Abstract
BackgroundAdverse soft-tissue reaction to metal debris (ARMD) continues to be major source of concern in metal-on-metal (MoM) hip replacements. In our earlier study we were able to establish several risk factors for ARMD in patients who had received a small-diameter (<50 mm) Articular Surface Replacement (ASR, DePuy, Warsaw, IN, USA). The aims of the present study were to analyze whether these previously established risk factors also apply to patients who have received a large-headed (>50 mm) ASR™ XL THR.MethodsLarge-headed ASR total hip replacements were used in 225 operations (196 patients) at our institution. 176 patients (203 hips) attended a screening programme, consisting of a clinical evaluation, whole blood cobalt and chromium measurements, and cross-sectional imaging.ResultsRevision surgery was performed on 84 hips (37%) in 75 patients. ARMD was diagnosed in the majority (n = 73 [87%]) of these revisions. Cumulative 8-year survivorship was 52%. The previously established risk factors for ARMD were not applicable. Interestingly, increasing femoral diameter and stem type were identified as independent risk factors for ARMD but reduced cup coverage had no significant association with ARMD.ConclusionsStem type and increasing femoral size as independent risk factors for ARMD in the cohort of ASR XL THR patients, support the importance of taper failure in the development of ARMD. The present results suggest that the degree of taper failure may be variable and dependent on the taper design.
Highlights
Adverse soft-tissue reaction to metal debris (ARMD) continues to be major source of concern in metal-on-metal (MoM) hip replacements
In addition to Articular Surface Replacement (ASRTM; DePuy, Warsaw, IN, USA) several other large-diameter metal-on-metal (LD-MoM) total hip replacements (THR) have been recalled along with Medical Device Alerts owing to high prevalence of ARMD [1,2]
The aims of our study were (1) to analyse and report the prevalence of ARMD among patients who received a large-headed (>50 mm) ASRTM XL THR system at our institution, and (2) to investigate whether previously identified risk factors apply to this specific patient population
Summary
Adverse soft-tissue reaction to metal debris (ARMD) continues to be major source of concern in metal-on-metal (MoM) hip replacements. In our earlier study we were able to establish several risk factors for ARMD in patients who had received a small-diameter (50 mm) MoM hip replacements [3] It is not exactly known whether this is solely due to taper wear and damage due to corrosion or if edge-loading and subsequent bearing surface wear have an affect. Registry studies suggest significantly higher revision rates with large-diameter (>50 mm) THR compared to large diameter (>50 mm) HRs when the same bearing couple is used [7]
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