Genetic test could tell millions of NHS patients if their hip or knee surgery will fail – iNews

Millions of people waiting for hip and knee surgery could soon be told whether their operation is likely to fail after scientists discovered a link between genetics and early failure of joint replacements.

In a world first, British researchers have found that DNA signals in saliva and blood samples are linked to an adverse reaction to the cobalt chrome materials in most joint implants.

It is thought a test to identify those patients who will have an adverse reaction to cobalt chrome will take at least two years before it can be rolled out but once in place should reduce the number of failed operations drastically.

About 15 per cent of Britons have these genetic characteristics, which make the immune system attack tissue around the material, causing pain and swelling, in a process similar to how a patient rejects an organ transplant.

Until now experts did not know what was causing the problem, which meant doctors had no way of telling if a patient would react badly to their new joint or not.

The research could lead to patients having more choice about what type of joint implant they decide on to boost their chance of success, which would transform the way orthopaedic surgery is carried out around the world.

In a trial, more than 600 patients who underwent joint-replacement surgery in the past 10 years were tested using saliva swabs and blood tests.

A computer analysed the data and revealed those patients who suffered complications carried specific genes. The team believe they can use this testing system to spot who would be at risk.

Currently, around 10 per cent of the population in the UK will have a joint surgically replaced in their lifetime, as a proven way to treat joint ailments such as arthritis. But as populations around the world grow older and heavier, this is leading to more joint replacement being performed, with some five million surgeries carried out across the world each year a number which is forecast to double over the next two decades.

The majority of patients are satisfied with the results of their surgery if joint replacements are successful they last between 15 and 25 years but a significant number of joint replacements fail early following adverse immune responses, leading to potentially dangerous and costly repeat surgery.

Patients with a genetic sensitivity to cobalt chrome usually have a second procedure within months of the first, using alternative materials.

The international study led by Newcastle University and published in Nature Communications Medicine, is the culmination of 14 years research by Dr David Langton, managing director at ExplantLab, a Newcastle-based organisation that investigates the links between genetics and the performance of medical devices which took part in the study.

Dr Langton said: Through our research we have been able to demonstrate that a significant percentage of patients carry a genotype that makes it more likely for them to have a reaction to a joint replacement made of a cobalt chrome component.

Our findings are a big step towards offering patients more choice about what type of joint implant they decide on, and helping them to make informed decisions about the risks involved.

Of the 6.4 million people currently on the waiting list for treatment on the NHS in England, more than 730,000 require orthopaedic surgery. Cobalt chrome is used in over 95 per cent of knee replacements, but alloys such as titanium and ceramic metals can be used as alternative, according to surgeons.

Tony Nargol, consultant orthopaedic surgeon at North Tees and Hartlepool NHS Foundation Trust, whose surgical team worked closely with Dr Langton, said: This exciting discovery comes as a result of the close working relationship our fantastic staff have had with Mr Langton and his team, as well as health staff from organisations across the world.

This work will help provide a practical way for health professionals to help patients in selecting the best type of implants for their individual bodies. It will mean better outcomes for our patients and could transform the quality of care we provide to our patients.

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Genetic test could tell millions of NHS patients if their hip or knee surgery will fail - iNews