Bone Joint J. 2018 Jan; 100-B(1): 20–27.

The risk of cardiac failure following metal-on-metal hip arthroplasty

S. A. Sabah, MRCS, Specialist Registrar,1 J. C. Moon, MD, Professor of Cardiology ,2 S. Jenkins-Jones, MSc, Honorary Senior Research Associate,3 C. Ll. Morgan, MSc, Honorary Research Associate,4 C. J. Currie, PhD, Professor of Applied Pharmacoepidemiology,5 J. M. Wilkinson, PhD, Professor of Orthopaedics,6 M. Porter, FRCS(Ed) FRCS Ed (Orth), Consultant Orthopaedic Surgeon and Medical Director NJR,7 G. Captur, PhD, Specialist Registrar and Academic Clinical Lecturer,8 J. Henckel, MRCS, Specialist Registrar,9 N. Chaturvedi, MD, Professor of Clinical Epidemiology, and Director, MRC Lifelong Health and Ageing Unit,10 P. Kay, FRCS, Orthopaedic Surgeon,11 J. A. Skinner, MBBS, FRCS(Eng), FRCS(Orth), Consultant Orthopaedic Surgeon, Professor of Orthopaedic Surgery,12 A. J. Hart, MA, MD, FRCS (Orth), Professor of Orthopaedics ,12 and C. Manisty, MBBS MRCP PhD, Senior Lecturer and Consultant Cardiologist8

Hip

Aims

The aim of this study was to determine whether patients with metal-on-metal (MoM) arthroplasties of the hip have an increased risk of cardiac failure compared with those with alternative types of arthroplasties (non-MoM).

Patients and Methods

A linkage study between the National Joint Registry, Hospital Episodes Statistics and records of the Office for National Statistics on deaths was undertaken. Patients who underwent elective total hip arthroplasty between January 2003 and December 2014 with no past history of cardiac failure were included and stratified as having either a MoM (n = 53 529) or a non-MoM (n = 482 247) arthroplasty. The primary outcome measure was the time to an admission to hospital for cardiac failure or death. Analysis was carried out using data from all patients and from those matched by propensity score.

Results

The risk of cardiac failure was lower in the MoM cohort compared with the non-MoM cohort (adjusted hazard ratio (aHR) 0.901; 95% confidence interval (CI) 0.853 to 0.953). The risk of cardiac failure was similar following matching (aHR 0.909; 95% CI 0.838 to 0.987) and the findings were consistent in subgroup analysis.

Conclusion

The risk of cardiac failure following total hip arthroplasty was not increased in those in whom MoM implants were used, compared with those in whom other types of prostheses were used, in the first seven years after surgery.

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