The aim of this study is to investigate whether Metal-on-Metal (MoM) implants result in more chromosome aberrations and increased blood metal ions post-operatively when compared to Metal-on-Polyethylene (MoP) implants. Metal-on-metal arthroplasties are being inserted in increasing numbers of younger patients due to the increased durability and reduced requirement for revision in these implants. Recent studies have raised many concerns over possible genotoxicity of MoM implants. This is a prospective study of patients who have undergone elective total hip replacement, they were selected and then randomised into two groups. Group A received a MoP implant and group B received a MoM implant. Patients are reviewed pre-operatively (control group), at 3 months, 6 months, 1 year and 2 years post-operatively. On each occasion blood tests are taken to quantify metal ion levels (chromium, cobalt, titanium, nickel and vanadium) using HR-ICPMS method and chromosome aberrations in T lymphocytes using 24 colour fluorescent in situ hybridisation (FISH). 53 patients have been recruited to date. 24 of whom had MoP prosthesis and 29 a MoM. 37 of these have had their one year follow-up with blood analysis and 14 have had 2 year follow up. Cobalt and chromium concentration increased during the first 6 months in both MoM and MoP groups, in the MoM group the chromium levels were twice that of MoP group and 12x that of the preoperative samples. Chromosome aberrations occurred in both groups. At 6 months both the MoM and MoP groups showed increase frequency of aneuploidy aberrations with further increases after one year. Structural damage in the form of translocations occurred in the MoM group after one year, but not in the MoP group, by two years there was a profound increase in translocations Preliminary results of this study show that the levels of chromium and cobalt are significantly higher in the MoM group compared to the MoP group. This corresponds to increases in chromosome aberrations in the groups with increases in structural chromosome damage after two years.

In 2002 the UK government in its attempt to reduce long total joint arthroplasty waiting lists, arranged for local councils via NHS trusts to send patients abroad for their surgery. In theory it was a win-win situation where pressures upon surgeons were reduced, trusts could reach government targets and of course, patients got their operation with a bonus holiday! Unfortunately, it was not until patients had returned from their surgery that problems with this method of waiting list reduction were realised. The majority of patients were discharged after only one check up and often had very little in the way of post operative physiotherapy. A few presented to our clinic with more serious complaints with two cases eventually requiring revision surgery.

We undertook a case-control study looking at an age and sex matched group of patients who underwent total knee arthroplasty, Group A (Belgium) and Group B (Local Institution) during the same time period from November 2003 to November 2004. We compared their Oxford knee score (OKS), Knee society score (KSS) and SF12 physical and mental component scores.

Introduction

We discuss the use of the SMILES (Stanmore Modular Individualised Lower Extremity System) in salvage revision knee surgery and review the medium-long term results of 42 cases.