None of the authors hold any stocks or shares in an organization that may in any way gain or lose financially from the publication of this manuscript. None of the authors hold or are currently applying for any patents relating to the content of the manuscript. TP has received a grant from Smith-Nephew, personal fee from Stryker and non-financial support from DePuy (not related to this manuscript), Biomet, Zimmer and Stryker. JP has received a personal fee from Zimmer, Biomet and DePuy (not related to this manuscript). AE has received a personal fee from DePuy (not related to this manuscript) and Stryker. AR and PE have no competing interests to declare.
AR collected the data, analysed the data and drafted the manuscript. PE analysed the data and commented on the draft manuscript. TP and JP commented on the draft manuscript. AE designed the study and commented on the draft manuscript. All authors read and approved the final manuscript.
Adverse soft-tissue reaction to metal debris (ARMD) continues to be major source of concern in metal-on-metal (MoM) hip replacements. In our earlier study we were able to establish several risk factors for ARMD in patients who had received a small-diameter (<50 mm) Articular Surface Replacement (ASR, DePuy, Warsaw, IN, USA). The aims of the present study were to analyze whether these previously established risk factors also apply to patients who have received a large-headed (>50 mm) ASR™ XL THR.
Large-headed ASR total hip replacements were used in 225 operations (196 patients) at our institution. 176 patients (203 hips) attended a screening programme, consisting of a clinical evaluation, whole blood cobalt and chromium measurements, and cross-sectional imaging.
Revision surgery was performed on 84 hips (37%) in 75 patients. ARMD was diagnosed in the majority (n = 73 [87%]) of these revisions. Cumulative 8-year survivorship was 52%. The previously established risk factors for ARMD were not applicable. Interestingly, increasing femoral diameter and stem type were identified as independent risk factors for ARMD but reduced cup coverage had no significant association with ARMD.
Stem type and increasing femoral size as independent risk factors for ARMD in the cohort of ASR XL THR patients, support the importance of taper failure in the development of ARMD. The present results suggest that the degree of taper failure may be variable and dependent on the taper design.
Medicines and Healthcare Products Regulation Agency. Medical Device Alert: ASR™ hip replacement implants manufactured by DePuy International Ltd (MDA/2010/069). 2010. http://www.medsafe.govt.nz/hot/RecallActionNoticesNew/MetalOnMetalHipImplants/MHRA%20MDA-2010-069.pdf.
Medicines and Healthcare Products Regulation Agency. Medical Device Alert: All metal-on-metal (MoM) hip replacements (MDA/2012/036). 2012. https://assets.digital.cabinet-office.gov.uk/media/5485abf6ed915d4c10000273/con155767.pdf.
Bolland BJ, Culliford DJ, Langton DJ, Millington JP, Arden NK, Latham JM. High failure rates with a large-diameter hybrid metal-on-metal total hip replacement: clinical, radiological and retrieval analysis. J Bone Joint Surg (Br). 2011;93(5):608–15. CrossRef
Langton DJ, Jameson SS, Joyce TJ, Gandhi JN, Sidaginamale R, Mereddy P, et al. Accelerating failure rate of the ASR total hip replacement. J Bone Joint Surg (Br). 2011;93(8):1011–6. CrossRef
Coulter G, Young DA, Dalziel RE, Shimmin AJ. Birmingham hip resurfacing at a mean of ten years: results from an independent centre. J Bone Joint Surg (Br). 2012;94(3):315–21. CrossRef
Murray DW, Grammatopoulos G, Pandit H, Gundle R, Gill HS, McLardy-Smith P. The ten-year survival of the Birmingham hip resurfacing: an independent series. J Bone Joint Surg (Br). 2012;94(9):1180–6. CrossRef
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. CrossRef
Glyn-Jones S, Pandit H, Kwon YM, Doll H, Gill HS, Murray DW. Risk factors for inflammatory pseudotumour formation following hip resurfacing. J Bone Joint Surg (Br). 2009;91(12):1566–74. CrossRef
Underwood R, Matthies A, Cann P, Skinner JA, Hart AJ. A comparison of explanted articular surface replacement and Birmingham Hip resurfacing components. J Bone Joint Surg (Br). 2011;93(9):1169–77. CrossRef
Hart AJ, Satchithananda K, Liddle AD, Sabah SA, McRobbie D, Henckel J, et al. Pseudotumors in association with well-functioning metal-on-metal hip prostheses: a case-control study using three-dimensional computed tomography and magnetic resonance imaging. J Bone Joint Surg Am. 2012;94(4):317–25. PubMed
Ollivere B, Darrah C, Barker T, Nolan J, Porteous MJ. Early clinical failure of the Birmingham metal-on-metal hip resurfacing is associated with metallosis and soft-tissue necrosis. J Bone Joint Surg (Br). 2009;91(8):1025–30. CrossRef
Bosker BH, Ettema HB, Boomsma MF, Kollen BJ, Maas M, Verheyen CC. High incidence of pseudotumour formation after large-diameter metal-on-metal total hip replacement: a prospective cohort study. J Bone Joint Surg (Br). 2012;94(6):755–61. CrossRef
Matthies AK, Racasan R, Bills P, Blunt L, Cro S, Panagiotidou A, et al. Material loss at the taper junction of retrieved large head metal-on-metal total hip replacements. J Orthop Res. 2013;31(11):1677–85. PubMed
- Femoral diameter and stem type are independent risk factors for ARMD in the Large-headed ASR THR group
- BioMed Central
Neu im Fachgebiet Orthopädie und Unfallchirurgie
Mail Icon II