Archives of Orthopaedic and Trauma Surgery

, Volume 138, Issue 7, pp 1021–1028 | Cite as

Periprosthetic acetabular radiolucency progression in mid-term follow-up of the articular surface replacement hip system

  • Sean J. Matuszak
  • Vincent P. Galea
  • James W. Connelly
  • Janus Christiansen
  • Orhun Muratoglu
  • Henrik Malchau
Hip Arthroplasty



Recent registry studies show that aseptic loosening secondary to osteolysis is the second leading cause of hip implant failure in patients implanted with metal-on-metal (MoM) bearings. The primary aim of our study was to report on the progression of acetabular osteolysis during mid-term follow-up in patients treated with MoM hip resurfacing arthroplasty (HRA) and MoM total hip arthroplasty (THA). The secondary aim was to identify independent predictors of osteolytic lesion progression.

Materials and methods

A total of 805 patients (805 hips) were included in this study (541 MoM HRA, 264 MoM THA) from a prospective, international clinical registry of the Articular Surface Replacement Hip System. Patients were enrolled a median of 6.6 years from surgery. Osteolytic lesion progression was defined either as any lesion developing de novo, or as an existing lesion progressing from radiolucency to osteolysis during the study period (range 0.5–4.3 years).


The number of cases with any osteolysis or radiolucency was 21 (3.9%) for ASR HRA and 29 (11.0%) for ASR XL THA at enrollment and increased to 69 (12.8%) for ASR HRA and 41 (15.5%) for ASR XL THA after follow-up. Osteolytic lesion progression was found in 66 (12.2%) ASR HRA patients and 31 (11.7%) ASR XL THA patients. Multivariate models determined that lower acetabular version angle (OR 0.963, p = 0.011) and elevated whole blood chromium (OR 1.110, p = 0.044) were independent predictors of osteolytic lesion progression in ASR HRA.


We suggest that physicians of patients implanted with ASR HRA implants closely monitor patients with higher chromium levels and lower version angles, as they are at increased risk for osteolytic lesion progression, and we recommend annual radiographic follow-up on all patients with ASR implants.


Osteolysis Radiolucency Metal-on-metal THA HRA 



This study was funded by DePuy Synthes (Grant number 1200220692).

Compliance with ethical standards

Conflict of interest

The following authors declare a conflict of interest: OM—receives royalties from: Zimmer, Biomet, Corin, Iconacy, Renovis, Conformis, Aston Medical, Meril Healthcare, Arthrex, Mako; owns stock in: Cambridge Polymer Group, Orthopedic Technology group; receives institutional support from: Mako, DePuy. HM—receives royalties from Zimmer, Biomet, Corin, RSA Biomedical; owns stock in RSA Biomedical; receives institutional support from: Biomet, Smith & Nephew, DePuy, Zimmer, Mako.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Sean J. Matuszak
    • 1
  • Vincent P. Galea
    • 1
  • James W. Connelly
    • 1
  • Janus Christiansen
    • 1
    • 2
  • Orhun Muratoglu
    • 1
    • 2
  • Henrik Malchau
    • 1
    • 2
  1. 1.Harris Orthopaedic Laboratory, Orthopaedic DepartmentMassachusetts General HospitalBostonUSA
  2. 2.Department of Orthopaedic SurgeryHarvard Medical SchoolBostonUSA

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