Original Research

Minimum 5-Year Follow-up of Articular Surface Replacement Acetabular Components Used in Total Hip Arthroplasty

Publish date: June 21, 2018

Udai S. Sibia, MD, MBA

Paul J. King, MD

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High rate of failure of DePuy Synthes ASR™ XL Acetabular hip system used in THA, approaching 34.4% at 5 years.
Mean time to revision was 3.1 years with pain being the most common indication for revision surgery.
Age, gender, acetabular component abduction angle, acetabular size, and serum cobalt or chromium levels were not associated with increased rate of failure.
Serum cobalt and chromium levels decreased significantly within 6 months of revision surgery.
Close clinical surveillance and laboratory monitoring of patients is required.

References

Bernthal NM, Celestre PC, Stavrakis AI, Ludington JC, Oakes DA. Disappointing short-term results with the DePuy ASR XL metal-on-metal total hip arthroplasty. J Arthroplasty. 2012;27(4):539. doi:10.1016/j.arth.2011.08.022.
de Steiger RN, Hang JR, Miller LN, Graves SE, Davidson DC. Five-year results of the ASR XL acetabular system and the ASR hip resurfacing system: An analysis from the Australian Orthopaedic Association National Joint Replacement Registry. J Bone Joint Surg Am. 2011;93(24):2287. doi:10.2106/JBJS.J.01727.
Langton DJ, Jameson SS, Joyce TJ, Hallab NJ, Natu S, Nargol AV. Early failure of metal-on-metal bearings in hip resurfacing and large-diameter total hip replacement: a consequence of excess wear. J Bone Joint Surg Br. 2010;92(1):38-46. doi:10.1302/0301-620X.92B1.22770.
Siebel T, Maubach S, Morlock MM. Lessons learned from early clinical experience and results of 300 ASR hip resurfacing implantations. Proc Inst Mech Eng H. 2006;220(2):345-353. doi:10.1243/095441105X69079.
Jameson SS, Langton DJ, Nargol AV. Articular surface replacement of the hip: a prospective single-surgeon series. J Bone Joint Surg Br. 2010;92(1):28-37. doi:10.1302/0301-620X.92B1.22769.
Australian Orthopaedic Association National Joint Replacement Registry annual report 2010. Australian Orthopaedic Association Web site. https://aoanjrr.sahmri.com/annual-reports-2010. Accessed June 19, 2018.
Wolford ML, Palso K, Bercovitz A. Hospitalization for total hip replacement among inpatients aged 45 and over: United States, 2000-2010. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/nchs/data/databriefs/db186.pdf. Accessed July 13, 2015.
Hodgkinson J, Skinner J, Kay P. Large diameter metal on metal bearing total hip replacements. British Hip Society Web site. https://www.britishhipsociety.com/uploaded/BHS_MOM_THR.pdf. Accessed August 6, 2015.
Hart AJ, Ilo K, Underwood R, et al. The relationship between the angle of version and rate of wear of retrieved metal-on-metal resurfacings: a prospective, CT-based study. J Bone Joint Surg Br. 2011;93(3):315-320. doi:10.1302/0301-620X.93B3.25545.
Langton DJ, Joyce TJ, Jameson SS, et al. Adverse reaction to metal debris following hip resurfacing: the influence of component type, orientation and volumetric wear. J Bone Joint Surg Br. 2011;93(2):164-171. doi:10.1302/0301-620X.93B2.25099.
Steele GD, Fehring TK, Odum SM, Dennos AC, Nadaud MC. Early failure of articular surface replacement XL total hip arthroplasty. J Arthroplasty. 2011;26(6):14-18. doi:10.1016/j.arth.2011.03.027.
De Haan R, Campbell PA, Su EP, De Smet KA. Revision of metal-on-metal resurfacing arthroplasty of the hip: the influence of malpositioning of the components. J Bone Joint Surg Br. 2008;90(9):1158-1163. doi:10.1302/0301-620X.90B9.19891.
Griffin WL, Nanson CJ, Springer BD, Davies MA, Fehring TK. Reduced articular surface of one-piece cups: a cause of runaway wear and early failure. Clin Orthop Relat Res. 2010;468(9):2328-2332. doi:10.1007/s11999-010-1383-8.
Grammatopolous G, Pandit H, Glyn-Jones S, et al. Optimal acetablular orientation for hip resurfacing. J Bone Joint Surg Br. 2010;92(8):1072-1078. doi:10.1302/0301-620X.92B8.24194.
MacDonalad SJ, McCalden RW, Chess DG, et al. Meta-onmetal versus polyethylene in hip arthoplasty: a randomized clinical trial. Clin Orthop Relat Res. 2003;(406):282-296.
Bin Nasser A, Beaule PE, O'Neill M, Kim PR, Fazekas A. Incidence of groin pain after metal-on-metal hip resurfacing. Clin Orthop Relat Res. 2010;468(2):392-399. doi:10.1007/s11999-009-1133-y.
Mahendra G, Pandit H, Kliskey K, Murray D, Gill HS, Athanasou N. Necrotic and inflammatory changes in metal-on-metal resurfacing hip arthroplasties. Acta Orthop. 2009;80(6):653-659. doi:10.3109/17453670903473016.
Neumann DRP, Thaler C, Hitzl W, Huber M, Hofstädter T, Dorn U. Long term results of a contemporary metal-on-metal total hip arthroplasty. J Arthroplasty. 2010;25(5):700-708. doi:10.1016/j.arth.2009.05.018.
Mao X, Wong AA, Crawford RW. Cobalt toxicity--an emerging clinical problem in patients with metal-on-metal hip prostheses? Med J Aust. 2011;194(12):649-651.
Information statement: current concerns with metal-on-metal hip arthroplasty. American Academy of Orthopaedic Surgeons Web site. https://aaos.org/uploadedFiles/PreProduction/About/Opinion_Statements/advistmt/1035%20Current%20Concerns%20with%20Metal-on-Metal%20Hip%20Arthroplasty.pdf. Accessed June 19, 2018.

ABSTRACT

The articular surface replacement (ASR) monoblock metal-on-metal acetabular component was recalled due to a higher than expected early failure rate. We evaluated the survivorship of the device and variables that may be predictive of failure at a minimum of 5-year follow-up. A single-center, single-surgeon retrospective review was conducted in patients who received the DePuy Synthes ASR™ XL Acetabular hip system from December 2005 to November 2009. Mean values and percentages were calculated and compared using the Fisher’s exact test, simple logistic regression, and Student’s t-test. The significance level was P ≤ .05. This study included 29 patients (24 males, 5 females) with 32 ASR™ XL acetabular hip systems. Mean age and body mass index (BMI) reached 55.2 years and 28.9 kg/m², respectively. Mean postoperative follow-up was 6.2 years. A total of 2 patients (6.9%) died of an unrelated cause and 1 patient was lost to follow-up (3.4%), leaving 26 patients with 28 hip replacements, all of whom were available for follow-up. The 5-year revision rate was 34.4% (10 patients with 11 hip replacements). Mean time to revision was 3.1 years. Age (P = .76), gender (P = .49), BMI (P = .29), acetabular component abduction angle (P = .12), and acetabulum size (P = .59) were not associated with the increased rate for hip failure. Blood cobalt (7.6 vs 6.8 µg/L, P = .58) and chromium (5.0 vs 2.2 µg/L, P = .31) levels were not significantly higher in the revised group when compared with those of the unrevised group. In the revised group, a 91% decrease in cobalt and 78% decrease in chromium levels were observed at a mean of 6 months following the revision. This study demonstrates a high rate of failure of ASR acetabular components used in total hip arthroplasty at a minimum of 5 years of follow-up. No variable that was predictive of failure could be identified in this series. Close clinical surveillance of these patients is required.

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References

Bernthal NM, Celestre PC, Stavrakis AI, Ludington JC, Oakes DA. Disappointing short-term results with the DePuy ASR XL metal-on-metal total hip arthroplasty. J Arthroplasty. 2012;27(4):539. doi:10.1016/j.arth.2011.08.022.
de Steiger RN, Hang JR, Miller LN, Graves SE, Davidson DC. Five-year results of the ASR XL acetabular system and the ASR hip resurfacing system: An analysis from the Australian Orthopaedic Association National Joint Replacement Registry. J Bone Joint Surg Am. 2011;93(24):2287. doi:10.2106/JBJS.J.01727.
Langton DJ, Jameson SS, Joyce TJ, Hallab NJ, Natu S, Nargol AV. Early failure of metal-on-metal bearings in hip resurfacing and large-diameter total hip replacement: a consequence of excess wear. J Bone Joint Surg Br. 2010;92(1):38-46. doi:10.1302/0301-620X.92B1.22770.
Siebel T, Maubach S, Morlock MM. Lessons learned from early clinical experience and results of 300 ASR hip resurfacing implantations. Proc Inst Mech Eng H. 2006;220(2):345-353. doi:10.1243/095441105X69079.
Jameson SS, Langton DJ, Nargol AV. Articular surface replacement of the hip: a prospective single-surgeon series. J Bone Joint Surg Br. 2010;92(1):28-37. doi:10.1302/0301-620X.92B1.22769.
Australian Orthopaedic Association National Joint Replacement Registry annual report 2010. Australian Orthopaedic Association Web site. https://aoanjrr.sahmri.com/annual-reports-2010. Accessed June 19, 2018.
Wolford ML, Palso K, Bercovitz A. Hospitalization for total hip replacement among inpatients aged 45 and over: United States, 2000-2010. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/nchs/data/databriefs/db186.pdf. Accessed July 13, 2015.
Hodgkinson J, Skinner J, Kay P. Large diameter metal on metal bearing total hip replacements. British Hip Society Web site. https://www.britishhipsociety.com/uploaded/BHS_MOM_THR.pdf. Accessed August 6, 2015.
Hart AJ, Ilo K, Underwood R, et al. The relationship between the angle of version and rate of wear of retrieved metal-on-metal resurfacings: a prospective, CT-based study. J Bone Joint Surg Br. 2011;93(3):315-320. doi:10.1302/0301-620X.93B3.25545.
Langton DJ, Joyce TJ, Jameson SS, et al. Adverse reaction to metal debris following hip resurfacing: the influence of component type, orientation and volumetric wear. J Bone Joint Surg Br. 2011;93(2):164-171. doi:10.1302/0301-620X.93B2.25099.
Steele GD, Fehring TK, Odum SM, Dennos AC, Nadaud MC. Early failure of articular surface replacement XL total hip arthroplasty. J Arthroplasty. 2011;26(6):14-18. doi:10.1016/j.arth.2011.03.027.
De Haan R, Campbell PA, Su EP, De Smet KA. Revision of metal-on-metal resurfacing arthroplasty of the hip: the influence of malpositioning of the components. J Bone Joint Surg Br. 2008;90(9):1158-1163. doi:10.1302/0301-620X.90B9.19891.
Griffin WL, Nanson CJ, Springer BD, Davies MA, Fehring TK. Reduced articular surface of one-piece cups: a cause of runaway wear and early failure. Clin Orthop Relat Res. 2010;468(9):2328-2332. doi:10.1007/s11999-010-1383-8.
Grammatopolous G, Pandit H, Glyn-Jones S, et al. Optimal acetablular orientation for hip resurfacing. J Bone Joint Surg Br. 2010;92(8):1072-1078. doi:10.1302/0301-620X.92B8.24194.
MacDonalad SJ, McCalden RW, Chess DG, et al. Meta-onmetal versus polyethylene in hip arthoplasty: a randomized clinical trial. Clin Orthop Relat Res. 2003;(406):282-296.
Bin Nasser A, Beaule PE, O'Neill M, Kim PR, Fazekas A. Incidence of groin pain after metal-on-metal hip resurfacing. Clin Orthop Relat Res. 2010;468(2):392-399. doi:10.1007/s11999-009-1133-y.
Mahendra G, Pandit H, Kliskey K, Murray D, Gill HS, Athanasou N. Necrotic and inflammatory changes in metal-on-metal resurfacing hip arthroplasties. Acta Orthop. 2009;80(6):653-659. doi:10.3109/17453670903473016.
Neumann DRP, Thaler C, Hitzl W, Huber M, Hofstädter T, Dorn U. Long term results of a contemporary metal-on-metal total hip arthroplasty. J Arthroplasty. 2010;25(5):700-708. doi:10.1016/j.arth.2009.05.018.
Mao X, Wong AA, Crawford RW. Cobalt toxicity--an emerging clinical problem in patients with metal-on-metal hip prostheses? Med J Aust. 2011;194(12):649-651.
Information statement: current concerns with metal-on-metal hip arthroplasty. American Academy of Orthopaedic Surgeons Web site. https://aaos.org/uploadedFiles/PreProduction/About/Opinion_Statements/advistmt/1035%20Current%20Concerns%20with%20Metal-on-Metal%20Hip%20Arthroplasty.pdf. Accessed June 19, 2018.

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Minimum 5-Year Follow-up of Articular Surface Replacement Acetabular Components Used in Total Hip Arthroplasty

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