Early Failure of Articular Surface Replacement XL Total Hip Arthroplasty

• Published in: The Journal of arthroplasty Vol. 26; no. 6; pp. 14 - 18
• Main Authors: Steele, Garen D., MD, Fehring, Thomas K., MD, Odum, Susan M., MEd, Dennos, Anne C., BS, Nadaud, Matthew C., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2011
• Subjects: Adolescent; Adult; Aged; Arthroplasty, Replacement, Hip - instrumentation; Arthroplasty, Replacement, Hip - methods; Bone Malalignment - epidemiology; Female; Follow-Up Studies; Hip Joint - diagnostic imaging; Hip Joint - surgery; Hip Prosthesis; Humans; Incidence; Male; Metals; Middle Aged; Orthopedics; Osteoarthritis, Hip - surgery; Prosthesis Failure; Prosthesis-Related Infections - epidemiology; Radiography; Reoperation; Retrospective Studies; Treatment Outcome; Young Adult
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2011.03.027

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.