Metal on metal hips and implants have drawn recent coverage in the national media. Here is our break down of this information.
These articles have focussed upon two clearly separate issues.
Revised MHRA Guidance
There has been some revised guidance published by the Medicines and Healthcare Products Regulatory Agency (MHRA). The MHRA have in recent years issued various guidance documents about metal on metal hips.
The 2017 guidance shows an increased understanding of metal on metal issues. It is based upon learning lessons from previous hip failures. Essentially this is a refining previous guidance rather than something new.
Metal on metal Hip Testing and Monitoring
The guidance recommends follow-up testing and monitoring for those with a metal on metal hip still inside them. These guidance notes appreciate that many have already been revised.
The type of monitoring includes MRI scans, with metal artefact reduction to examine fluid, which may be around the hip joint. They also suggest testing blood metal ion levels to see how much cobalt and chromium is in a patient’s blood.
The new guidance, if followed, should help to check on the many thousands of patients who have had these implants. It could help those who have had them removed.
Soft Tissue Damage Can Occur Without Pain
A key change in the MHRA guidance is the acceptance that soft tissue necrosis (which is essentially the destruction of bodily tissues) can occur in patients with or without hip pain.
This destruction of bodily tissue in patients who otherwise have no symptoms means that people might not know there was anything wrong with their hip without medical testing. The MHRA stress that it is important for hospitals to ensure adequate regular follow-up appointments for all people who have a metal on metal hip in place.
The guidance stresses the importance of individuals to contact their treating hospital to ensure they are part of any review programme. They should make sure they have not fallen off the hospital radar, perhaps due to a house move or name change.
Blood Metal Ion Levels Do Not Reflect What Is Happening In the Hip
Another key change is that previous MHRA advice said that consideration should be given to revision surgery once a patient’s blood metal ion levels exceeded seven parts per billion.
The new advice confirms that,
“There is no agreed threshold value for whole blood metal levels that either predicts outcome, or mandates revision”.
It has long been Corries view that even people with low metal ion levels in their blood can suffer major adverse reactions to their metal hip. This may need revision. We have seen and discussed this with our clients.
It is heartening that the MHRA recognise that it is not possible to use blood metal ion levels ALONE as a diagnostic tool. This is because the level in the blood does not necessarily reflect what is happening in the hip joint.
This guidance stresses the need for both blood tests and MRI scans in people with a metal on metal hip in place.
Metal on metal hip – Poisoning
An article published on 10th July 2017 focussed upon cobalt, which is one of the metals used in hip prostheses. The article centred upon whether the cobalt particles could cause heart problems or dementia in hips patients.
As solicitors we represent a large numbers of patients with metal on metal hips. We are acutely aware of the worries of our clients that other health problems may have been caused by the metal in their bodies. Unfortunately, many of these health conditions are those associated with general ageing. In large part hip patients are among the more mature age group.
This article notes research has noted an increased amount of certain health issues in patients whose implants were being replaced. These include heart and memory problems. However, it was noted that there were only thirty reported instances of metal poisoning worldwide. This is worrying to those who have metal on metal hips in place.
Corries are pleased that this article highlights this issue. It is not only a concern for our clients but is also of concern for the medical community at large.
The Times has quoted Dr Neil McGuire (the clinical director of medical devices at the MHRA) as saying
“If we find something we’re not going to keep quiet about it”
To those acting for patients, this is vital. Currently there is no evidence that cobalt has caused problems among many patients. However if something arises then it will be published and the public will be made aware. Certainly, this will be an area of on-going study for medical professions. We are keeping a close eye on this. If any link is ever established then we will bring it to public attention so that people are properly informed.
What Does This Mean For You?
These recent publications are a reflection of increasing knowledge in the medical community about metal on metal hips. The reports show how they fail and how this failure differs to failure of other medical products which can occur without pain.
The articles reflect an on-going interest in ensuring that there are no long lasting effects to metal in the human body. This is vital for existing metal on metal hip patients and for patients with future medical prostheses.
Our conclusion is for patients not to worry excessively but to ensure that they receive the appropriate follow-up appointments from their medical professionals. If in doubt about whether this applies to you, call your doctor as soon as possible.
Corries expert medical claims team have unrivalled experience in dealing with medical claims. Call our team today for a no obligation discussion on 0800 655 6550.
Follow this link for more information about hips https://www.corries.co.uk/product-liability/hip-replacements/