Intended for healthcare professionals


Follow-up of patients with metal-on-metal hip replacements

BMJ 2017; 358 doi: (Published 18 July 2017) Cite this as: BMJ 2017;358:j3387
  1. Andy Carr, Nuffield professor of orthopaedic surgery
  1. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
  1. andrew.carr{at}

Manufacturers should share the financial burden of MHRA’s more stringent requirements

The Medicines and Healthcare Products Regulatory Agency (MHRA) has revised its advice for follow-up of all patients who have received metal-on-metal hip replacements.1 This change is based on consultation with its independent expert advisory group and evidence from the 13th annual report of the UK National Joint Registry, which suggests a continuing risk of adverse soft tissue reactions to metal particulate debris in recipients.2

Types of implant

Over 65 000 metal-on-metal prostheses were implanted in the UK, and, although most continue to function well, more than 17 000 patients have ongoing symptoms and a large number have required revision surgery.3 The best way to monitor and advise patients is still debated. Not all metal-on-metal implants are the same, and essentially there are two classes: non-stemmed surface replacements, which have metal bearing surfaces that can produce wear particles from the articulation, and stemmed replacements, which have a metal taper junction between head and stem and a …

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