Metal hip failures

SIR – I write in relation to your report (June 30) about the high failure rate of metal-on-metal hips. We cannot with a clear conscience relegate this episode to history until it has been re-appraised in the round.

These implants did not implant themselves. That means debating what role, if any, orthopaedic surgeons and hospitals played in the genesis of the metal-on-metal problem.

Orthopaedic surgeons know that metal-on-metal joints were first used in the Sixties and Seventies. The main causes of failure were then pain, aseptic loosening and adverse reactions to metal debris. These are the same problems that brought down recent metal-on-metal hips.

These complications were published in mainstream orthopaedic literature in the Seventies and Eighties in relation to the pioneering metal-on-metal implants of Ring and Mckeefarrar. The issues of raised metal ions and fragments in the tissues and bloodstream were first published then.

When a hospital was considering the introduction of “new” modular metal-on-metal joint replacements and resurfacings, any reasonable duediligence process would have uncovered these earlier publications. These complications should not, then, have been unexpected, and were material to the consent process that patients undergoing metal-on-metal hips took part in. Hopefully they were disclosed, in the majority of cases.

Looking forward, the initiatives called “Beyond Compliance” and “Getting It Right First Time”, introduced by the British Orthopaedic Association will reduce the chance of similar problems happening again.

My sympathies go out first to the patients who have borne the suffering of metal-on-metal hip failure with remarkable stoicism, who in some cases will continue to live with consequent disability long into the future. Secondly, I salute the orthopaedic surgeons who have had to perform surgical salvage in situations that may present very considerable technical challenges.

Richard J Montgomery FRCS Middleton St George, Co Durham