Correspondence should be sent

The long-term effects of metal-on-metal arthroplasty are currently under scrutiny because of the potential biological effects of metal wear debris. This review summarises data describing the release, dissemination, uptake, biological activity, and potential toxicity of metal wear debris released from alloys currently used in modern orthopaedics. The introduction of risk assessment for the evaluation of metal alloys and their use in arthroplasty patients is discussed and this should include potential harmful effects on immunity, reproduction, the kidney, developmental toxicity, the nervous system and carcinogenesis. Total hip replacement (THR) and resurfacing arthroplasty have become some of the most successful elective surgical procedures in modern medicine, restoring mobility and quality of life to hundreds of thousands of patients annually. In 2004, a total of 48 987 hip procedures were carried out in Englan