Abstract
Introduction
The Birmingham Hip Resurfacing (Smith & Nephew London, UK) is the most popular hip resurfacing (HR) in the UK. However, it is now subject to two Medical Device Alerts (MDA) from the Medicines and Healthcare products Regulatory Agency (MHRA).
Patients/Materials & Methods
A cross-sectional survey of primary metal-on-metal hip procedures recorded on the National Joint Registry for England, Wales and Northern Ireland (NJR) until 5th November 2013 was performed.
Cost-analysis was based on an algorithm for surveillance of HR at a tertiary referral centre and followed previous MHRA guidance. NIHR NHS Treatment costs were used.
The local protocol encompassed: patient outcome scoring (Oxford hip score), blood metal ion measurement (cobalt, chromium), cross-sectional imaging (MRI) and discussion at an internet-enabled multidisciplinary team meeting (iMDT) in addition to routine hip surveillance.
Results
A total of 33996 patients have Hip Resurfacings in the UK. 18478 have BHR and 9457 are female or small men.
Costs:
Cobalt and Chromium levels £34.64
Single site MRI scan £438.91
Review of medical notes is £97.98
New Patient Appointment £137.
Every patient requires at least 1 set of blood tests, an MRI and discussion in iMDT in our unit at a minimum cost of £571.53. This excludes clinic appointments; repeat testing, or costs of revision surgery and litigation.
Total minimum cost to NHS £5.4 million.
Discussion
It is important to not ignore nationally delivered guidance and therefore this patient group now requires comprehensive follow up as described by the MHRA. Other HR devices may now need to be considered to require further follow-up with inherently increased costs to the NHS.
Conclusion
We recommend a streamlining of review via regional iMDTs in order to effectively manage MDA's and minimise potential costs.
