Hospital stops hip procedure as metal joints fail

EXCLUSIVE: Helen Puttick, Health Correspondent

1 Nov 2010

Doctors at a major Scottish hospital are being told to investigate the number of hip replacements that are failing early.

Figures show a higher proportion of patients have needed repairs to an artificial joint at Glasgow’s Southern General than at any other mainland NHS hospital in Scotland.

Medical experts say the use of a particular metal hip prosthesis in south Glasgow, which has now been recalled, may be behind the problem.

NHS Borders has also conducted a review because of the proportion of hip replacement patients suffering dislocations after surgery.

The problems were highlighted by an audit of joint replacements, carried out as part of the Scottish Arthroplasty Project.

This year for the first time the auditors examined the number of patients given artificial hips and knees who had to return for revision surgery.

In south Glasgow more than two patients in every 100 had a repair within a year and more than 4% within three years.

This failure rate is more than double that for north Glasgow and the only rate considered below the normal success range in Scotland. The Southern General performs nearly 400 hip replacements a year.

The auditors are poised to demand a review of the findings from health board NHS Greater Glasgow and Clyde.

Colin Howie, chairman of the Scottish Committee for Orthopaedics and Trauma, which oversees the audit, said the majority of hip-replacement repairs are conducted more than five years after the initial operation because the joints wear out. However, he said they could also become loose or infected.

New all-metal ball and socket joints were introduced to reduce wear, he explained, and were thought to be a potentially good solution for younger patients.

However, there has been concern that metal particles cause a tissue reaction, which was found to be an issue with a design used in a study at the Southern General.

The problem, Mr Howie said, would leave patients with dead muscle and a loose hip joint, causing pain and a limp.

“All the patients who have metal-on-metal in Scotland should already have been contacted by their hospital,” he said.

“Patients have been warned to look out for symptoms, and ones who are at high risk have been formally recalled.”

Mr Howie added: “We can always make things better and we should be improving both the technology and techniques we use, but we have to make sure in introducing new techniques that we do not go backwards.

“In this situation we do appear to have gone backwards, but it has been identified early and it is being dealt with.” The team behind the audit are expected to agree to write to the Southern General about their findings and ask them to conduct a review this week.

NHS Borders has already examined its dislocation figures and said there was no evidence of ongoing problems, but they have made changes to surgical techniques and their prosthesis.

A spokeswoman for NHS Greater Glasgow and Clyde said: “We have received the Scottish Arthroplasty Project report and are looking in detail at its findings. Revision arthroplasty is a complex procedure which is carried out by a relatively small number of surgeons in the west of Scotland

“At the Southern General, surgeons carry out revision procedures not just for Greater Glasgow and Clyde patients but for patients from other health board areas. As such, the number of revision procedures carried out in Glasgow are maybe slightly higher than at other sites.”