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A Multinational Assessment of Metal-on-Metal Bearings in Hip Replacement
Stephen E. Graves, MBBS, DPhil, FRACS, FAOrthA1; Alastair Rothwell, MBChM Otago, FRACS, FNZOA2; Keith Tucker, FRCS3; Joshua J. Jacobs, MD4; Art Sedrakyan, MD, PhD5
1 Australian Orthopaedic Association National Joint Replacement Registry, Discipline of Public Health University of Adelaide, MDP DX650 511, Adelaide SA 5005, Australia. E-mail address: segraves@aoanjrr.org.au
2 New Zealand Joint Replacement Registry, Department of Orthopaedic Surgery and Musculoskeletal Medicine, Private Bag 4710, Christchurch, New Zealand
3 National Joint Replacement Registry England and Wales, The Mill House, Mill Road Barnham Broom, Norwich, Norfolk NR9 4DE, United Kingdom
4 Department of Orthopedic Surgery, Rush University Medical Center, 1725 West Harrison Street, Professional Office Building, Suite 1063, Chicago, IL 60612
5 Weill Cornell Medical College of Cornell University, Suite LA 223, 402 East 67th Street, New York, NY 10065
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Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

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Investigation performed at the National Arthroplasty Registries of Australia, England and Wales, and New Zealand

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Dec 21;93(Supplement 3):43-47. doi: 10.2106/JBJS.K.01220
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There is emerging evidence that many metal-on-metal (MoM) bearings, when used with large femoral heads in conventional hip replacement and some resurfacing prostheses, are associated with increased rates of revision arthroplasty. Registries are the main sources of data on MoM prostheses. At the recent International Consortium of Orthopaedic Registries (ICOR) meeting, data were presented from the Australian, England and Wales, and New Zealand registries. All registries reported an increased rate of revision for large femoral head MoM prostheses when prostheses were aggregated compared with the aggregated data of hip prostheses with other bearing surfaces. There was also evidence, however, that the outcome varied, depending on the type of prostheses used, in both large femoral head MoM conventional hip replacement as well as resurfacing hip replacement.

The relevance of the recent isolated case reports on systemic metal toxicity was also discussed at the ICOR meeting. Although systemic metal toxicity appears to be a rare occurrence, there is a need to undertake appropriately designed studies to define the true prevalence of this phenomenon. There may be advantages in nesting these studies within registries. The ICOR meeting highlighted the implications of the MoM experience for the orthopaedic industry, regulators, and surgeons.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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