Metal/Metal Evaluation

Evaluation of Patients with Hip Resurfacing or a Metal-Metal Bearing Total Hip


Clinical history and laboratory testing demonstrated the low wear potential of metal-metal bearings.  The majority of hips today with a metal-metal bearing have low wear and are functioning well.  However, it has been recognized that certain circumstances can produce higher wear and higher metal ion production.  The patient may not have any pain or other symptoms.

The Evaluation
All patients with a hip resurfacing or a metal-metal bearing total hip should have an annual evaluation by an orthopaedic surgeon.  The evaluation should include an interview and an examination, x-rays including a true lateral of the hip, and a blood test for cobalt and chromium ion levels.  Depending upon the results of that evaluation, cross-sectional imaging of the hip(s) (ultrasound, CT scan, or metal-artifact reduction MRI scan) may be indicated.  If there are concerns about any other organs, a qualified internist can direct additional evaluations.

The fundamental question to be addressed on a case-by-case basis is, does the benefit-to-risk ratio favor a revision surgery or not?  The decision to revise has historically been most influenced by 1) how the hip feels and functions and 2) how risky is a revision for that patient?  At this time, there is debate regarding the role of cobalt and chromium ion levels in decision-making for revision surgery.  Cross-sectional imaging, which can demonstrate reactive changes in the adjacent soft tissues, is of more value in surgical decision-making.

The JRI physicians and staff are knowledgeable and experienced in the evaluation of artificial hip joints, including hip resurfacings and total hips with metal-metal bearings.

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