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The London Implant Retrieval Centre
The London Implant Retrieval Centre (LIRC) is leading the way in understanding how best to improve the performance of hip replacements.
The LIRC was set up in 2008 by two consultant orthopaedic surgeons, Alister Hart and John Skinner working at UCL and the Royal National Orthopaedic Hospital in Stanmore.
One hundred and fifty two orthopaedic surgeons have contributed more than 2000 failed metal-on-metal (MOM) hip components from 60 hospitals and 16 countries.
In 2011 we had 21 papers accepted for publication and in 2012 we are presenting 12 further papers at the American Academy of Orthopaedic Surgeons to help understand the variability in clinical outcome of patients with MOM hips.
The LIRC clinical translational research program has assessed more than 400 patients with painful metal-on-metal hips and performed revision operations on more than 100 of these patients. This clinical activity has contributed to our research which in turn has contributed to our clinical decision making and development of guidelines for patients referred to us.
The LIRC is funded by the British Orthopaedic Association (BOA) and through an industry consortium of nine manufacturers: Depuy, Zimmer, Smith & Nephew, Biomet, JRI, Finsbury, Corin, Mathys and Stryker. The contract allows for freedom to publish all results.
Our clinical guidelines work has been adopted by
What do we do?
We aim to better understand the mechanism of failure of metal-on-metal hip replacements. We currently use this knowledge to help surgeons, our patients referred to us and implant manufacturers to determine:
- when to revise?
- which patients with a MOM hip are at risk of future problems?
- how to select patients for MOM hip replacement?
- can the design of MOM hips be improved?
- can the metallurgy of MOM hips be improved?
- can the technique of implanting hips be improved?
The Diamond Light Source synchrotron facility
Alister Hart’s MD (Cambridge University) was on “the effects of wear debris from metal-on-metal hip replacements” and was supervised by John Skinner and Prof Jonathan Powell (MRC HNR, Cambridge). This included biocompatibility work performed at the Diamond Light Source synchrotron facility (where he is one of only a handful of clinicians leading experiments) which was presented at the 350th anniversary Royal Society Summer Science Exhibition, June 2010 (attended by 46,000 visitors).
This field is rapidly advancing. For instance, a worldwide recall of the Depuy ASR and ASR XL metal-on-metal hip arthroplasties was announced on 27th august 2010 (96,000 patients worldwide and 7,500 in the UK). However, a publication in October 2010 showed good results from 5000 patients for another type of hip resurfacing. Thus, there is conflicting evidence and lively debate that needs translational research such as that being carried out by the LIRC. Research from the LIRC has influenced advice on this subject from the Medicines and Health Regulatory Agency (MHRA), the British Orthopaedic Association and the British Hip Society.
Please see articles in the British Orthopaedic News (BON) about our history:
We have developed a standard operating protocol for hip wear analysis. This has been validated with the assistance of the Centre for Precision Technologies.
Diamond Light Source facility image courtesy Diamond Light Source
Page last modified on 26 apr 13 10:25