02.17.11
Maybe it was some sort of sixth sense or perhaps it was just coincidence, but Joshua J. Jacobs, M.D., has never been a big fan of metal-on-metal implants.
“I have been doing research in this area for many years, and I simply thought there were alternatives that would be better [than metal],” Jacobs said during an expert roundtable discussion with journalists during the first full day of the 2011 American Academy of Orthopaedic Surgeons Annual Meeting in San Diego, Calif. “The degree of research and development on polyethylene was more intense historically at time of my decision than for other bearing surfaces. That’s why I chose polyethylene.”
While Jacobs’ revelation of his choice of implant material did little to add to the controversy surrounding metal-on-metal artificial joints, it nevertheless provided a good forum for discussion of the issue and a unique perspective from an orthopedic surgeon who also is an adjunct professor of materials science and engineering. Jacobs currently is the second vice president of AAOS.
The roundtable discussion in which Jacobs participated on Wednesday was the first of several that AAOS set up in lieu of daily press briefings throughout the course of the annual meeting. The roundtable discussions are informal, small group sessions that give journalists the opportunity to learn more about specific new research and ask questions of the top leading orthopedic surgeons in their respective fields.
Jacobs spent about 35 minutes Wednesday discussing metal-on-metal implants with a handful of reporters. The topic has become an increasingly popular one as the U.S. Food and Drug Administration (FDA) takes a closer look at these implants amid recalls and concerns about wear particles and revision procedures.
Concerns about revision procedures forced Johnson & Johnson’s DePuy Orthopaedics unit last summer to recall its ASR XL Acetabular System, a hip socket used in traditional replacement surgery, and the ASR Hip Resurfacing System, a partial hip replacement that involves placing a metal cap on the ball of the femur in order to preserve more bone. The company reportedly recalled both products due to the number of patients who needed a second hip replacement.
The recall of DePuy’s hip implants was not a surprise to orthopedic industry experts. In June 2010, media reports surfaced about orthopedic surgeons souring on metal-on-metal hip implants. Most surgeons surveyed at that time said they planned to reduce their use of the devices.
In the U.S., metal-on-metal hip implants are used in roughly 250,000 of all hip replacements annually and are also used in hip resurfacing procedures. The implants, whose ball-and-socket joints are made from metals like cobalt and chromium, were thought to be more durable than earlier devices.
Hip implants should last about 15 years; however, a New York Times investigation published earlier this year found that many metal-on-metal implants require replacement surgery within one or two years. Studies indicate that hip implants quickly can wear, generating high volumes of metallic debris that is absorbed into a patient’s body, leading to soft-tissue and bone destruction.
In March, DePuy warned that one of its hip implant devices appeared to have a high early failure rate. Since early 2008, DePuy received about 300 complaints on ASR devices from U.S. patients, according to FDA records. In April, European regulators announced they would be conducting a review of 40,000 metal-on-metal hip replacements over fears the devices could cause non-cancerous tumors and tissue damage.
Despite such concerns, however, most metal-on-metal implants work well and seldom cause problems for patients, Jacobs said. He noted that only a small percentage of metal implants fail; still, even a small percentage can produce large failure rate figures when the number of total joint replacement procedures performed annually in the United States is taken into consideration. “There are about 350,000 total joint [replacements] done each year. Even if the failure rate is, say, 1 percent…1 percent of 350,000 is still a lot of people,” he told reporters.
Though metal implant failures can be caused by many factors, Jacobs believes one of the main reasons for the inadequacy (and high revision rates among certain patient populations) is shortcomings within the technology.
“There are pros and cons of any choice,” he said. “The holy grail in hip reconstruction surgery is the 25- to 30-year hip—the kind of hip you can put in that will last the rest of your life. That is the goal. That is what many of our patients demand, but we are not there yet with the technology. That’s what we are seeking. But in order to get there, we have to be able innovate.”
“I have been doing research in this area for many years, and I simply thought there were alternatives that would be better [than metal],” Jacobs said during an expert roundtable discussion with journalists during the first full day of the 2011 American Academy of Orthopaedic Surgeons Annual Meeting in San Diego, Calif. “The degree of research and development on polyethylene was more intense historically at time of my decision than for other bearing surfaces. That’s why I chose polyethylene.”
While Jacobs’ revelation of his choice of implant material did little to add to the controversy surrounding metal-on-metal artificial joints, it nevertheless provided a good forum for discussion of the issue and a unique perspective from an orthopedic surgeon who also is an adjunct professor of materials science and engineering. Jacobs currently is the second vice president of AAOS.
The roundtable discussion in which Jacobs participated on Wednesday was the first of several that AAOS set up in lieu of daily press briefings throughout the course of the annual meeting. The roundtable discussions are informal, small group sessions that give journalists the opportunity to learn more about specific new research and ask questions of the top leading orthopedic surgeons in their respective fields.
Jacobs spent about 35 minutes Wednesday discussing metal-on-metal implants with a handful of reporters. The topic has become an increasingly popular one as the U.S. Food and Drug Administration (FDA) takes a closer look at these implants amid recalls and concerns about wear particles and revision procedures.
Concerns about revision procedures forced Johnson & Johnson’s DePuy Orthopaedics unit last summer to recall its ASR XL Acetabular System, a hip socket used in traditional replacement surgery, and the ASR Hip Resurfacing System, a partial hip replacement that involves placing a metal cap on the ball of the femur in order to preserve more bone. The company reportedly recalled both products due to the number of patients who needed a second hip replacement.
The recall of DePuy’s hip implants was not a surprise to orthopedic industry experts. In June 2010, media reports surfaced about orthopedic surgeons souring on metal-on-metal hip implants. Most surgeons surveyed at that time said they planned to reduce their use of the devices.
In the U.S., metal-on-metal hip implants are used in roughly 250,000 of all hip replacements annually and are also used in hip resurfacing procedures. The implants, whose ball-and-socket joints are made from metals like cobalt and chromium, were thought to be more durable than earlier devices.
Hip implants should last about 15 years; however, a New York Times investigation published earlier this year found that many metal-on-metal implants require replacement surgery within one or two years. Studies indicate that hip implants quickly can wear, generating high volumes of metallic debris that is absorbed into a patient’s body, leading to soft-tissue and bone destruction.
In March, DePuy warned that one of its hip implant devices appeared to have a high early failure rate. Since early 2008, DePuy received about 300 complaints on ASR devices from U.S. patients, according to FDA records. In April, European regulators announced they would be conducting a review of 40,000 metal-on-metal hip replacements over fears the devices could cause non-cancerous tumors and tissue damage.
Despite such concerns, however, most metal-on-metal implants work well and seldom cause problems for patients, Jacobs said. He noted that only a small percentage of metal implants fail; still, even a small percentage can produce large failure rate figures when the number of total joint replacement procedures performed annually in the United States is taken into consideration. “There are about 350,000 total joint [replacements] done each year. Even if the failure rate is, say, 1 percent…1 percent of 350,000 is still a lot of people,” he told reporters.
Though metal implant failures can be caused by many factors, Jacobs believes one of the main reasons for the inadequacy (and high revision rates among certain patient populations) is shortcomings within the technology.
“There are pros and cons of any choice,” he said. “The holy grail in hip reconstruction surgery is the 25- to 30-year hip—the kind of hip you can put in that will last the rest of your life. That is the goal. That is what many of our patients demand, but we are not there yet with the technology. That’s what we are seeking. But in order to get there, we have to be able innovate.”