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Lessons learnt: preventing future artificial joint failures - world-class thought leadership at the Institution

March 29, 2012

In the first three months of this year alone, global media has highlighted the tragic consequences of artificial joint failures.  The Institution has therefore brought together the leading figures whose expertise was sought by BBC Newsnight and other media, for a ground-breaking event ‘Lessons learnt: preventing future artificial joint failures’ at One Birdcage Walk on Saturday 21 April, to share their knowledge and insight into the technical issues involved and consider the best way forward to improve patients’ lives in the future.

The total hip replacement was termed the ‘operation of the century’ and, over the last few years, many patientsTom-Joyce-article with impaired mobility were routinely advised by their orthopaedic surgeons that metal artificial hip joints were the best products ever and that after their operation, they would be as active and healthy as ever before.  However, this has not happened.  Since 2008, researchers like Dr Tom Joyce, Reader in Biotribology at Newcastle University have been at the forefront of raising the health issues associated with metal-on-metal hips, and in 2010, one of the manufacturers withdrew one of their metal-on-metal hip designs, though not before almost 100,000 had been implanted worldwide.

Since then, working hand-in-hand with orthopaedic colleagues and with key funding from the British Orthopaedic Association, Dr Joyce has continued through his publishing of scientific research papers to highlight the issues of metal-on-metal hips, and between 2011 and 2012, these findings have been publicised on Channel 4’s Dispatches, BBC’s The One Show and Newsnight, UK regional news broadcasts, RTE in Ireland, the Australian investigative programme Four Corners, and Danish television, as well as via articles in the Daily Telegraph, The Guardian and Sunday Times.  As a result of this high profile global sharing of scientific findings, much of it in conjunction with the British Medical Journal, The Lancet this year has called for a ban on stemmed metal-on-metal hips, a Senate enquiry was held in Australia, while the Danish Orthopaedic Society recently announced that no more metal-on-metal hips should be fitted.

Around the world, however, thousands of people have metal-on-metal hips and are very worried about the long-term implications of having these artificial joints.  There is a real need to hear the fears and concerns of these people, and at the same time to re-establish trust in medicine and trust in the professionals designing, manufacturing and regulating artificial joints.

It is to address this need that the Institution is hosting ‘Lessons learnt: preventing future artificial joint failures’ at One Birdcage Walk on Saturday 21 April.

This unique colloquium will bring together clinical practitioners, industry experts, patient groups, regulators, notifying bodies and learned societies to discuss major problems with orthopaedic joint replacements; the history of the problems; and how the many stakeholders should deal with these problems. In a neutral and transparent way, they will consider how the orthopaedic community might prevent problems from happening again and rebuild trust in joint replacements and the systems around them.

The Keynote Speaker is Dr Tom Joyce, while the other major speakers include:

  • Deborah Cohen, the Investigations Editor, British Medical Journal who has collaborated on documentaries with the BBC, Channel 4 News and Dispatches, and has also reported for BBC Newsnight about metal on metal hips and regulation.
  • Mr Antoni Nargol, Consultant Orthopaedic Surgeon, University Hospital of North Tees, Stockton who will be considering: ‘Surgeons – voices unheard’ including why some surgeon whistleblowers were criticised by their peers.
  • Dr Carl Heneghan, Director of the Centre of Evidence-Based Medicine, University of Oxford who will be considering the role of regulatory data.
  • Vesa Saikko, Senior Lecturer, School of Engineering, Aalto University who has focused on the development of methods and devices for the study of tribology of prosthetic joints and their materials.
  • Mr David Langton, Orthopaedic Registrar, University Hospital of North Tees and Newcastle University who will outline the history of metal-on-metal research at North Tees Hospital and the implications for orthopaedics globally.

A unique feature of the event will be the chance to hear the experiences of patients.  The Patient Voice session will be chaired by Dr Pauline McCormack, Research Associate at Newcastle University who has experience in helping to build meaningful relationships between patients and health professionals.  The panel will feature Carol Holland, Sara Starkey, Ruth Smith, Chris Mounsey and Sheila Sunley talking about their experiences with failed metal-on-metal hip replacement.  The panel sets out to make the real, every day experiences of these patients central to the event’s deliberations as delegates hear about the devastating impacts it can have on people’s health, their families, plus their social and work lives.  

Sara Starkey, one of the patients who will be part of this panel, shared the tragic consequences of being fitted with DePuy metal-on-metal hips with Daily Telegraph readers earlier this year.  Since surgery for a double hip replacement in 2007, 33 year old Sara has been in constant pain and has struggled to carry her baby daughter.  Before her surgery, Miss Starkey loved to cycle and walk with her fiancé, but is now fearful for her future and has had to put wedding plans on hold. Extra weight during pregnancy added to the stress on Miss Starkey’s joints, and the physical demands of caring for her baby daughter are tough.

Summing up the unique importance of ‘Lessons learnt: preventing future artificial joint failures’, Dr Tom Joyce said: “This is a ground-breaking event.  Issues surrounding metal-on-metal hips are of international importance, and on 21 April, we will be discussing them in depth.  What is unique about the event is the wide range of views, insights and experiences; we have purposefully invited patients, engineers, researchers, orthopaedic surgeons, regulators and journalists to contribute to discussing solutions.”

“For me, it is crucial that we have patients there telling us their experiences.  Unless we work collaboratively with patients and understand their needs, we are not doing our jobs.”

“We are committed to addressing questions about regulatory issues, orthopaedic experience and how some products may have come to market too soon.  It is very important that no external sponsorship of this event was sought.  The Institution offered a neutral, learned society environment for these important discussions so that we can try to get the best possible solutions.”

‘Lessons learnt: preventing future artificial joint failures’ takes place at One Birdcage Walk on Saturday 21 April.  Register for this event today.



  1. 11 Keith Armstrong 30 Mar
    A good idea this Conference.  I had a hip replacement about 5 years ago after tripping over a deep kerb in Kefalonia.  I was flown home and could not get the operation until a week after the event.

    My surgeon dropped a large lump of the acrylic adhesive used into my pelvic cup which went un-noticed.  My Physiotherapist got annoyed with me because I could not lift my knee high enough and was quite rude because she thought I|was being difficult.  An X-ray showed the lump of cured adhesive in my pelvic cup and an apologetic surgeon said "I will do the operation again tomorrow.  This was one week after the first op.  I cannot walk a great distance before pain starts, but too far to get a blue badge. The faster I walk the sooner it hurts. I can walk , almost normally for short distances.  I cannot bend down properly before a "Klonk"can be felt, and heard, so there is something wrong with my replacement hip joint but not enough to have the op again.  I sympathise with Miss Starkey because playing with children at floor level must be very difficult for her.  These ops need to be done very carefully because alignment and length are critical.  I should be on holiday on the date of this Conference, Staff Travel permitting.  If I cannot get away I will try to attend this meeting.     Dr Keith Armstrong  Fellow.

  2. 10 S. A. Kaye 30 Mar
    I have had a hip joint replacement three years ago, luckily not metal-on-metal, the socket being of plastic. I have suffered discomfort ever since. I have seen four consultants for "second opinions", have had three radiographic examinations and an MRI scan, and no detectable defect was found. The last consultant I saw admitted that, in a few percent of cases, patients suffered discomfort, which the medics cannot explain. This apparently is sometimes of a transitory nature, but my "transition" has lasted three years and is not getting better. So I am on a diet of various anti-inflammatories, pain killers,etc.
    Perhaps my case could also be thrown into the melting pot.
  3. 9 Jack Moore 02 Apr
    Patients have been let down.

    Do we need their stories?

    A re-design is more important.

    I am glad my car does not have metal 2 metal bearings unless oiled!

    Jack Moore (member)
  4. 8 David Martin C Eng, M I Mech E 02 Apr
    I had two metal on metal re-surfaced joints, fitted in one operation in 2005 and they have been great. I have played squash (ruptured my achilles tendon in the process), been skiing several times and play golf regularly. Unfortunately in 2010 I got an infection (a streptococyl form) in the right hip joint, which probably would not have occurred had NICE not changed it's advice to Dentists, and have had to have the joint replaced with a more normal type of joint. I now have a direct comparison between the two types of joint, and although both are working exceptionally well, the re-surfaced one feels better and based on the x-rays looks to a humble engineer to be a better and more stable design.
  5. 7 Duncan R Muirhead 02 Apr
    I had a hip resurfacing six years ago using the Conserve metal on metal unit.  I am now 74 years old and active and have had no trouble whatsoever.  I have a full range of motion and I don't know it is there at all.   My conclusion is that not all metal on metal hips are bad.  I picked this unit because the ball and socket are about double the size of a total hip replacement which gives four times the bearing area - I am about 114 kgs.   Apart from the high load it has to carry, I was also attracted by the lower chance of a dislocation.

    D R Muirhead (member)
  6. 6 John L. Gardner 03 Apr
    My 86 year old friend had her second hip replacement (right hip / left hip replaced
    approx. 6 years ago and has been very satisfactory) Surgery took place Dec 13th 2011
    and she should have been released 5 or 6 days later.unfortunately she had two cases
    of C Dificele infections and did not go home until Feb 13th 2012.A very unpleasant
    situation and a bad reflection on the poor standards of cleaning and infection control
    in Canadian hospitals!
    Further info. will be found at www.cbc.ca/marketplace  A programe called
    "Dirty hospitals" aired about 3 weeks ago and is still available on this web page.
  7. 5 David Hambly 03 Apr
    I had a metal on metal hip resurfacing in July 2010.  Prior to the replacement the breakdown in the joint was worrying.  Lack of movement, "discomfort" and muscle wasting.  The result has been simply fantastic.  The hip feels normal as well as my posture.  I've stopped limping.  My activity level is substantial.  The improvement in mobility, stamina and strength has been remarkable, a revelation.  It has to be experienced to be understood.  I accept there is risk associated with wear and I was aware of this prior to the operation.  My view is that the risk is far outweighed by the quality of life imprvement.  Faced with the same choice, I would not hessitate in having the same procedure.
  8. 4 Charles Dellow 09 Apr
    Charles Dellow 09 Apr

    At the age of 71, I had a Birmingham hip resurfacing (metal on metal) in November 2003 at the Southampton General Hospital. The result has been excellent, I have full mobility and have an active life style which includes Scottish Country Dancing, rambling and mountain walking.

  9. 3 Editor, Agenda magazine 11 Apr
    Only yesterday in Finland, the Finnish newspaper Helsingin Sanomat featured a full page article about metal-on-metal implants and argued that thousands of Finns tragically may have faulty hip joints.  You can read the article here: http://www.hs.fi/english/article/Thousands+of+Finns+may+have+faulty+hip+implants/1329103769371

    Fittingly, Vessa Saikko, the Finnish bioengineer is a leading expert in the field, and he will be one of the key speakers at Lessons Learnt at One Birdcage Walk on 21 April.

    The fact that global media has now identified the tragic issues experienced by patients in North Amercia, Australia, Denmark, the Netherlands, the UK, and how Finland, shows that this is a global problem, so it is very timely that the Institution is bringing together world experts from medical research, regulatory bodies, and the media, as well as patients, to discuss this issue and consider the best way forward to improve lives in the future.
  10. 2 JRB 13 Apr
    I was considering to register and attend this conference after i read your introduction:

     ‘unique colloquium will bring together clinical practitioners, industry experts, patient groups, regulators, notifying bodies and learned societies to discuss major problems with orthopaedic joint replacements; the history of the problems; and how the many stakeholders should deal with these problems. In a neutral and transparent way, you will help consider how the orthopaedic community might prevent problems from happening again and rebuild trust in joint replacements and the systems around them’.

    But, when i saw the agenda (the absence of MHRA, NJR, NBs, The Lancet and clinical experts in Metal on Metal) and the strong patient prescence; one feels it is a forum for patients to discuss their personal experience rather than clinicians, engineers & scientists to discuss the MoM and THR. I will, therefore, NOT be registering my attendance.
  11. 1 Dr Tom Joyce, Keynote Speaker at 'Lessons Learnt' 17 Apr

    May I respond to JRB?  Thanks for the feedback, and sorry to hear you won't be attending. The conference speakers represent, we believe, a highly-respected roster of independent, objective experts in the field who will be able to speak frankly and openly about the issues that caused this systemic failure to take place. It is vitally important that the patients affected are also included in this discussion - you will note that the FDA hearing on the matter will also feature patients' views - though it is worth noting that the patient panel forms just one session of a day including senior clinicians and respected academics.  

    Could we also make it clear that the event is not  focused on one implant only, but on several types of artificial joints, and thus there is real breadth of 'lessons learnt' in the view of multiple stakeholders.  Moreover, relevant regulatory and professional bodies have been invited to attend. 

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