I am somewhat surprised that no one has mentioned the recent series of articles in the NY Times concerning reports of high rates of failure of MOM hips. (By my count there have been at least 4 articles in the past 2 or 3 months. These are all essentially the same info regenerated: ie, There has been an alarming number of reported failures of MOM hips, specifically the Dupuy ASR, and the ASR's failure numbers are almost exponentially increasing as time passes. The articles, if I understand them correctly, are speaking more about the ASR acetabular cup when it was coupled with a MOM THR stem and less about the ASR cup when it was used in a resurfacing scenario. As we all know, the ASR was withdrawn and in fact recalled from the market internationally.)
I do not wish to comment, per se, about these NYT articles. I found that the information provided was woefully incomplete, and they left me with more questions than answers. One point that was made in all the articles is that the high failure rates of this particular prosthesis were only discovered through rigorously analyzing information from Australien and British registries. Herein, I believe, is the crux of the matter: Why do we (ie Americans and Canadians) not have our own registry??? I would think it not terribly difficult, in this age of internet/computer access, to create and fund a national registry so that our implants can have safe and effective epidemiological follow up. The registry could probably be funded through obligatory contributions from the prosthesis companies themselves, as they are consistently posting huge yearly profits.
Transmittal of info to the registry should be obligatory by state/federal law, and should be done on standardized computerized forms for each patient/implant, ideally with the info filled out by the operative surgeon on the day of surgery. Data entered could look something like this:
Patient Initials: JD
Hospital Name/Location: Good Samaritan, LA, CA
Chart #: 123456
Patient Age: 45
Patient Sex: Female
Surgeon's Name: Dr Feelgood Kutumup
Date of Implant: 09/18/2011
Type of Implant: Birmingham Hip Resurfacing
Lot/Serial #: A3349966773
Operative Diagnosis: Osteo-Arthrosis Left Hip
Intra-Operative Complications Noted: None
The info could be transmitted to the registry by simply pressing the "Enter" button, or alternatively some type of bar code could be scanned and transmitted with the info attached. Once that info is transmitted to the central registry the patient is given a sticker or computer chip with essentially the same info scanned onto it. If he/she ever presents back to any hospital for any reason with a complication from that implant (dislocation, infection, loosening, fracture etc, but especially a complication that requires further surgery), the chip or sticker can be re-scanned into the registry data base with the updated complication data. If things continue to go well for the patient, his surgeon can re-scan his info at each follow up visit and simply check off a box on the form that states "No complications noted".
With this info a national registry could, I believe, capture useful information about the performance of specific brands of implants, specific hospital performance, and even specific surgeon performance. At the same time, the patient's specific identifying info would remain completely confidential.
I know that the Obama administration has talked somewhere in their Obama care legislation, about the creation of a joint registry, but my understanding is that it would be voluntary, which I think would defeat the purpose.
I would be interested to hear from other poster's on this subject.