Article

Early Failure of Articular Surface Replacement XL Total Hip Arthroplasty

OrthoCarolina, PA, Charlotte, North Carolina 28207, USA.
The Journal of arthroplasty (Impact Factor: 2.37). 05/2011; 26(6 Suppl):14-8. DOI: 10.1016/j.arth.2011.03.027
Source: PubMed

ABSTRACT The ASR (articular surface replacement) XL (DePuy, Warsaw, Ind) metal-on-metal hip arthroplasty offers the advantage of stability and increased motion. However, an alarming number of early failures prompted the evaluation of patients treated with this system. A prospective study of patients who underwent arthroplasty with the ASR XL system was performed. Patients with 2-year follow-up or any revision were included. Failure rates, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, and radiographs were evaluated. Ninety-five patients (105 hips) were included. There were 16 revisions. Thirteen (12%) were aseptic acetabular failures. Eight were revised for aseptic loosening; 4, for metallosis; 1, for malposition; 2, for infection; and 1, for periprosthetic fracture. Mean time to revision was 1.6 years (0.18-3.4 years). The ASR XL with a revision rate of 12% is the second reported 1 piece metal-on-metal system with a significant failure rate at early follow-up. This particular class of implants has inherent design flaws that lead to early failure.

1 Follower
 · 
86 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Use of large-diameter metal-on-metal (MoM) articulations in THA increased, at least in part, because of the possibility of achieving improved joint stability and excellent wear characteristics in vitro. However, there have been subsequent concerning reports with adverse reactions to metal debris (ARMD), pseudotumors, and systemic complications related to metal ions.
    Clinical Orthopaedics and Related Research 11/2014; 473(2). DOI:10.1007/s11999-014-3976-0 · 2.88 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Metal-on-metal implants are a special form of hip endoprostheses that despite many advantages can entail serious complications due to release of wear particles from the implanted material. Metal wear particles presumably activate local host defence mechanisms, which causes a persistent inflammatory response with destruction of bone followed by a loosening of the implant. To better characterize this inflammatory response and to link inflammation to bone degradation, the local generation of proinflammatory and osteoclast-inducing cytokines was analysed, as was systemic T cell activation. By quantitative RT-PCR, gene expression of cytokines and markers for T lymphocytes, monocytes/macrophages and osteoclasts, respectively, was analysed in tissue samples obtained intraoperatively during exchange surgery of the loosened implant. Peripheral T cells were characterized by cytofluorometry before surgery and 7 to 10 days thereafter. At sites of osteolysis, gene expression of cathepsin K, CD14 and CD3 was seen, indicating the generation of osteoclasts, and the presence of monocytes and of T cells, respectively. Also cytokines were highly expressed, including CXCL8, IL-1ss, CXCL2, MRP-14 and CXCL-10. The latter suggest T cell activation, a notion that could be confirmed by detecting a small, though conspicuous population of activated CD4+ cells in the peripheral blood T cells prior to surgery. Our data support the concept that metallosis is the result of a local inflammatory response, which according to histomorphology and the composition of the cellular infiltrate classifies as an acute phase of a chronic inflammatory disease. The proinflammatory environment, particularly the generation of the osteoclast-inducing cytokines CXCL8 and IL1-Ss, promotes bone resorption. Loss of bone results in implant loosening, which then causes the major symptoms of metallosis, pain and reduced range of motion.
    Journal of Translational Medicine 03/2014; 12(1):74. DOI:10.1186/1479-5876-12-74 · 3.99 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In this study, periacetabular pressures produced by different acetabular liner geometries were analyzed using Finite Element Method. The cup models consist of hemispherical metal shells fitted with normal and different chamfered polyethylene liner geometries, with the same degree of femoral head coverage. The aim of this study was to understand the influence of the design parameters of the chamfered liners, which are primarily designed to increase the range of motion (ROM) of the hip joint and reduce the risk of impingement, on the acetabular contact pressures. The cup models were loaded to simulate periacetabular pressures during routine activities. The results show that the difference in contact pressure between the normal and chamfer models was not substantial in the given orientation of the cup. Also, the increase of the chamfer angle has a small influence on the maximum contact pressures, although that could be also dependent on the reduction of the polyethylene thickness. Pre-clinical testing of total hip prostheses using Finite Element Method enables the evaluation of contact pressures and stress distribution, and proves to be a valuable tool to analyze the parameters reducing the contact pressure.
    Key Engineering Materials 03/2014; 601:159-162. DOI:10.4028/www.scientific.net/KEM.601.159 · 0.19 Impact Factor