Early Failure of Articular Surface Replacement XL Total Hip Arthroplasty

OrthoCarolina, PA, Charlotte, North Carolina 28207, USA.
The Journal of arthroplasty (Impact Factor: 2.67). 05/2011; 26(6 Suppl):14-8. DOI: 10.1016/j.arth.2011.03.027
Source: PubMed


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.

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    • "The introduction of new implants in orthopedic surgery is intended to ultimately benefit patients and to improve clinical outcomes. However, new implants and new technology often produce unforeseen problems and generate inferior outcomes compared to traditional/preexisting technologies [16] [17] [18] [19] [20] [21] [22] [23]. Such problems can only be discovered through methodical analysis of early and mid-term clinical outcome data retrieved from properly conducted studies. "
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