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International metal-on-metal multidisciplinary teams: do we manage patients with metal-on-metal hip arthroplasty in the same way? An analysis from the International Specialist Centre Collaboration on MOM Hips (ISCCoMH)

Berber, R; Skinner, J; Board, T; Kendoff, D; Eskelinen, A; Kwon, YM; Padgett, DE; ... ISCCoMH, .; + view all (2016) International metal-on-metal multidisciplinary teams: do we manage patients with metal-on-metal hip arthroplasty in the same way? An analysis from the International Specialist Centre Collaboration on MOM Hips (ISCCoMH). Bone and Joint Journal , 98-B (2) pp. 179-186. 10.1302/0301-620X.98B2.36201. Green open access

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Abstract

AIMS: There are many guidelines that help direct the management of patients with metal-on-metal (MOM) hip arthroplasties. We have undertaken a study to compare the management of patients with MOM hip arthroplasties in different countries. METHODS: Six international tertiary referral orthopaedic centres were invited to participate by organising a multi-disciplinary team (MDT) meeting, consisting of two or more revision hip arthroplasty surgeons and a musculoskeletal radiologist. A full clinical dataset including history, blood tests and imaging for ten patients was sent to each unit, for discussion and treatment planning. Differences in the interpretation of findings, management decisions and rationale for decisions were compared using quantitative and qualitative methods. RESULTS: Overall agreement between the orthopaedic centres and the recommended treatment plans for the ten patients with MOM hip implants was moderate (kappa = 0.6). Full agreement was seen in a third of cases, however split decisions were also seen in a third of cases. Units differed in their interpretation of the significance of the investigation findings and put varying emphasis on serial changes, in the presence of symptoms. DISCUSSION: In conclusion, the management of raised or rising blood metal ions, cystic pseudotumours and peri-acetabular osteolysis led to inconsistency in the agreement between centres. Coordinated international guidance and MDT panel discussions are recommended to improve consensus in decision making. TAKE HOME MESSAGE: A lack of evidence and the subsequent variation in regulator guidance leads to differences in opinions, the clinical impact of which can be reduced through a multi-disciplinary team approach to managing patients with MOM hip implants. Cite this article: Bone Joint J 2016;98-B:179-86.

Type: Article
Title: International metal-on-metal multidisciplinary teams: do we manage patients with metal-on-metal hip arthroplasty in the same way? An analysis from the International Specialist Centre Collaboration on MOM Hips (ISCCoMH)
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1302/0301-620X.98B2.36201
Publisher version: http://doi.org/10.1302/0301-620X.98B2.36201
Language: English
Additional information: © 2016 The British Editorial Society of Bone & Joint Surgery
Keywords: Metal-on-Metal hip, Multi-disciplinary Team, Revision, Academic Medical Centers, Aged, Arthroplasty, Replacement, Hip, Biomarkers, Female, Granuloma, Plasma Cell, Hip Prosthesis, Humans, Interprofessional Relations, Ions, Male, Metal-on-Metal Joint Prostheses, Metals, Middle Aged, Observer Variation, Osteolysis, Patient Care Team, Postoperative Complications, Range of Motion, Articular, Reoperation
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Ortho and MSK Science
URI: https://discovery.ucl.ac.uk/id/eprint/1491797
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