Early Failure of Articular Surface Replacement XL Total Hip Arthroplasty
Section snippets
Methods
A retrospective review of a consecutive series of ASR implants was performed at 2 centers. Institutional review board approval was obtained by each institution. Cases were selected from institutional prospective total joint registries. All primary total hips performed with an ASR implant between 2006 and 2008 were included in the study. Patient age at the date of surgery and sex was recorded. Postoperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were
Results
At an average of only 1.6 years (0.18-3.4 years), the overall revision rate in this consecutive series was 15% (16/105). Of these 16 revisions, 13 were aseptic acetabular component failures. Eight were revised for aseptic loosening, 4 were revised for metallosis, 2 were revised for infection, 1 was revised for a periprosthetic fracture, and 1 was revised due to acetabular implant malposition. Therefore, the aseptic acetabular component failure rate was 12% (13/105).
Of the 89 remaining unrevised
Discussion
Metal-on-metal articulations have been heralded as a solution for wear and osteolysis inherent in metal-on-plastic articulations in young active patients [21]. An added benefit of this articulation is the ability to use large femoral heads, thus improving intrinsic hip stability 1, 2, 3, 4. The original ASR implant was designed as a surface replacement coupling a nonmodular cementless acetabular component, a resurfaced femoral head, and a metal-on-metal articulation.
Because both stability and
Conclusion
The purpose of our study was to determine the clinical and radiographic outcome of the ASR XL total hip system. Although the theoretical advantages of extra large heads are attractive, the 12% early aseptic revision rate and the 28% combined clinical and radiographic failure rates are clearly unacceptable. This implant is the second recently reported 1-piece metal-on-metal hip system with a significant failure rate at early follow-up. This particular class of implants, that is, 1-piece
References (26)
- et al.
Large versus small femoral heads in metal-on-metal total hip arthroplasty
J Arthroplasty
(2004) Metal-on-metal bearings in cementless primary total hip arthroplasty
J Arthroplasty
(2004)- et al.
Metal-on-metal total hip replacement: what does the literature say?
J Arthroplasty
(2005) - et al.
An American experience with metal-on-metal total hip arthroplasties: a 7-year follow-up study
J Arthroplasty
(2004) - et al.
Painful metal-on-metal total hip arthroplasty
J Arthroplasty
(2006) - et al.
The effects of acetabular shell deformation and liner thickness on frictional torque in ultrahigh-molecular-weight polyethylene acetabular bearings
J Arthroplasty
(2010) - et al.
Effect of femoral head diameter and operative approach on risk of dislocation after primary total hip arthroplasty
J Bone Joint Surg Am
(2005) - et al.
Metal-on-metal total hip arthroplasty with large heads may prevent early dislocation
Clin Orthop Relat Res
(2005) - et al.
Contemporary total hip replacement with metal on metal articulation
Clin Orthop Relat Res
(1996) - et al.
Metal-on-metal hip arthroplasty does equally well in osteonecrosis and osteoarthritis
Clin Orthop Relat Res
(2008)
Modern metal on metal articulation for total hip replacements
Clin Orthop Relat Res
Failure of the Durom Metasul acetabular component
Clin Orthop Relat Res
Blood metal ion concentrations after hip resurfacing arthroplasty: a comparative study of articular surface replacement and Birmingham Hip Resurfacing arthroplasties
J Bone Joint Surg Br
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The Conflict of Interest statement associated with this article can be found at doi:10.1016/j.arth.2011.03.027.