Barry Meier’s article in The New York Times documents the high failure rate of a hip replacement device known as a Articular Surface Replacement, or A.S.R., which is designed and sold by DePuy Orthopaedics and has been recently removed from the marketplace. Thought to be a breakthrough in the orthopedic hip replacement field, the use of A.S.R. type devices are increasingly being questioned in the medical world.

Unlike new drugs, which typically go through a series of clinical trials before receiving approval from the FDA, hip replacement devices are often sold without such testing and approval. The Times article reveals a loophole in this approval process.

However, what is missing in this article and in this current discussion is the controversy brewing in the medical field about metal on metal hip replacement devices in general. What was once touted as the next innovative wave in hip replacement work is now being questioned by many orthopedic surgeons. One of the major concerns expressed by the medical field is the high amount of metal ions, such as cobalt and chromium, which are being found in patients’ urine, tissue and blood work. As a result, the orthopedic field is beginning to question the long term safety and viability of these metal on metal surface replacement and hip replacement devices.

The problem of metal on metal hip replacement implants is much larger than The New York Times article documents. While I applaud the reporting of Mr. Meier in exposing the loopholes which could jeopardize the health and safety of our patients, what is not being discussed and reported on today is the enormous sea change that has taken place among highly regarded orthopedic surgeons about the viability and long term safety of these metal on metal hip replacement implants. Nearly 400,000 Americans received hip replacement devices in 2010. Approximately 10 percent of those patients received metal on metal devices similar to the A.S.R. device.

At the Joint Replacement Center at Mount Sinai’s School of Medicine we now believe that the medical and anecdotal data reveal to us that these devices might not be the best choice for our patients. The high rate of metal toxicity in the blood, tissue and urine found in patients is of major concern. The very fact that these devices are not recommended for women at child bearing age and for patients with certain medical conditions reaffirms our concerns about these implants.

The belief that these devices would revolutionize the hip replacement field is seriously being called into question.

About Dr. Michael Bronson  

Dr. Bronson is the founding surgeon of the Joint Replacement Center and LeFrak Center for Patient Education at Mount Sinai’s School of Medicine, one of the leading centers if its kind in the country and the only one of its kind in New York City. Dr. Bronson is one of the nation’s leading orthopedic surgeons, specializing in the field of joint replacement. He has been published extensively and lectured around the world.