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• W2400517571 abstract "We are writing with reference to the article by Dumbleton and Manley [1Dumbleton J.H. Manley MT. Metal-on-metal total hip replacement. What does the literature say?.J Arthroplasty. 2005; 20: 174Abstract Full Text Full Text PDF PubMed Scopus (114) Google Scholar] entitled “Metal-on-metal total hip replacement. What does the literature say?” published in the Journal of Arthroplasty on February 2005. Although we regard the above-mentioned article as an interesting historical review on the issue of metal on metal coupling for hip arthroplasty [1Dumbleton J.H. Manley MT. Metal-on-metal total hip replacement. What does the literature say?.J Arthroplasty. 2005; 20: 174Abstract Full Text Full Text PDF PubMed Scopus (114) Google Scholar], we also feel that the following observations may aid the readers in critically appraising the publication of Dumbleton and Manley [1Dumbleton J.H. Manley MT. Metal-on-metal total hip replacement. What does the literature say?.J Arthroplasty. 2005; 20: 174Abstract Full Text Full Text PDF PubMed Scopus (114) Google Scholar]. In our viewpoint, the main flaw unfortunately affecting their review is the lack of disclosure of any type of criteria used for literature retrieval. In other words, the authors have provided no clear definition either of the literature research strategy or of the types of databases used for their search. Furthermore, the critical appraisal criteria for assessing the literature findings have not been indicated anywhere in the article. As a matter of fact, even if a review does not use the rigorous methodological data processing of meta-analysis, it should at least strive to be systematic lest any bias be inadvertently introduced. More specifically, it is quite surprising that among other potential literature contributions, the authors have not cited the review by Vale et al [2Vale L. Wyness L. McCormack K. et al.A systematic review of the effectiveness and cost-effectiveness of metal-on-metal hip resurfacing arthroplasty for treatment of hip disease.Health Technol Assess. 2002; 6: 1PubMed Google Scholar] (indexed on MEDLINE and downloadable from the Internet for free at http://www.ncchta.org/fullmono/mon615.pdf) in their references. Such review is not only an excellent source of material on the subject (at least until the time of its publication), but it includes as well a detailed guide to assess the quality of a review article about total hip replacement (Appendix 4) [2Vale L. Wyness L. McCormack K. et al.A systematic review of the effectiveness and cost-effectiveness of metal-on-metal hip resurfacing arthroplasty for treatment of hip disease.Health Technol Assess. 2002; 6: 1PubMed Google Scholar]. We agree with the authors that we should “know what does the literature say” and we believe that our clinical practice should rely on sound research data; however, we should at least try to guarantee that every single piece of available information has been evaluated. This is especially important whenever a conflict of interest is disclosed by the authors, which may lead some to regard an incomplete literature search as a bias weakening the impact of a review as far as clinical applicability is concerned. Since its appearance in the early 1990s, evidence-based medicine (EBM) has been widely cited as a paradigm shift [3Bhandari M. Tornetta III, P. Evidence-based orthopaedics: a paradigm shift.Clin Orthop Relat Res. 2003; : 9PubMed Google Scholar], and we believe that several health care practitioners have based their practice on evidence from then onward, although even before 1992 [4Evidence-based medicine. A new approach to teaching the practice of medicine. Evidence-Based Medicine Working Group.JAMA. 1992; 268: 2420Crossref PubMed Scopus (3440) Google Scholar] the need to build one's own clinical creeping into the literature. However, the key innovation that we owe to EBM is the ability to provide clinicians with rules and tools to find and produce the best evidence in a valid and reproducible manner. Therefore, in this EBM era, even systematic reviews ought to be based on sound methodological criteria in order not to inadvertently skip meaningful published papers on the subject, which may, or may not, change readers' view on a given issue. Metal-on-Metal Total Hip Replacement: What Does the Literature Say?The Journal of ArthroplastyVol. 20Issue 2PreviewSecond-generation metal-on-metal (M/M) total hip replacements were introduced into clinical use in the late 1980s and demonstrate equivalent survivorship to conventional metal-on-polyethylene prostheses. Wear rates are comparable to those of first-generation designs that survived for a long time in the body. Biological effects from metal ions remain a concern. Patients with both first- and second-generation M/M hips have higher levels of cobalt and chromium in their blood and urine than either patients with metal-on-polyethylene devices or unoperated patients. Full-Text PDF Response to Letter to the EditorThe Journal of ArthroplastyVol. 20Issue 6PreviewThank you for the opportunity to respond to the letter by Romanini and Lupparelli regarding our article entitled “Metal-on-Metal Total Hip Replacement: What Does the Literature Say” published in the Journal of Arthroplasty in February 2005. Full-Text PDF" @default.
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