![]() This publication is also known as the Blue Book. The British Hip Society on the follow up of patients given in the Primary Total Hip Replacement: A Guide to Good Practice, Nov 2012.This advice also draws on information from: MHRA’s clinical orthopaedic experts have also observed that soft tissue necrosis may occur in both asymptomatic and symptomatic patients, and believe early detection of these events should give a better revision outcome should this becomes necessary. Data from the 13th Annual Report of the National Joint Registry of England, Wales, Northern Ireland and the Isle of Man, published in 2016, continued to show a risk of adverse soft tissue reaction to particulate debris. However, some patients will develop progressive soft tissue reactions to the wear debris associated with MoM articulations. The majority of patients with MoM hip replacements currently have well-functioning hips. MHRA, in consultation with its independent Metal-on-Metal Expert Advisory Group (MoM EAG), has continued to monitor the performance of MoM hip joint articulations for the occurrence of soft tissue reaction associated with these devices. Staff involved in the management of patients with joint replacement implants.Īctions complete:Ē7 July 2017 Problem / background.Each patient must be assessed individually. * The advice in table 1 has been produced based on current knowledge, it will not necessarily cover all clinical situations. If no cause is found, further blood metal level measurement and cross-sectional imaging should be considered. Persistent symptoms should be investigated for potential causes that include: failure of fixation, component loosening, infection and instability. * After revision surgery, whole blood metal levels of chromium and/or cobalt are expected to fall and symptoms to improve. ![]() * Rising blood metal levels may indicate potential for soft tissue reaction. * Local symptoms may occur in otherwise well-functioning hips these should be investigated for other causes. * An isolated fluid collection (unless very large) around the joint in an asymptomatic patient, can be observed with interval scanning and clinical review. ![]() * Patients with muscle or bone damage shown on MARS MRI are those of most concern. * MARS MRI scans or ultrasound scans should carry more weight in decision-making than isolated blood metal levels alone. Follow the patient management advice given in table 1 of the appendix in the MDA document below, in conjunction with the following guidance notes:.Put updated systems in place for the follow-up and investigation of all patients implanted with MoM hip replacements. ![]()
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