Abstract
BackgroundThere were at least 31,171 metal-on-metal (MoM) hip implants in the UK between 2003 and 2011. Some of these were subject to failure and widescale recalls and revisions followed.MethodThis is a presentation of ten cases (mean age 60 years) where we evaluated neuropsychiatric morbidity following metal-on-metal hip implant failure and revision. Implants were ASR total hip replacement (acetabular implant, taper sleeve adaptor and unipolar femoral implants) performed between 2005 and 2009. This case series describes, for the first time, neuropsychiatric complications after revision where there has been cobalt and chromium toxicity.ResultsPre-revision surgery, nine patients had toxic levels of chromium and cobalt (mean level chromium 338 nmol/l, mean cobalt 669.4 nmol/l). Depression assessment showed 9 of 9 respondents fulfilled the BDI criteria for depression and 3 of these were being treated. 7 of 9 patients showing short term memory deficit with mean mini mental state examination score of 24.2. The normal population mean MMSE for this group would be expected to be 28 with <25 indicating possible dementia.ConclusionsWe found neurocognitive and depressive deficits after cobalt and chromium metallosis following MoM implant failure. Larger studies of neurocognitive effects are indicated in this group. There may be implications for public health.
Highlights
There were at least 31,171 metal-on-metal (MoM) hip implants in the UK between 2003 and 2011
Neurocognitive abnormalities might be mediated by either static brain damage caused by chromium and cobalt toxicity or could represent a dynamic process, that is an early onset dementia triggered by metallosis
We conclude that all clinicians, including those working the fields of orthopaedic, psychiatry and primary care should be aware of the need to assess the neuropsychiatric state of their patients after MoM implant operations
Summary
There were at least 31,171 metal-on-metal (MoM) hip implants in the UK between 2003 and 2011. Some of these were subject to failure and widescale recalls and revisions followed. Metal-on-metal (MoM) hip implants are used in total hip replacement surgeries and hip resurfacing procedures. These implants have both the ball and socket components made of metal. There have been high failure rates associated with these hip implants: 5-year revision rates in women aged 55 were 8.3% [30]. Regulators including the US Food and Drug Administration, Health Canada and the Therapeutic Goods Administration of Australia
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