Abstract
Background
The Articular Surface Replacement™ (ASR™) metal-on-metal hip arthroplasty system (DePuy Orthopaedics, Inc, Warsaw, IN, USA) reportedly has a higher than anticipated early failure rate leading to a voluntary recall. This prompted us to evaluate all ASR™ components implanted at our center.
Questions/Purposes
In all ASR™ components, we reported (1) revision rate, (2) blood metal ion levels, and (3) intraoperative findings for revisions related to adverse reaction to metal debris (ARMD).
Methods
We retrospectively reviewed all 172 patients (190 hips) who underwent THA (149 hips) or hip resurfacing (41 hips) with the ASR™ system. We determined failure rates. We obtained blood metal ion concentrations from 93 patients at last followup. We evaluated MRI studies and intraoperative histopathology. Minimum followup was 12 months (mean, 40 months; range, 12–74 months).
Results
At latest followup, we had revised 24 of 190 hips (13%): in 18 patients with THA and five patients with resurfacing. Mean time to revision was 45 months (range, 12–75 months). Mean blood concentrations were 13 μg/L (range, 0–150 μg/L) for cobalt and 6 μg/L (range, 0–87 μg/L) for chromium. Mean prerevision blood metal ion levels were higher in the revised group (cobalt: 48 μg/L; chromium: 18 μg/L) than in the nonrevised group (cobalt: 5 μg/L; chromium: 2 μg/L). ARMD was present in 14 of the 24 hips revised in this study.
Conclusions
Surgeons must have a low threshold for concern for ARMD in patients with ASR™ systems. Blood metal ion levels and MRI can be used to evaluate patients with underperforming implants. Intraoperative histopathologic analysis and joint fluid cytology can help diagnose ARMD at the time of revision.
Level of Evidence
Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
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Acknowledgments
We thank Dr. Benjamin J. Hansen MD, Duke University Medical Center, for manuscript editing, Diane B. Covington PA, Duke University Medical Center, for data collection, and Leslie G. Dodd MD, Duke University Medical Center, for histologic review of soft tissue samples.
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One of the authors (TPV) certifies that he, or a member of his immediate family, has received or may receive payments or benefits, during the study period, an amount of more than $100,000 from DePuy Orthopaedics, Inc, a Johnson and Johnson company, Warsaw, IN, USA. One of the authors (KTH) certifies that he has received a stipend, during the study period, from Duke University’s CTSA Grant TL1RR024126 from NCCR/NIH. Each remaining author certifies that he or she, or a member of his or her immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
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This work was performed at Duke University Medical Center, Durham, NC, USA.
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Hug, K.T., Watters, T.S., Vail, T.P. et al. The Withdrawn ASR™ THA and Hip Resurfacing Systems: How Have Our Patients Fared Over 1 to 6 Years?. Clin Orthop Relat Res 471, 430–438 (2013). https://doi.org/10.1007/s11999-012-2547-5
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DOI: https://doi.org/10.1007/s11999-012-2547-5