The prestigious British Journal, The Lancet recently published follow-up data on more than 400,000 total hip replacements done between 2003 and 2011. ‘Failure rate’, defined as need for revision, was nearly 4 times as likely in the 7% of patients who had metal on metal implants, versus those with ceramic on ceramic. Interestingly, ‘failure’ rates in the US are 2 to 3 times greater than in Sweden. The reasons for this large disparity are unclear but may include medical/legal/political issues.
There are currently about 500,000 people in the US with metal on metal prostheses, so the potential cost associated with revising all of them is staggering. However, what should be pointed out is that more than 93% of the metal on metal arthroplasties did not require revision in the British study.