Tag Archives: failure rates

All-metal hips ‘wear down faster’

Published on Monday 4 June 2012 03:23

“Experts are calling for controversial metal-on-metal hip implants to be banned,” according to the Guardian. the newspaper said that research has found “unequivocal evidence” of high failure rates of these implants, particularly among women.

In recent months there has great deal of scrutiny about the safety of some types of metal-on-metal hip replacements, with concerns they wear out much faster than implants featuring plastic and ceramic parts.

To examine the issue, researchers working on behalf of the National Joint Registry in England and Wales analysed data on 402,051 hip surgeries performed using implants attached to the thigh bone by a metal stem, including 31,171 metal-on-metal implants. Researchers found that these had higher failure rates than other types of hip replacement, with an overall five-year failure rate of 6.2%. those with larger ‘heads’ (the part of the implant fitting into the hip joint socket) had a higher failure rate than those with smaller heads, as did hip implants in women.

This study provides more information on the longer-term performance of metal-on-metal hip replacements, and supports claims that they do not last as long as other types of hip implants.

The use of this type of implant in England and Wales is reported to have dropped dramatically since 2008, and the ongoing concerns seem likely to reduce its use further. Overall, this study supports the recent recommendations by UK health regulators. It states that people with large-headed metal-on-metal implants should be monitored carefully over time to identify whether their implants are wearing down at a faster rate.

The study was carried out by researchers from the Universities of Bristol and Exeter, and the Centre for Hip Surgery at the Wrightington Hospital in Lancashire. It was performed on behalf of the National Joint Registry of England and Wales, which also funded the research.

The study was published in the peer-reviewed medical journal the Lancet.

This story was covered in a balanced way by the Guardian.

In recent months there has been some concern over the use of certain all-metal hip implants, particularly over whether they wear down at a faster rate compared to other types of implants.

Hip implants come in a variety of different sizes and materials, but the debate has centred on large-headed ‘metal-on-metal’ implants. These implants are designed so that both the ball replacing the top of the thigh bone and the artificial socket placed in the pelvis are made from metal.

This research was a registry study looking at data on hip implants collected by the National Joint Registry of England and Wales, which records all hip and knee replacement surgeries. This includes the first operation to install the implant, and any revision operations carried out to replace or remove part of the original implant.

Just like with natural bone, metal hip implants experience wear and tear and can eventually deteriorate. This means any implant may eventually need revision surgery, although analysing the revision rate gives an estimate of how often and how soon implants fail early. while the revision rate is an important indicator of the outcomes of hip replacement, it should be noted that not all hip implants that do not function well or cause pain will be replaced.

The researchers say that due to their resistance to wear, large diameter metal-on-metal hip stemmed implants have become popular. ‘Large diameter’ refers to the size of the ‘head’ part of the implant that sits in the hip socket section of the implant. Stemmed means the head is attached to an elongated stem that sits inside the top of the high bone and holds the head in place.

The study’s authors note that there have been concerns about the high failure rate of one particular brand of metal-on-metal hip stemmed implant called ASR, which was withdrawn from use in 2010. given this withdrawal and fresh concerns about other types of metal-on-metal implants, the researchers aimed to look at whether general metal-on-metal hip stemmed implants fail any more regularly than other hip implants (ceramic-on-ceramic or metal-on-polythene). they also looked at whether large diameter hip implants lasted any longer than implants with smaller diameter heads.

This type of registry analysis is useful for monitoring the long-term performance of devices once they are in use. It can help to identify any problems that are occurring with the implants. Ideally, data on the comparative performance of different implants would come from randomised controlled trials, but the researchers report that there are few such studies available.

The researchers looked at 402,051 first total-hip replacements using a stemmed implant carried out in England and Wales between April 2003 and September 2011. they then identified any revision operations carried out on these hip implants. This allowed them to determine how long it took before a revision operation was needed for each type.

The researchers did not include data on ASR implants in their analysis, because they are already known to have much higher revision rates than other brands and have already been withdrawn from the market. the researchers also only included data on hip replacements that had sufficient data recorded to allow them to identify which operations were revisions of which earlier hip replacements. This allowed them to analyse data on 82% of all first total-hip replacements using a stemmed implant performed in the study period.

The researchers tried to make sure the hip implant operations being compared were as similar as possible. for example, they only included those where the implants were not ‘cemented’ in, and where the operation was being performed in ‘typical’ patients.

Typical patients were defined as those whose hip replacement was needed due to osteoarthritis only, and who were generally healthy or with only mild illness at the time of primary surgery. This was defined using a recognised measure of pre-operative health. the researchers also took into account the age of the patient, and looked at men and women separately.

The researchers found that metal-on-metal hip implants were used in 8% of the 402,051 first total hip replacements using a stemmed implant. This equated to 31,171 replacements. use of these types of implants peaked around 2008 but then reduced sharply after this.

Overall, metal-on-metal implants required revision due to failure more quickly than other implants, with a 6.2% needing revision within five years of implantation. the size of the head of the metal on metal implant affected the failure rate in men and women, with larger heads failing earlier. Overall, each 1mm increase in head size increased the risk of revision over time by about 2% (hazard ratio [HR] 1.020 in men, 95% confidence interval [CI] 1.004 to 1.037; HR in women 1.019, 95% CI 1.001 to 1.038).

In men aged 60 years, the five-year revision rate was 3.2% for 28mm head metal-on-metal implants, and 5.1% for 52mm head implants. In younger women, the five-year revision rate was 6.1% for 46mm head metal-on-metal implants, compared with 1.6% for 28mm head metal-on-polyethylene implants.

Revision rates for metal-on-metal implants were higher for women than men, even with implants with the same head size. for example, a 36mm head metal-on-metal implant in women aged 60 had a five-year revision rate of 5.1% compared to 3.7% among men of the same age and implant head size.

However, larger head sizes were more durable for ceramic-on-ceramic hip implants. In men aged 60 years, the five-year revision rate was 3.3% with 28mm head ceramic-on-ceramic implants, and 2.0% with 40mm head ceramic-on-ceramic hip implants.

Age also had an effect on hip implant survival for women, with younger women receiving hip implants more likely to have revision surgery.

The most common reasons for revisions were loosening and pain, and these were more common in people who had metal-on-metal implants.

The researchers concluded that metal-on-metal stemmed hip implants have a higher failure rate than other options, and should no longer be used. they say all patients with these types of implants should be carefully monitored, particularly young women whose hip implants have large diameter heads. they say that their findings support the continued use of large diameter ceramic-on-ceramic bearings as they seem to perform well.

Metal-on-metal hip implants have been under intense scrutiny in recent months, and this analysis provides useful data on how often they require revision and how they compare to hip implants made of other materials. Overall, this research indicates that metal-on-metal hip implants have higher revision rates (rates of replacement) than other types of hip implants in England and Wales.

As with all such studies, there is the possibility that factors other than the implant type differed between the groups being compared, and that these other factors may influence the results. the researchers tried to minimise the risk of this by:

  • comparing similar operations in similar patients
  • looking at men and women separately
  • looking at the effect of age and implant head size

However, there are other factors such as activity levels that could still be having an effect.

As the data used in this study came from a surgical registry, not a lot of information was available about factors such as body mass index (BMI) or activity levels. These two factors could potentially influence the stress implants are placed under and therefore the wear that they display. the researchers say that in their opinion there is no obvious reason to suppose that these factors would vary to a large extent between people receiving the different large head metal and ceramic hip implants.

Due to these inherent limitations with observational research it is difficult to conclude that the differences seen are definitely due to the implants alone. the advantage of this registry data is that a large number of people were assessed. furthermore, this is not a selected subsample of people receiving hip implants but all patients from different surgeons and using different implants. the researchers say that these strengths and the consistency of their findings support the suggestion that these findings do represent the true effects of the implant types.

Overall, these findings do seem to suggest that metal-on-metal hips do require revisions more frequently than other types of hip implants. This study reports that since 2008 there has been a dramatic reduction in the use of metal-on-metal hip implants in England and Wales. Overall it found that most hip replacements analysed in the study period (92% between April 2003 and September 2011) did not use metal-on-metal implants.

It seems likely that based on this study their use may decline further. It is important to bear in mind that the overall five-year revision rates with metal-on-metal hips is 6.2%, so the majority of these implants have not needed revision in this time. This study supports the authors’ suggestion and MHRA recommendation that people with these implants should be monitored carefully over time, to identify when such revisions might be required.

Analysis by Bazian

All-metal hips ‘wear down faster’

New Study Reveals PIP Breast Implants High Failure Rate

A new research conducted by British doctors suggests that the rate of failure of PIP silicone breast implants could be up to 33.8 percent, which is significantly higher than the 2 percent to 5 percent failure rates usually reported by previous studies.

Under the new study, researchers examined patients who had PIP implants for primary/secondary breast augmentation from January 2000 to August 2005 in order to determine the rate of failure and other complications. The study found that PIP implants’ failure rate could range from 15.9 percent to 33.8 percent.

Most of the earlier researches typically used clinical examination and were based on multiple technique, multiple surgeon, with small number of study participants and shorter follow up time period. with the new study, all patients were scanned with ultrasound, providing conclusive sign of rupture, said lead authors Miles Berry and Jan Stanek, whose work appeared in the Journal of Plastic, Reconstructive and Aesthetic Surgery.

PIP silicone implants were formally recalled in the UK market two years ago due to concerns on its durability. There have been also concerns on the filler gel and outer cover of the breast implant called elastomer.

For the new study, plastic surgeons used PIP implants for secondary and primary breast augmentation. They then created a database of patients, who were offered a consultation for free and referral for ultrasound scan. Among the major outcome measures were implant rupture rate, time to rupture and secondary surgery.

The researchers identified 453 patients with PIP implants, 30 of whom had already gone through implant exchange. One hundred eighty patients or 39.7 percent could not be reached and 19 had gone through implant removal. Forty-seven of the patients who were contacted refused consultation for they didn’t have any concern. Ninety-seven patients had neither radiographic evidence nor clinical signs of rupture and chose to stay under regular review, while 38 had gone through implant exchange following ultrasonographic sign of rupture.

Given that those who could not be contacted had no ruptures, the overall rate of rupture would stand at 15.9 percent. But if they had the same rate of rupture as the patients examined in the research, the overall rate would reach 33.8 percent.

With these findings, researchers suggest that all PIP silicone breast implants may have to be removed due to the high rate of rupture and the uncertainty on the nature of the gel. Implants among patients with rupture will have to be removed, while those without evidence of rupture will have to be monitored regularly. on the nature of the gel filler and elastomer, further study may still be needed to determine if there is a need to explant all PIP implants in the future.

This initial research is just the tip of the iceberg that may affect 40,000 women with PIP breast silicone implants in the UK. More than 400,000 women worldwide are estimated to have received PIP implants.

New Study Reveals PIP Breast Implants High Failure Rate

No cancer rise in hip implant patients – Health – Halifax Evening Courier

Published on Wednesday 25 April 2012 09:49

“There is no evidence that metal-on-metal hip replacements increase the risk of cancer,” the BBC reported today.

The story is based on a study that found that patients with metal-on-metal hip replacements did not have a higher risk than the general population of developing cancer up to seven years after surgery, or than patients with hip replacements made of other materials.

The study comes in the wake of recent concerns about metal-on-metal hip implants, including high failure rates and the possible risks of small amounts of metal (ions) being released into the body. while the findings are reassuring, this type of study has limitations. In particular, it only looked at the risk of cancer within a few years of having hip replacement surgery. given that several cancers can take many years to develop, a study of longer-term outcomes of metal-on-metal implants is required and recommended by the researchers.

Recommendations from UK health regulators state that people with large metal-on-metal implants should be monitored annually. if they have any concerns, they can consult their doctor for patient-specific guidance.

The study was carried out by researchers from the University of Bristol, University of Exeter and Wrightington Hospital, Wigan. It was funded by the National Joint Registry for England and Wales.

The study was published in the peer-reviewed British Medical Journal, which has recently published a number of pieces on the wear rate and safety of metal-on-metal hip implants. most notably, it conducted a joint investigation with BBC’s Newsnight.

The research was reported fairly by the media. both the BBC and The Daily Telegraph pointed out that the study only looked at cancer rates up to seven years after surgery, and that ongoing monitoring may need to be performed.

The authors point out that metal-on-metal hip implants have become popular over the past decade. These consist of:

  • resurfacing implants – where only the articulated surfaces of the existing hip joint are replaced with metal 
  • ‘stemmed’ implants – in which the ball replacing the top of the thigh bone and the artificial socket placed in the pelvis are made of metal. As their name suggests, stemmed implants feature an elongated metal stem that surgeons slide down into the thighbone to secure the implant in place

However, recent data show that all-metal stemmed implants have significantly higher failure rates and that metal-on-metal resurfacing implants have an above-average failure rate compared with implants made of other materials (such as ceramic or plastic).

In addition, the researchers say that little is known about the biological effects of the metals – predominantly cobalt, chromium and molybdenum – which are released into the body as the surface of the implants wears down. The researchers say that traces of these metals can be found in many organs, including the marrow, blood, liver, kidneys and bladder. They also say there is evidence that patients who have had joint replacements show a higher than normal incidence of DNA (genetic) damage, although there is no proven link between this and an increased risk of cancer.

To assess any raised risk of cancer, this study compared rates of cancer in patients with metal-on-metal hip implants to rates in patients with hip replacements made of alternative material, within seven years of surgery. It also compared cancer rates in patients undergoing hip replacements with those of a section of the general population, with predicted cancer rates matched for age and sex.

The researchers used data on hip replacements from the National Joint Registry of England and Wales, a database that holds records on over 1 million joint replacement procedures undertaken since its establishment in 2003. Researchers consulted all relevant data up until April 2011. The Registry is also linked annually to national hospital episode statistics data, in order to routinely monitor health information on patients who have had joint replacements. The hospital episode statistics data collection contains details of all admissions to NHS hospitals in England. It includes private patients treated in NHS hospitals, patients who were resident outside England and care delivered by treatment centres (including those in the independent sector) funded by the NHS.

For their study, the researchers used data from 289,571 patients in England who underwent hip replacements from 2003 to 2010, for whom joint registry data could be linked to hospital episode statistics. this comprised 40,576 patients who had metal-on-metal hip replacements and 248,995 who had hip implants made of other materials.

The researchers looked at hospital episode statistics data on these patients between 1997 and 2010, including any diagnoses of cancer (other than non-melanoma skin cancers) in the years after hip replacement. They also looked separately at specific cancers suspected of being related to metal ions, including blood cancers (such as leukaemia), malignant melanoma, prostate cancer and renal tract cancer (cancer of the bladder, ureter or kidney). They excluded from their analysis any patient who had a recorded diagnosis of the specific cancer before or at the time of their hip replacement.

They compared the outcomes in patients with metal-on-metal hip replacements (both stemmed and resurfaced) with patients who had hip implants made of other materials. They separated patients into three groups: those with stemmed metal implants, those with metal resurfacing, and total hip replacement with other materials. They adjusted their results for other factors that might affect the risk of cancer such as age, sex and general health.

In addition, they compared cancer rates in patients undergoing any type of hip replacement with those in the general population, using age- and sex-matched predicted incidence rates derived from national data.

The study found that, compared with patients who had hip implants made of other materials, there was no evidence that metal-on-metal implants were associated with an increased risk of any cancer diagnosis in the seven years after surgery. this was based on an average (mean) follow-up of three years, with 23% of patients observed for five years or more. Similarly, there was no increase in the risk of malignant melanoma or cancers of the blood, prostate and renal tract.

For men aged 60, the risk of being diagnosed with any cancer in five years after surgery was:

  • 4.8% (4.4% to 5.3%) after metal-on-metal resurfacing
  • 6.2% (5.7% to 6.7%) after a stemmed metal-on-metal implant
  • 6.7% (6.5% to 7.0%) after a hip implant made of other materials

For women aged 60 the rates were lower:

  • 3.1% (2.8% to 3.4%) after resurfacing
  • 4.0% (3.7% to 4.3%) after a stemmed metal-on-metal implant
  • 4.4% (4.2% to 4.5%) after other types of material

The researchers also found that one year after hip replacement, the incidence of new diagnoses of cancer was 1.25% (95% confidence interval [CI] 1.21% to 1.30%). this was lower than the predicted incidence of 1.65% (95% CI 1.60% to 1.70%) for the age- and sex-matched general population.

The researchers said the findings are reassuring and pointed out that, compared with the general population, the risk of cancer for hip replacement patients is low. however, they also said that a study of longer-term outcomes is needed.

This study’s strength lies in its large sample of patients who have had hip replacements. however, it should be noted that:

  • The study only shows results for up to seven years after surgery. Since some cancers take time to develop, an analysis of longer-term data is required.
  • All hip implants produce some metal ‘debris’, even if the surfaces are not metal. It would, therefore, be better to compare the cancer rates of patients having metal implants with a control group of patients with osteoarthritis without any implants. The registry used does not include data on these people.
  • The fact that the study found lower cancer rates after one year in patients with metal-on-metal implants compared with the age- and sex-matched ‘normal’ population is not easy to explain. It may indicate the influence of other factors (confounders) because patients undergoing hip replacements are checked to ensure they are healthy before surgery. People of the same sex and age in the comparison group may not be as healthy. In the comparison of different hip replacement types, those selected for resurfacing may also be younger and fitter as this is one of the reasons these devices are fitted. These confounders could have explained some of the effect reported.
  • Using hospital statistics to identify cancers may underestimate cancer risk. this is because some patients are diagnosed and treated without hospital admission, for example only as outpatients.

While these findings offer some reassurance about the potential carcinogenic effect of hip replacement implants, further longer-term study of the effects of metal-on-metal implants is required. given the various concerns about these types of implants, it is likely that their use will be reduced in future and that monitoring of any cancer risks will continue.

No cancer rise in hip implant patients – Health – Halifax Evening Courier

New research suggests PIP implant failures significantly higher than previously thought

[ Back to EurekAlert! ]Public release date: 17-Apr-2012 [ | E-mail | Share Share ] Contact: Sacha Boucheries.boucherie@elsevier.com31-204-853-564Elsevier

London, April 17, 2012 – new research published in the Journal of Plastic, Reconstructive and Aesthetic Surgery suggests that the failure rate of silicone breast implants manufactured by Poly Implant Prosth

No cancer rise in hip implant patients

Published on Wednesday 18 April 2012 08:47

“There is no evidence that metal-on-metal hip replacements increase the risk of cancer,” the BBC reported today.

The story is based on a study that found that patients with metal-on-metal hip replacements did not have a higher risk than the general population of developing cancer up to seven years after surgery, or than patients with hip replacements made of other materials.

The study comes in the wake of recent concerns about metal-on-metal hip implants, including high failure rates and the possible risks of small amounts of metal (ions) being released into the body. while the findings are reassuring, this type of study has limitations. In particular, it only looked at the risk of cancer within a few years of having hip replacement surgery. given that several cancers can take many years to develop, a study of longer-term outcomes of metal-on-metal implants is required and recommended by the researchers.

Recommendations from UK health regulators state that people with large metal-on-metal implants should be monitored annually. if they have any concerns, they can consult their doctor for patient-specific guidance.

The study was carried out by researchers from the University of Bristol, University of Exeter and Wrightington Hospital, Wigan. It was funded by the National Joint Registry for England and Wales.

The study was published in the peer-reviewed British Medical Journal, which has recently published a number of pieces on the wear rate and safety of metal-on-metal hip implants. Most notably, it conducted a joint investigation with BBC’s Newsnight.

The research was reported fairly by the media. Both the BBC and The Daily Telegraph pointed out that the study only looked at cancer rates up to seven years after surgery, and that ongoing monitoring may need to be performed.

The authors point out that metal-on-metal hip implants have become popular over the past decade. These consist of:

  • resurfacing implants – where only the articulated surfaces of the existing hip joint are replaced with metal 
  • ‘stemmed’ implants – in which the ball replacing the top of the thigh bone and the artificial socket placed in the pelvis are made of metal. as their name suggests, stemmed implants feature an elongated metal stem that surgeons slide down into the thighbone to secure the implant in place

However, recent data show that all-metal stemmed implants have significantly higher failure rates and that metal-on-metal resurfacing implants have an above-average failure rate compared with implants made of other materials (such as ceramic or plastic).

In addition, the researchers say that little is known about the biological effects of the metals – predominantly cobalt, chromium and molybdenum – which are released into the body as the surface of the implants wears down. The researchers say that traces of these metals can be found in many organs, including the marrow, blood, liver, kidneys and bladder. They also say there is evidence that patients who have had joint replacements show a higher than normal incidence of DNA (genetic) damage, although there is no proven link between this and an increased risk of cancer.

To assess any raised risk of cancer, this study compared rates of cancer in patients with metal-on-metal hip implants to rates in patients with hip replacements made of alternative material, within seven years of surgery. It also compared cancer rates in patients undergoing hip replacements with those of a section of the general population, with predicted cancer rates matched for age and sex.

The researchers used data on hip replacements from the National Joint Registry of England and Wales, a database that holds records on over 1 million joint replacement procedures undertaken since its establishment in 2003. Researchers consulted all relevant data up until April 2011. The Registry is also linked annually to national hospital episode statistics data, in order to routinely monitor health information on patients who have had joint replacements. The hospital episode statistics data collection contains details of all admissions to NHS hospitals in England. It includes private patients treated in NHS hospitals, patients who were resident outside England and care delivered by treatment centres (including those in the independent sector) funded by the NHS.

For their study, the researchers used data from 289,571 patients in England who underwent hip replacements from 2003 to 2010, for whom joint registry data could be linked to hospital episode statistics. This comprised 40,576 patients who had metal-on-metal hip replacements and 248,995 who had hip implants made of other materials.

The researchers looked at hospital episode statistics data on these patients between 1997 and 2010, including any diagnoses of cancer (other than non-melanoma skin cancers) in the years after hip replacement. They also looked separately at specific cancers suspected of being related to metal ions, including blood cancers (such as leukaemia), malignant melanoma, prostate cancer and renal tract cancer (cancer of the bladder, ureter or kidney). They excluded from their analysis any patient who had a recorded diagnosis of the specific cancer before or at the time of their hip replacement.

They compared the outcomes in patients with metal-on-metal hip replacements (both stemmed and resurfaced) with patients who had hip implants made of other materials. They separated patients into three groups: those with stemmed metal implants, those with metal resurfacing, and total hip replacement with other materials. They adjusted their results for other factors that might affect the risk of cancer such as age, sex and general health.

In addition, they compared cancer rates in patients undergoing any type of hip replacement with those in the general population, using age- and sex-matched predicted incidence rates derived from national data.

The study found that, compared with patients who had hip implants made of other materials, there was no evidence that metal-on-metal implants were associated with an increased risk of any cancer diagnosis in the seven years after surgery. This was based on an average (mean) follow-up of three years, with 23% of patients observed for five years or more. Similarly, there was no increase in the risk of malignant melanoma or cancers of the blood, prostate and renal tract.

For men aged 60, the risk of being diagnosed with any cancer in five years after surgery was:

  • 4.8% (4.4% to 5.3%) after metal-on-metal resurfacing
  • 6.2% (5.7% to 6.7%) after a stemmed metal-on-metal implant
  • 6.7% (6.5% to 7.0%) after a hip implant made of other materials

For women aged 60 the rates were lower:

  • 3.1% (2.8% to 3.4%) after resurfacing
  • 4.0% (3.7% to 4.3%) after a stemmed metal-on-metal implant
  • 4.4% (4.2% to 4.5%) after other types of material

The researchers also found that one year after hip replacement, the incidence of new diagnoses of cancer was 1.25% (95% confidence interval [CI] 1.21% to 1.30%). This was lower than the predicted incidence of 1.65% (95% CI 1.60% to 1.70%) for the age- and sex-matched general population.

The researchers said the findings are reassuring and pointed out that, compared with the general population, the risk of cancer for hip replacement patients is low. however, they also said that a study of longer-term outcomes is needed.

This study’s strength lies in its large sample of patients who have had hip replacements. however, it should be noted that:

  • The study only shows results for up to seven years after surgery. since some cancers take time to develop, an analysis of longer-term data is required.
  • All hip implants produce some metal ‘debris’, even if the surfaces are not metal. It would, therefore, be better to compare the cancer rates of patients having metal implants with a control group of patients with osteoarthritis without any implants. The registry used does not include data on these people.
  • The fact that the study found lower cancer rates after one year in patients with metal-on-metal implants compared with the age- and sex-matched ‘normal’ population is not easy to explain. It may indicate the influence of other factors (confounders) because patients undergoing hip replacements are checked to ensure they are healthy before surgery. People of the same sex and age in the comparison group may not be as healthy. In the comparison of different hip replacement types, those selected for resurfacing may also be younger and fitter as this is one of the reasons these devices are fitted. These confounders could have explained some of the effect reported.
  • Using hospital statistics to identify cancers may underestimate cancer risk. This is because some patients are diagnosed and treated without hospital admission, for example only as outpatients.

While these findings offer some reassurance about the potential carcinogenic effect of hip replacement implants, further longer-term study of the effects of metal-on-metal implants is required. given the various concerns about these types of implants, it is likely that their use will be reduced in future and that monitoring of any cancer risks will continue.

No cancer rise in hip implant patients