CORR Insights®: Early Lessons From a Worldwide, Multicenter, Followup Study of the Recalled Articular Surface Replacement Hip System

Abstract

T he development of adverse local tissue reactions (ALTRs) in patients implanted with metal-on-metal (MoM) bearing surfaces for hip arthroplasty may cause early failure or silent progression of the destructive reaction, making revision even more complex. Because of this early revision rate, the Articular Surface Replacement (ASR) system (DePuy Orthopaedics, Warsaw, IN, USA), both for resurfacing and for THA, was recalled in 2010 after 6 years of commercial use [6]. This raises a few interesting questions: How do we screen nonrevised patients in order to detect ALTRs? Should we treat such lesions by revision based on risk stratification, as recently proposed in the consensus statement of American Academy of Orthopaedic Surgeons, American Association of Hip and Knee Surgeons, and the Hip Society [4]? This screening currently includes a combination of cross-sectional imaging, patient symptomatology and/or reported outcome, and metal ions level. The location and severity of ALTRs are important factors to be considered, as well as the interrelation with the patient outcomes. In their current study, Malchau and colleagues examined the location of ALTRs, their severity, and the clinical consequences of using metal artifact reduction MRI and patient reported outcome scores on 288 individuals evaluated at a mean time of 6 years of either resurfacing or THA ASR. Nearly one-fourth of the nonrevised patients showed signs of moderate or severe ALTRs (pseudotumors), although they could not intraoperatively confirm this finding. Nevertheless, this incidence should be considered valid since all of the revised ASR implants showed solid pseudotumors on cross-sectional imaging, with MRI as the primary imaging modality [5]. Malchau and colleagues assessed patient MRIs for the presence and This CORR Insights is a commentary on the article ‘‘Early Lessons From a Worldwide, Multicenter, Followup Study of the Recalled Articular Surface Replacement Hip System’’ by Madanat and colleagues available at: DOI: 10.1007/s11999-015-4456-x. The author certifies that he, or a member of his immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/ licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR or The Association of Bone and Joint Surgeons. This CORR Insights comment refers to the article available at DOI: 10.1007/s11999015-4456-x. J.-N. A. Argenson MD, PhD (&) Aix-Marseille University Hopital SainteMarguerite, BP 29, 13274 Marseille Cedex 09, France e-mail: jean-noel.argenson@ap-hm.fr CORR Insights Published online: 8 September 2015 The Association of Bone and Joint Surgeons1 2015