On October 1, 2011, the New York Times reported that metal-on-metal hip implants have been associated with severe and permanent side effects, with the article even saying that one surgeon found a ?biological dead zone? when replacing a failed metal-on-metal hip in a patient. Additionally, the New York Times reported in September that rates of failures in metal-on-metal implants were increasing, according to the National Joint Registry for England and Wales. This article also cited that the US Food and Drug Administration received a record number of complaints regarding these devices in the first 6 months of 2011 compared to the previous four years combined. This attention comes in the wake of a number of studies published at the beginning of 2010, which also questioned the performance of these devices. The effects of these studies were examined in detail in MRG's Physician Forum titled Controversies in Hip Arthroplasty published in May 2010.

While at the time it was not predicted that these articles would have a major impact on adoption patterns of physicians?unit sales volumes were anticipated to increase despite declining as a proportion of overall hip implant sales?continued attention on failures leaves us to wonder whether the metal-on-metal hip implant market will die out completely. Some sources indicate, however, that they might remain useful in certain circumstances?for example, if a patient is very old and the surgeon is concerned about dislocation. In these cases, the patient is unfortunately unlikely to live long enough to feel any negative effects of using a metal-on-metal implant.

One of the main issues, however, is that surgeons continue to remain divided over whether or not there is one ?gold standard? material to be used in hip implants. Ceramic-on-ceramic? Too expensive. Metal-on-highly-cross-linked-polyethylene? Too many concerns about polyethylene wear. Ceramic-on-metal or polyetheretherketone (more affectionately referred to as ?PEEK?)? Both too new to know for sure.

Maybe this market is just waiting for a game-changing material that will sweep everyone away.

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