1. Metal on Metal Arthroplasty Dr. R. Coup Whangarei Hospital

3. Objectives Recent Concerns Prevention Approach to Patient

4. ASR Recall August 2010 “Voluntary”

6. British Journal bad results ASR

7. Already withdrawn in Australia and NZ

9. Every joint replacement entered in registry. NZ since 1999 Australia 2001

10. Australian registry

12. Failure Reaction to metal debris Effects local not systemic

14. Raised chromium and cobalt levels Soft tissue mass Bone destruction

16. Most important surgical factor Choice of implant Registry data

17. General Practice ASR Introduced 2003 Very few in Northland Other designs MoM

18. Pain continuing after hip replacement Operation note Contact Surgeon Await Clinic Appointment

19. Infection Peri- prosthetic fracture cRP, X-ray rather than ion levels

20. Pain persisting No plan 2nd opinion

21. Thank you