METAL-ON-METAL HIP REPLACEMENT AND PREGNANCY

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(Date of issue: October 2017, Version: 2)

This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a pregnancy reporting form. Please encourage all women to complete an online reporting form.

A corresponding patient information leaflet on hip replacement in pregnancy is available at www.medicinesinpregnancy.org.

Summary

Prosthetic hip joints consist of two components: the femoral component and the articular interface; each of which may be metallic or non-metallic. Metal-on-metal (MOM) prostheses were previously considered to offer improved durability, and have in the past been suggested for hip replacements in younger patients. However, an analysis of data from the National Joint Registry of England and Wales showed poor implant survival for MOM-stemmed prostheses compared with other materials.

MOM prostheses of cobalt and chromium have been associated with high blood concentrations of these metals, and current UK guidelines recommend post-operative monitoring in recipients of a MOM implant. Cobalt and chromium ions cross the placenta and concern has therefore been expressed about potential adverse effects on the developing fetus.

The available data provide no indication of an increased risk of congenital malformation in infants born to women with MOM hip prostheses, but are too limited to conclude that there is no increase in risk. Data on other adverse pregnancy outcomes are too limited to permit an evidence-based risk assessment. Additional fetal monitoring may be advisable in cases of high maternal blood concentrations of cobalt or chromium. Other risk factors may also be present in individual cases which may independently increase the risk of adverse pregnancy outcome. Clinicians are reminded of the importance of consideration of such factors when performing case-specific risk assessments. Discussion with UKTIS is recommended in all cases, but particularly where there is associated maternal toxicity and/or high blood cobalt and chromium concentrations.

This document is regularly reviewed and updated. Only use full UKTIS monographs downloaded directly from TOXBASE.org to be sure you are using the most up-to-date version. The summaries of these monographs are openly available on UKTIS.org.

This is a summary of the full UKTIS monograph for health care professionals and should not be used in isolation. The full UKTIS monograph and access to any hyperlinked related documents is available to health care professionals at www.toxbase.org.

If you have a patient with exposure to a drug or chemical and require assistance in making a patient-specific risk assessment, please telephone UKTIS on 0344 892 0909 to discuss the case with a teratology specialist.

If you would like to report a pregnancy to UKTIS please click here to download our pregnancy reporting form. Please encourage all women to complete an online reporting form.

Disclaimer: Every effort has been made to ensure that this monograph was accurate and up-to-date at the time of writing, however it cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes of the measures recommended. The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber. This material may be freely reproduced for education and not for profit purposes within the UK National Health Service, however no linking to this website or reproduction by or for commercial organisations is permitted without the express written permission of this service. This document is regularly reviewed and updated. Only use UKTIS monographs downloaded directly from TOXBASE.org or UKTIS.org to ensure you are using the most up-to-date version.