretary Jeremy Hunt has announced.

Registries are an asset for patients and an ally for surgeons

Orthopaedic registries are still emerging within Europe. The Scandinavians have the longest track record with registries. The National Joint Replacement Registry for England, Wales, Northern Ireland and the Isle of Man is the largest in the world. Finally, a U.S. registry is emerging, as well. These increased numbers of registries will foster greater global collaboration concerning common implant problems.

Why ‘Useless’ Surgery Is Still Popular

It looks as if the onus is on patients to ask what evidence, if any, shows that surgery is better than other options.  New York Times article.

Delays in NHS treatment puts early inflammatory arthritis patients at risk

A report published by HQIP (Healthcare Quality Improvement Partnership).

UK government report: Future of an ageing population

Foresight report looking at the challenges and opportunities of an ageing society.

Wright Medical to sell its hip/knee unit for $33M

Wright Medical Group, which merged with Tornier last autumn, announced the divestiture of its large joints business to Corin Orthopaedics for €29.7 million ($33 million) in cash.

Arthritis Statistics Infographic - Did you know...

Arthritis Care's article gives key statistics about arthritis in the UK.

FDA approves first cartilage implant for osteoarthritis

Article in FierceBiotech.  Cartiva has won an FDA premarket approval for its cartilage implant to treat osteoarthritis at the base of the big toe. It is the first synthetic cartilage implant approved by the FDA.

Bioelectronic device improves rheumatoid arthritis symptoms in first-in-human trial

A trio of collaborators announced that clinical trial data showing that an implantable neuromodulation device improved symptoms of rheumatoid arthritis.  The results may also have an impact on patients with other inflammatory diseases, such as Parkinson’s, Alzheimer’s and Crohn’s disease.  This article published by FierceBiotech gives more detail.

Hip Implants—Metal Wear Impairs Bone-Forming Cells' Function

Release of metal ions from metal-on-metal pairings can create concerns for patients.  Article published in Orthopedic Design and Technology.  

Maximising impact in orthopaedic research

There are some 8.5 million people in the UK affected by orthopaedic problems.  This article discusses the need for funded researc to be directed towards more meaningful and translational outcomes that lead to effective treatments, products and services for patients.

Metal hips implanted in last decade more prone to failure

Highlighting the increasing number of hips that were manufactured outside the stated specification - with more than a third of hips manufactured to the wrong size – our research team, at Newcastle, said this may be to blame for the high failure rate of this implant.

Metal-on-metal hip replacements implanted since 2006 'more prone to failure'

Report on itv.com.  New research has suggested that metal-on-metal hip replacements implanted since 2006 are more prone to failure.

The first hip-replacement on the NHS is still intact - making Norman, 91, a world record breaker

A man who had the first hip replacement on the newly-founded NHS in 1948 is now a world record holder – because those hips have survived to this day.  Published by the Western Daily Press.

Summary of key facts about joint replacement (2014/2015)

Poster produced by the NJR.

It is a myth that a higher proportion of young people are getting hip replacements, says National Joint Registry

The information on the number of young people undergoing primary hip surgery is misleading.  What recent reports have failed to highlight is that percentage of patients under-60 years undergoing hip replacement has not changed as a proportion.  There is consistently around twenty per cent of patients each year under-60.

FDA dials up regulation for metal-on-metal hip implants with new premarket approval (PMA) requirement

The FDA has faced reports of problems with metal-on-metal hip implant devices for years.  Regulators think that "there is insufficient evidence and information" that would ensure the "safety and effectiveness of these devices," the FDA said on its website. So the agency issued a final order this week that requires companies to submit a premarket approval (PMA) application for two types of metal-on-metal hip replacement devices.

Have you experienced a snapping hip?

Snapping hip is a condition in which you feel a snapping sensation or hear a popping sound in your hip when you walk, get up from a chair, or swing your leg around.The snapping sensation occurs when a muscle or tendon (the strong tissue that connects muscle to bone) moves over a bony protrusion in your hip.Although snapping hip is usually painless and harmless, the sensation can be annoying. In some cases, snapping hip leads to bursitis, a painful swelling of the fluid-filled sacs that cushion the hip joint.

FDA Ordered Postmarket Studies to Better Understand Safety Issues, and Many Studies Are Ongoing

The US Government Accountability Office (GAO) report on which the  link below is based.

1/2 GAO study finds 510(k)-cleared devices account for 94% of unplanned postmarket safety studies

The GAO (US Government Accountability Office) study analyzed the 313 postapproval market studies and 392 postmarket surveillance studies conducted between 2007 and February 2015.

Australian Orthopaedic Association Annual Report 2015

Australian Joint Registry releases 2015 annual reports on hips, knees, shoulders and more.

FDA slaps most serious label on MicroPort hip implant device recall

China's MicroPort earned the FDA's most serious designation over a recall of devices used in hip joint replacement surgery after reports surfaced that showed the products could be endangering patients' lives.

Launch of the World report on ageing and health

From The World Health Organization.

FDA's new patient-centric advisory committee to provide additional input on device regulation

Article in FierceMedicalDevices.  The FDA's device arm (CDRH) announced the launch of the Patient Engagement Advisory Committee to provide additional perspective on topics like patient preference information, risk-benefit determinations and device labeling. The move is an attempt to ensure that the actual users of devices can influence decision-making, in addition to industry and the medical community.

NJR 12th Annual Report

2015 National Joint Registry is now published.

Zimmer Biomet expands joint preservation procedure into foot and ankle markets

FierceMedicalDevices article.  Zimmer Biomet has widened its patented and trademarked surgical procedure subchondroplasty into use for foot and ankle joints. The company acquired the technology in its 2013 purchase of Knee Creations for an undisclosed amount.

Tornier, Wright merger to close soon after foot and ankle implant divestiture

Tornier just announced a divestiture needed to secure completion of its $3.3 billion merger with Wright Medical. Integra Lifesciences will acquire Tornier's ankle and toe replacement orthopedic devices in the U.S. for an undisclosed amount. It also gained an option to purchase the ex-U.S. rights to Tornier's toe replacement devices.

China FDA signs off on 3-D printed hip implants

FierceMedicalDevices article.  The Chinese Food and Drug Administration (CFDA) approved 3-D printed hip implants in China, encouraging innovation amid an increasingly stringent regulatory environment.

High risk medical devices backed by few studies

Many high-risk therapeutic devices get Food and Drug Administration (FDA) approval with only one study proving their safety and efficacy before going to market.

 
Data from the Nordic Arthroplasty Register Association published in Acta Orthopaedica. 

FDA approves the first implantable, above-the-knee prosthesis

The OPRA (Osseointegrated Prostheses for the Rehabilitation of Amputees) Implant System, as the newly approved prosthetic is known, is from Swedish bone-anchored prosthetic specialist Integrum AB.  Article published in FierceMedicalDevices

NSF spends almost $31M to develop dissolvable metal surgical implants

The National Science Foundation has been investing this research money since 2008 in an effort to develop what it has dubbed "smart implants" that address the underlying medical issue but then dissolve.  (Article published by FierceMedicalDevices).

Budget 2015: our concerns about changes to the welfare system

Read Arthritis Research UK's verdict on how Budget2015 could affect people with arthritis.

Medical device makers beef up product guarantees to woo U.S. hospitals

An article published by Reuters.  Medical device makers, facing sluggish sales and increasing pressure to prove the value of their products, are beefing up guarantees to compensate U.S. hospitals if a device does not perform as expected.  Medtronic Plc, Johnson & Johnson and St Jude Medical Inc are among the first to provide the newer guarantees.  Orthopedic implant makers are exploring such agreements for hip and knee devices.

Study: Web-Based Tutorials Can Help Patients Better Understand Orthopedic Procedures

First-time surgery can be concerning to any patient. Knee surgery—even arthroscopic surgery to treat a torn meniscus—can require significant preparation and rehabilitation. According to a new study appearing in the June 17 issue of The Journal of Bone & Joint Surgery (JBJS), a Web-based tutorial can not only increase a patient’s understanding of the surgery but also provide a better experience.  Article by Orthopedic Design and Technology.

From Australia "Expert review of medicines and medical devices regulation - first report released"

Review of Medicines and Medical Devices: Stage One Report covers recommendations on the regulatory frameworks for medicines and medical devices.

Daily walking 'does not have a negative impact on knee osteoarthritis'

New study discussed by Arthritis Research UK.

Arthritis Research UK: Study to investigate the economic benefits of musculoskeletal research to society

A new study initiated this month by five leading research funders and institutions will estimate the health and economic benefits of UK investment in medical research into musculoskeletal conditions.

UK BBC Radio 4 "You and Yours"

Consumer affairs programme features metal-on-metal hips.

Raising Transparency of  Pricing for Total Hip and Total Knee Replacements

This link provides access to letter from Professor Tim Briggs outlining the price ranges currently being paid by English NHS Trusts for a number of types of hip and knee prosthetic joints.

Why a national implant registry is vital for patient safety

The controversy around PIP breast implants highlights the need for robust systems to track and monitor quality across all surgical devices, says Andy Gordon Jones.

Comparative Epidemiology of Revision Arthroplasty: Failed THA Poses Greater Clinical and Economic Burdens Than Failed TKA

The revision burden for THA is 52% greater than for TKA, but revision TKAs are increasing at a faster rate (article in Clinical Orthopaedics and Related Research).

Is a Revision a Revision? An Analysis of National Arthroplasty Registries’ Definitions of Revision

The reported survival of implants depends on the definition used for the endpoint.  Revision, which is the most common main endpoint used by arthroplasty registries, is not universally defined. This implies that some reoperations that are considered a revision in one registry are not considered a revision in another registry. Therefore, comparisons of implant performance using data from different registries have to be performed with caution.

Middle-age hip replacements nearly double from 2002-2011, outpacing growth in elderly population

Continued growth in hip replacement utilization in patients age 45 to 64, and need for revision surgeries as these patients age, could present significant challenges related to cost and access. The number of total hip replacements (THRs) nearly doubled among middle-aged patients between 2002-2011, primarily due to the expansion of the middle-aged population in the U.S., according to a new study presented at the 2015 Annual Meeting of the American Academy of Orthopaedic Surgeons. Continued growth in utilization of hip replacement surgery in patients age 45 to 64, an increase in revision surgeries for this population as they age, and a nearly 30 percent decline in the number of surgeons who perform THR, could have significant implications for future health care costs, THR demand and access.

What is Rheumatoid Arthritis?

Rheumatoid arthritis is an inflammatory disease, mainly affecting joints and tendons. An inflamed joint looks swollen and red, and appears warm to the touch. The disease usually starts in the wrists, hands or feet, and can spread to other joints and other parts of the body. Rheumatoid arthritis is an autoimmune disease that causes inflammation in your joints. The main symptoms are joint pain and swelling.  Learn more and download a booklet from the Arthirtis Care site on the link above.

Diagnosing arthritis in children

Research at Newcastle University has sped up the diagnosis of arthritis in children.  Doctors all over the world are now using a simple clinical skill to help recognise the most common  form of childhood arthritis, thanks to research by paediatric rheumatologists at Newcastle University.  Early diagnosis of juvenile idiopathic arthritis (JIA) is critical, as the disease – which affects one in every 1,000 children – is most aggressive in its initial stages and can lead to joint deformities, poor quality of life and even blindness if not treated promptly.  The Newcastle team has developed a new tool for the examination of joints called pGALS (paediatric Gait Arms Legs and Spine), which is now taught as a simple clinical skill to medical students and is being used by doctors worldwide.

New device could stop rheumatoid arthritis pain without pills

Researchers are testing out a possible new treatment for rheumatoid arthritis that doesn’t require taking any pills.  The device is surgically inserted into a patient’s neck, where it rests against a nerve. Patients turn the device on for three minutes each day using a magnet. It then sends electrical impulses that reduce the number of immune cells that travel to joints, causing painful inflammation.

Precaution, governance and the failure of medical implants: the ASR(TM) hip in the UK

The failure rate of the Articular Surface Replacement metal-on-metal hip system, implanted almost 100,000 times world-wide, has re-opened debate about appropriate and timely implant governance.  The authors of this article argue that there has been a systemic failure of the governance system entrusted with the safety of patients fitted with medical implants. Commercial considerations of medical implants and the status quo of medical implant governance have been given priority over patient safety despite the availability of significant failure data in an example of uncertainty about what constitutes appropriate precautionary action.  Published in Life Sciences, Society and Policy.

Are Metal-on-Metal hip implants safe?

This fact sheet is based on the Opinion of the independent Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR): “The safety of Metal-on-Metal joint replacements with a particular focus on hip implants".

Rheumatoid arthritis sufferers offered hope after electrical implants leave patients 'pain free'

Article from The Independant.  People suffering from rheumatoid arthritis have been given new hope after some patients fitted with electrical implants reported they had become “pain free

ARUK: Which joints are affected by osteoarthritis?

Osteoarthritis can affect any joint, especially if it’s been badly injured. The most commonly affected joints are: knees, hips, neck and back, big toes and hands.

"Unique Device Identifiers (UDIs): A Roadmap for Effective Implementation"

The U.S. Food and Drug Administration (FDA) is establishing a national unique device identification system to adequately identify medical devices through their distribution and use. When the system is fully implemented, the label of most devices will include a unique device identifier (UDI) in human- and machine-readable form.  Article by Brookings.

Metal on Metal Toxicity from Hip Implants

A video showing a presentation given by Dr. Stephen Tower at Healthwatch USA

Arthritis Today: Sugary Sodas May Raise Rheumatoid Arthritis Risk

A new study finds a link between sugar-sweetened soda and rheumatoid arthritis risk

National Rhuematoid and Arthritis Society (NRAS) have updated their 'What is RA' article

An article by the NRAS to find out more about rheumatoid arthritis

ARUK: To make musculoskeletal conditions a public health priority we need them at the heart of public health activities

Musculoskeletal conditions can have a huge impact on people’s lives. They may not take life, but for many they take away the quality of life.  Prevent, Transform, Cure – the Arthritis Research UK manifesto calls for decision makers to put in place policies that will lead to the prevention and cure of musculoskeletal conditions while transforming the service provided to those that live with them.

From Australia "Medical Devices Safety Update"

This article includes a section on joint replacements and their results

From the Department of Health at the Australian Government: Expert Review of Medicines and Medical Devices Regulation

This review will be performed to identify areas of unnecessary, duplicative, or ineffective regulation that could be removed or streamlined without undermining the safety or quality of therapeutic goods available in Australia; and opportunities to enhance the regulatory framework so that Australia continues to be well positioned to respond effectively to global trends in the development, manufacture, marketing and regulation of therapeutic goods.

From the EU: "Final opinion on Metal-on-Metal joint replacements"

The European Commission has mandated the Scientific Committee on Emerging Newly Identified Health Risks to produce an opinion on “the safety of Metal-on-Metal joint replacements with a particular focus on hip implants”.

Further investigation needed for assessment, treatment protocols of ASR implants

Among patients with Articular Surface Replacement metal-on-metal hip products, the relationship between MRI pathology, metal ion levels and acetabular inclination angles remains unclear, and further investigation is required for setting up protocols for assessment and treatment, according to researchers.

Do Retrieval Analysis and Blood Metal Measurements Contribute to Our Understanding of Adverse Local Tissue Reactions?

Article published in Clinical Orthopaedics and Related Research.  Metal-on-metal (MoM) total hip arthroplasties (THAs) and the head-neck and neck-body junctions in modular THA are associated with a variety of local and systemic reactions to their related wear and corrosion products.  The relationship between laboratory values—including serum metal ion levels—and adverse local tissue reactions (ALTRs) remains controversial and incompletely characterized.  This study showed that serum metal levels generally are elevated in the presence of ALTR but should not be used in isolation for clinical decision-making.  Many but not all patients with ALTR, including those with pseudotumors, demonstrate high wear, but more data and more systematic descriptions of the histopathology are needed to define the amount of wear that induces adverse reactions.

Titan Spine offers first spine implant warranty

This is the orthopedics industry's second product warranty in the U.S.  Titan Spine announced that it's becoming the first spine implant manufacturer to offer a warranty on its products. The 5-year warranty of its Endoskeleton line of spinal interbody fusion devices is the orthopedics industry's second product guarantee, joining Biomet's lifetime warranty of its Oxford Partial Knee.

Arthritis Research UK: Rates of knee osteoarthritis could double by 2035 according to a new charity report

Arthritis Research UK (ARUK) understand that we must address how we reduce the risk of developing a musculoskeletal condition, alongside how we reduce the impact of these painful conditions once they've developed.  Awareness of the link between healthy lifestyles and musculoskeletal health is low, particularly for people already living with the pain and disability of arthritis or back pain. We need to challenge these misconceptions and explode the myth that nothing can be done about arthritis. More information and PDFs are available at the link above.

Medical Device Registries: Recommendations for Advancing Safety and Public Health

In 2012, FDA issued a report, “Strengthening Our National System for Medical Device Postmarket Surveillance,” outlining four key steps for creating a national surveillance system that would quickly identify poorly performing medical devices. One step was to encourage the development of national and international device registries, which contain information on patients who use or are treated with a specific device.  The report outlines five objectives for stakeholders to work toward so that medical device registries can better contribute to the national surveillance system.  More information is given in the link provided above.

Invited comments of Prof. Tom Joyce, Newcastle University on the article below

Clinical Orthopaedics and Related Research invited Prof. Tom Joyce to comment on 'The John Charnley Award: Highly Crosslinked Polyethylene in Total Hip Arthroplasty Decreases Long-term Wear: A Double-blind Randomized Trial'.

Healthline: The effects of rheumatoid arthritis on the body

This article discusses the effects of rheumatoid arthritis on the whole body including the Circulatory System, Skin, Eyes and Mouth along with the skeletal system.

Orthopedic Design and Technology Magazine:"Reducing Medical Device Prices Could Save Australian Government $1 Billion"

Australia's government could save more than $1 billion over four years if prices for medical devices such as pacemakers and hip joints were brought into line with those paid in other countries, private health  insurers contend.  The Medical Technology Association of Australia (MTAA) said discounting to private hospitals does occur but the size of the discounts is not monitored and the Australian Competition and Consumer Commission has not expressed concerns about it.

Orthopedic Design and Technology Magazine: "Is the Hip Implant Market Improving?"

The hip replacement market is beginning to recover from the global recession and controversies surrounding metal-on-metal implants, with procedure volumes growing and patient confidence at an all-time high, according to an analyst with United Kingdom-based research and consulting firm GlobalData.

Intellijoint’s Hip Replacement Positioning System Cleared in U.S.

Intellijoint Surgical (Waterloo, ON) won FDA clearance for its Intellijoint HIP system that’s used to help orthopedic surgeons measure leg length and hip offset during hip replacements. The system consists of two disposable sensors and a display computer that provides the readings.  The company hopes that providing accurate real-time measurements during implantation will lead to improved outcomes, requiring fewer corrective procedures and overall improved comfort for patients.

Biomedical engineering: advancing UK healthcare report

This report by the Institution of Mechanical Engineers gives an overview of biomedical engineering in the UK and includes case studies from UK universities and industry. It looks at the role of technology and biomedical engineers in the NHS, and makes a number of key recommendations, which would help improve healthcare in the UK and stimulate grow in the sector.

Revisions of Monoblock Metal-on-metal THAs Have High Early Complication Rates

A relatively high percentage of monoblock metal-on-metal total hip arthroplasties (THAs) undergo early revision. Revision of these THAs poses challenges unique to this implant type. The early complications after these revisions remain unreported as do the clinical and demographic factors associated with these complications.  Complications and reoperations occur frequently after revision for failed monoblock metal-on-metal THA (20% and 16%, respectively), and older patients appear to be at greater risk for complications after these revisions.  Article published in Clinical Orthopaedics and Related Research.

Cementing broken hips leads to fewer deaths

British Orthopeadic Association response to Telegraph regarding the use of bone cement

The Walking Wounded - Background Information

After the ABC Four Cornerd TV programme in Australia, some valuable background informationis given including some of DePuy's test data

The Walking Wounded

Four Corners TV programme Australia, update on ASR metal-on-metal hip

From India: "CBI probe into faulty hip-implant case mooted" relating to ASR metal-on-metal hip

The Food and Drug Administration (FDA) of Maharashtra has recommended an investigation by the Central Bureau of Investigation in the faulty ASR hip-implant case

FDA Approval of Cardiac Implantable Electronic Devices

An important paper from JAMA discussing how the US Food and Drug Administration (FDA) evaluates high-risk medical devices such as cardiac implantable electronic devices (CIEDs)

EFORT 2013 e-Science Congress Session Online

The mid term survival of Birmingham Synergy total hip replacements

Improving Medical Device Regulation: The United States and Europe in Perspective

Recent debates and events have brought into question the effectiveness of existing regulatory frameworks for medical devices in the United States and Europe to ensure their performance, safety, and quality.  The authors explored and analysed medical device regulatory systems in the United States and Europe in accordance with the available gray and peer-reviewed literature and legislative documents and concluded that additional steps are needed to improve existing policy.

Cobalt poisoning by hip replacement: Arthroprosthetic-Cobaltism

Article by Dr. Stephen Tower discusses cobalt poisoning after metal implants

Seven million Americans are living with an artificial knee or hip

2 percent of Americans have new hips or knees.  Results reported at an American Academy of Orthopaedic Surgeons conference in New Orleans

VIDEO presentation: The Dangers of Metal-on-Metal Hip Implants

Slides presented by Dr. Steven Tower at Health Watch USA Meeting - From Alaska over Adobe Connect
Feb. 19, 2014

Hip Replacement Implant Materials

There is no consensus in the orthopedic community regarding the single “best” bearing or material.  Only a qualified orthopedic surgeon can determine which implant system is best for your unique situation. There are many factors your surgeon uses when recommending hip implants. Be sure to ask questions and share any concerns you might have regarding specific implants with your surgeon early in the process

Effects of Intensive Diet and Exercise on Knee Joint Loads, Inflammation, and Clinical Outcomes Among Overweight and Obese Adults With Knee Osteoarthritis

Among overweight and obese adults with knee osteoarthritis, after 18 months, participants in the diet + exercise and diet groups had more weight loss and greater reductions in IL-6 levels than those in the exercise group; those in the diet group had greater reductions in knee compressive force than those in the exercise group

Exercise therapy may postpone total hip replacement surgery in patients with hip osteoarthritis

A long-term follow-up of a randomised trial suggests that exercise therapy in addition to patient education can reduce the need for THR by 44% in patients with hip osteoarthritis

Fractures of a Single Design of Highly Cross-Linked Polyethylene Acetabular Liners

From Arthroplasty Watch. Researchers investigating 74 reports of fractured liners in a single design (Trilogy Longevity Zimmer) voluntarily filed to the FDA concluded that liners less than 7 mm thick at the weight bearing or 4.8 mm thick at the rim of this design should be used with caution

Blood cobalt levels, device type may predict metal-on-metal hip failure

Elevated concentrations of cobalt in the blood and device type may predict early failure of metal-on-metal hip replacements, according to researchers from the United Kingdom

Women less likely than men to have hip replacement

One in ten Australian women will have total hip replacement surgery during their lifetime, but women still lag behind males in rates of joint replacement for hip osteoarthritis, research suggests

Lifetime risk of total hip replacement surgery and temporal trends in utilisation: A population-based analysis

The lifetime risk of THR for females was similar to males

Arthritis Research UK. Shoulder and elbow replacement

Arthritis Research UK article.  Do you need a shoulder or elbow replacement?  Read more about the surgery at the link above.

Failure rate of cemented and uncemented total hip replacement

YouTube presentation posted by BMJ

Europe CE Approval Process for Medical Devices

Useful summary of "Europe CE Approval Process for Medical Devices"

Johnson & Johnson Shifting from Devices to Drugs in 2014

Drugmaker Johnson & Johnson is shifting its focus from medical devices and diagnostic equipment to pharmaceuticals

National Public Radio (US) on DePuy ASR settlement

Patients, Consumer Advocates Question Hip Implant Settlement

BioPen to rewrite orthopaedic implants

A handheld ‘bio pen’ developed in the labs of the University of Wollongong (UOW) will allow surgeons to design customised implants on-site and at the time of surgery

BBC: New genetic clues for rheumatoid arthritis 'cure'

An international team of researchers has found more than 40 new areas in DNA that increase the risk of rheumatoid arthritis

FDA Announces Improvements To The Medical Device Recalls Database

The Food and Drug Administration (FDA), Center for Devices and Radiological Health (CDRH) has announced improvements to several public databases that will increase access to safety information on marketed medical devices

Experience with ASR metal hip joint

Dr Steven Tower, orthopaedic surgeon and recipient of ASR metal hip talks of his experiences in a 1-hour video

Reuters: "EU Parliament stops short of U.S.-style approvals for medical devices"

The EU parliament backed plans for tighter monitoring of device manufacturers

REVIEW: 9th Annual Bath Biomechanics Symposium: Beyond Compliance – Post-Implant Clinical Release Surveillance

Orthopaedic Product News article on symposium discussing ways to improve and evolve today’s orthopaedics devices and implants

It's hip to be repaired

A useful summary of total hip replacement

Hip replacement

About the hip joint and hip replacement

In contrast to a previous view, some hyaluronic acid injections into the knee can have a benefical effect

Researchers have concluded that intra-articular injections of hyaluronic acid for the treatment of knee osteoarthritis significantly improve pain and function compared to placebo

Patients who receive medical implants are becoming younger and expecting more - but are there risks?

Trends in the ages of patients undergoing hip surgery

Industry-funded studies on HA present more favorable conclusions

An article discussing a paper in press presenting results on the use of hyaluronic acid injections in patients with osteoarthritis of the knee.

Diagnostic accuracy of MRI v ultrasound for detecting pseudotumors in asymptomatic metal-on-metal total hip arthroplasty

Ultrasound recommended

Commentary on "High Prevalence of Pseudotumors" article

Commentary on the article below

Journal Bone Joint Surg: "High Prevalence of Pseudotumors in Patients with a Birmingham Hip Resurfacing Prosthesis"

Investigation into the occurence of pseudotumors (lesions that are neither malignant nor infective in the soft tissues surrounding total hip arthroplasty components) after hip arthroplasties with metal-on-metal bearings

Metal ion concentrations in body fluids after implantation of hip replacements with metal-on-metal bearing – systematic review

Summarising and appraising published studies on metal ion concentrations after metal-on-metal total hip arthroplasty 

Metal-on-meta hip prostheses and systemic health: a cross-sectional association study 8 years after implantation

Investigation into the long term systemic health effects of metal released from hip replacement prostheses

Description of metal-on-metal pseudotumour

A radiography website gives a description of a metal -on-metal pseudotumour

National Joint Registry launches its first-ever eBulletin news service

A monthly email delivering news, events and other updates from the NJR and all other relevant healthcare organisations

Metal-on-metal hip implants questions and answers

Metal-on-metal hip Q&A from New Zealand Regulator with links to different hip implant designs at top of page

Metal ions point to metal-on-metal hip failure

A review of Dave Langton's recent (see below) BMJ Open paper on metal ion concentrations

BMJ Open (access) article on the clinical implications of blood metal ions in metal-on-metal hip resurfacing patients 

Are elevated blood cobalt (Co) concentrations associated with early failure of metal-on-metal hip resurfacings secondary to adverse reaction to metal debris

Tribology and Total Hip Arthroplasty Implants

Interview with orthopaedic specialist about aspects of tribology of implants

Berwick Review into Patient Safety in the NHS

Recommendations to improve patient safety in the NHS in England

Should we assume medical devices work until proven otherwise?

Blog article by the British Medical Journal

New England Journal of Medicine

Distribution of Industry Payments to Massachusetts Physicians 

Medical Device Alert for ADEPT

Medical device recall notice for the DePuy total hip replacement

Implants under the microscope

Finland British Medial Journal Paper examining the number of incidence of Cancer for hip replacement patients 

Risk of cancer with metal-on-metal hip replacements: population based study

Article from Professional Engineer, including comments from Tom Joyce on manufacture of medical devices

The DePuy hip replacement recall (text)

Debate session of the Committee on Health and Children of the Oireachtas - Irish National Parliament

The DePuy hip replacement recall (video)

Debate session of the Committee on Health and Children of the Oireachtas - Irish National Parliament

Researchers set safe upper limit metal ion levels for metal-on-metal hip resurfacings

Study from Finland advises safe levels should be set lower than current MHRA advice

Delays and Difficulties in Assessing Metal-on-Metal Hip Implants

New England Journal of Medicine opinion piece on medical device regulation in the USA

FDA panel discusses metal-on-metal hip arthroplasty systems

Blog which provided live coverage of the FDA review as it happened - patient comments stand out

Parliamentary Select Committee on the regulation of implants

British Medical Journal blog summarising problems with medical device regulation

KRO Reporter Netherlands covers metal-on-metal hip failures 

Dutch TV documentary about metal-on-metal hip failure that we took part in (in Dutch)

Newsnight feature metal-on-metal hips

UK Newsnight and BMJ TV documentary on metal-on-metal hips which we took part in

Metal-on-Metal Hip Replacement Recall Animation

Clear animation on how metal-on-metal hips are failing, although there are more issues than cup positioning

Medical devices: European Commission calls for immediate action

Press Release from the EC about the move to tighten controls, increase surveillance and restore confidence in medical devices

Calls for enquiry in New Zealand

New Zealand Labour party calls for Select Committee enquiry into faulty hip replacement equipment

Advice from Denmark

Danish Orthopaedic Society advises no more metal-on-metal hip implants in Denmark

How safe are metal-on-metal hip implants?

British Medical Journal raises new concerns over the evidence for failure with metal-on-metal hip implants

Metal on metal hips - patient advice

British Hip Society and British Orthopaedic Association issue advice for patients following news articles about total hip replacement and cancer

Ongoing problems with metal-on-metal hip implants

British Medical Journal article on problems with regulation affecting metal-on-metal hips

BMJ "Out of Joint" feature

British Medical Journal covers the background to the ASR failures

Tom Joyce discusses regulation

Video of Tom Joyce, made as part of the BMJ "Out of Joint" feature

Tony Nargol discusses ASR failures

Video of Tony Nargol, made as part of the BMJ "Out of Joint" feature

Dave Langton discusses engineering analysis

Video of Dave Langton,

ABC’s Four Corners “Joint Reaction”

Australian television programme about metal-on-metal hip failures, much of it from a patient viewpoint

Channel 4’s Dispatches “The Truth About Going Under The Knife”

UK investigative television programme - background details only - broadcast no longer available

  

UK Organisations

MHRA – Medicines and Healthcare products Regulatory Agency

Altogether ASR patient support group

Arthritis Care

NJR – National Joint Registry

BOA – British Orthopaedic Association

Joint Action. Keeping People Mobile

The Royal College of Surgeons of England

 

New European regulations covering medical devices will be final in June