Failure of Metal-on-Metal Total Hip Arthroplasty: The First Reported Case from the Caribbean and the Need for a National Joint Registry.

Introduction: The predicted advantages of better survivorship and function from metal-on-metal (MoM) total hip arthroplasty (THA) systems introduced in the early 2000s did not materialise. Instead, national registry data indicated high failure rates, and these devices were quickly withdrawn from the market. With over 1 million MoM articulations implanted worldwide, there is a need for close follow-up and surveillance of the at-risk population.

Case report: A 54-year-old woman presented with a painful right MoM hip arthroplasty. Serial radiographs demonstrated progressive migration of the acetabular shell with extensive osteolysis. After medical clearance, the patient underwent a successful isolated acetabular revision. The bone defects were filled with bone substitute, and the acetabulum was reconstructed using a metal cage and a cemented all-polyethylene cup.

Conclusion: MoM THA is associated with a high failure rate and the need for early revision. An unverified number of these implants were used in Trinidad in 2009, leaving patients at risk for premature failure. In the Caribbean, the medical devices industry is largely under-regulated, exposing the patient to unnecessary risks. The formation of a national joint registry administered through the Caribbean Association of Orthopedic Surgeons could provide outcome data, identify early implant failures, and improve patient safety.