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The withdrawn ASR™ THA and hip resurfacing systems: how have our patients fared over 1 to 6 years?

Publication ,  Journal Article
Hug, KT; Watters, TS; Vail, TP; Bolognesi, MP
Published in: Clin Orthop Relat Res
February 2013

BACKGROUND: The Articular Surface Replacement™ (ASR™) metal-on-metal hip arthroplasty system (DePuy Orthopaedics, Inc, Warsaw, IN, USA) reportedly has a higher than anticipated early failure rate leading to a voluntary recall. This prompted us to evaluate all ASR™ components implanted at our center. QUESTIONS/PURPOSES: In all ASR™ components, we reported (1) revision rate, (2) blood metal ion levels, and (3) intraoperative findings for revisions related to adverse reaction to metal debris (ARMD). METHODS: We retrospectively reviewed all 172 patients (190 hips) who underwent THA (149 hips) or hip resurfacing (41 hips) with the ASR™ system. We determined failure rates. We obtained blood metal ion concentrations from 93 patients at last followup. We evaluated MRI studies and intraoperative histopathology. Minimum followup was 12 months (mean, 40 months; range, 12-74 months). RESULTS: At latest followup, we had revised 24 of 190 hips (13%): in 18 patients with THA and five patients with resurfacing. Mean time to revision was 45 months (range, 12-75 months). Mean blood concentrations were 13 μg/L (range, 0-150 μg/L) for cobalt and 6 μg/L (range, 0-87 μg/L) for chromium. Mean prerevision blood metal ion levels were higher in the revised group (cobalt: 48 μg/L; chromium: 18 μg/L) than in the nonrevised group (cobalt: 5 μg/L; chromium: 2 μg/L). ARMD was present in 14 of the 24 hips revised in this study. CONCLUSIONS: Surgeons must have a low threshold for concern for ARMD in patients with ASR™ systems. Blood metal ion levels and MRI can be used to evaluate patients with underperforming implants. Intraoperative histopathologic analysis and joint fluid cytology can help diagnose ARMD at the time of revision. LEVEL OF EVIDENCE: Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

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Published In

Clin Orthop Relat Res

DOI

EISSN

1528-1132

Publication Date

February 2013

Volume

471

Issue

2

Start / End Page

430 / 438

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Retrospective Studies
  • Reoperation
  • Prosthesis Failure
  • Prosthesis Design
  • Osteoarthritis, Hip
  • Orthopedics
  • Middle Aged
  • Medical Device Recalls
  • Male
 

Citation

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Hug, K. T., Watters, T. S., Vail, T. P., & Bolognesi, M. P. (2013). The withdrawn ASR™ THA and hip resurfacing systems: how have our patients fared over 1 to 6 years? Clin Orthop Relat Res, 471(2), 430–438. https://doi.org/10.1007/s11999-012-2547-5
Hug, Kevin T., Tyler S. Watters, Thomas P. Vail, and Michael P. Bolognesi. “The withdrawn ASR™ THA and hip resurfacing systems: how have our patients fared over 1 to 6 years?Clin Orthop Relat Res 471, no. 2 (February 2013): 430–38. https://doi.org/10.1007/s11999-012-2547-5.
Hug KT, Watters TS, Vail TP, Bolognesi MP. The withdrawn ASR™ THA and hip resurfacing systems: how have our patients fared over 1 to 6 years? Clin Orthop Relat Res. 2013 Feb;471(2):430–8.
Hug, Kevin T., et al. “The withdrawn ASR™ THA and hip resurfacing systems: how have our patients fared over 1 to 6 years?Clin Orthop Relat Res, vol. 471, no. 2, Feb. 2013, pp. 430–38. Pubmed, doi:10.1007/s11999-012-2547-5.
Hug KT, Watters TS, Vail TP, Bolognesi MP. The withdrawn ASR™ THA and hip resurfacing systems: how have our patients fared over 1 to 6 years? Clin Orthop Relat Res. 2013 Feb;471(2):430–438.
Journal cover image

Published In

Clin Orthop Relat Res

DOI

EISSN

1528-1132

Publication Date

February 2013

Volume

471

Issue

2

Start / End Page

430 / 438

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Retrospective Studies
  • Reoperation
  • Prosthesis Failure
  • Prosthesis Design
  • Osteoarthritis, Hip
  • Orthopedics
  • Middle Aged
  • Medical Device Recalls
  • Male