METAL-ON-METAL – AN UNFAIRLY REJECTED COUPLE

Prof.Univ.Dr. Dan Cristian Grecu

University of Medicine and Pharmacy Craiova, Romania

For a brief period, metal-on-metal (MoM) bearings were the future of hip replacement. They promised less wear, bigger femoral heads with fewer dislocations, and a better option for young, active patients. Surgeons and patients alike embraced them.

Then came the backlash. Reports of adverse local tissue reactions, pseudotumor, and high cobalt and chromium levels triggered alarm. Lawsuits, recalls, and sensational media coverage followed. The entire concept was branded a failure.

But was it really?

The truth is more nuanced. Many failures were linked not to the MoM principle itself, but to poor implant design, incorrect positioning, or indiscriminate patient selection. In the right hands, with the right patient, MoM can still deliver outstanding results. Long-term data from Birmingham Hip Resurfacing, for example, show survival rates over 90% at 15–20 years—results that rival or surpass other bearing couples. Andy Murray had a BHR in 2019. His farewell match was played with this hip!

In my experience of 25 Implanted BHR, after 18 years, I had only one failure of BHR not relatedwith BHR: fracture of the femoral neck due to gender (female) and a light varus position of the head.

The lesson is clear: medicine should not throw out an entire technology because of high-profile failures. MoM is not for everyone, but neither should it be condemned universally. Instead, it deserves careful, evidence-based reconsideration. Also, is a mistake to judge all models of resurfacing prosthesis together. Is the same as judge all cemented metal-poly prosthesis together.