Revision of Articular Surface Replacement (ASR) Total Hip Arthroplasty: Correlation of Perioperative Data and Early Post-Revision Outcome Results

Cip, Johannes; Bach, Christian; Widemschek, Mark; Luegmair, Matthias; Martin, Arno

doi:10.1016/j.arth.2015.04.010

Cited by 9 publications

(9 citation statements)

References 37 publications

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“… 2014b , Pritchett 2014 , Cip et al. 2015 , Lainiala et al. 2015 ), defined as a mean Oxford Hip Score (OHS) of 34 or above or a Harris Hip Score (HHS) of 80 or above (Harris 1969 , Kalairajah et al.…”

Section: Outcomes Following Armd Revision Surgerymentioning

confidence: 99%

Revision surgery of metal-on-metal hip arthroplasties for adverse reactions to metal debris

et al. 2018

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Background and purposeThe initial outcomes following metal-on-metal hip arthroplasty (MoMHA) revision surgery performed for adverse reactions to metal debris (ARMD) were poor. Furthermore, robust thresholds for performing ARMD revision are lacking. This article is the second of 2. The first article considered the various investigative modalities used during MoMHA patient surveillance (Matharu et al. 2018a). The present article aims to provide a clinical update regarding ARMD revision surgery in MoMHA patients (hip resurfacing and large-diameter MoM total hip arthroplasty), with specific focus on the threshold for performing ARMD revision, the surgical strategy, and the outcomes following revision.Results and interpretationThe outcomes following ARMD revision surgery appear to have improved with time for several reasons, among them the introduction of regular patient surveillance and lowering of the threshold for performing revision. Furthermore, registry data suggest that outcomes following ARMD revision are influenced by modifiable factors (type of revision procedure and bearing surface implanted), meaning surgeons could potentially reduce failure rates. However, additional large multi-center studies are needed to develop robust thresholds for performing ARMD revision surgery, which will guide surgeons’ treatment of MoMHA patients. The long-term systemic effects of metal ion exposure in patients with these implants must also be investigated, which will help establish whether there are any systemic reasons to recommend revision of MoMHAs

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Section: Outcomes Following Armd Revision Surgerymentioning

confidence: 99%

Revision surgery of metal-on-metal hip arthroplasties for adverse reactions to metal debris

et al. 2018

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“…1,2,6,[17][18][19] Some case series have reported rerevision rates up to ⅓, mainly due to dislocations, infections and cup loosening. 1,2,6,[17][18][19] On the contrary, Matharu et al 18 identified a survival rate of 89.5% at 18 ASR XL showed higher-than-expected rates of failure (49% at 6 years), considerably overcoming MoM revision rates. 3 The combined wear and corrosion due to bearing surfaces and taper, resulting in much higher blood ion levels and soft tissue lesions, may alter the local pre-revision setting in a different, more frequent and more severe modality.…”

Section: Discussionmentioning

confidence: 99%

“…Articular Surface Replacement (ASR, DePuy, Warsaw, IN, USA) implants were introduced to reduce wear and improve hip stability. 1–3 However, ASR systems showed precocious and excessive rates of failure (17.7% at 6–7 years) due to non-hemispheric design and limited arc of coverage. 1,2 The ASR systems, when implanted as total hip arthroplasties (THAs), with or without stems manufactured by DePuy, achieved much lower outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…1–3 However, ASR systems showed precocious and excessive rates of failure (17.7% at 6–7 years) due to non-hemispheric design and limited arc of coverage. 1,2 The ASR systems, when implanted as total hip arthroplasties (THAs), with or without stems manufactured by DePuy, achieved much lower outcomes. 1,2 Although failure rates in ASR systems are difficult to determine due to technical (wide dispersion), legal (impending recall) and economic (reimbursements) reasons, revision rates up to 28% were reported at 6–7 years, with very high ion levels and frequent destructive soft tissue lesions.…”

Section: Introductionmentioning

confidence: 99%

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lsolated acetabular revisions of articular surface replacement (ASR) XL implants with highly porous titanium cups and Delta bearings

et al. 2019

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Introduction: Articular surface replacement (ASR) XL implants exhibit higher-than-expected revision rates, blood ion concentrations and soft tissue lesions, making revisions troublesome and potentially unsatisfying. Appropriate techniques and outcomes in ASR XL revisions are rarely documented. The aims of this study were the assessments of pre-revision data, post-revision clinical and radiographic outcomes and ion levels in isolated acetabular ASR XL revisions performed using highly porous titanium cups and Delta ceramic articulations. Methods: 18 isolated acetabular ASR XL revisions in 16 patients were performed using Ti-Por cups (Adler Ortho, Milan, Italy) and Delta bearings (CeramTec, Plochingen, Germany). Pre-revision demographic, clinical, radiological and implant-related features were assessed. Clinical and radiographic parameters (cup positioning, osseointegration) after revisions were evaluated at a minimum follow-up of 5 years. Ion concentrations in blood and urine were collected in pre-revision setting and 1 year after revision. Results: 4 complications occurred in 3 different revisions (16.7%), 1 dislocation, 2 infections, 1 psoas impingement. No re-revision was performed at 5 years (1 scheduled arthroscopy). Good clinical outcomes were achieved (HHS score: 88.3 ± 9.2). All the cups showed reassuring signs of osseointegration (>3 parameters). Blood ion concentrations significantly decreased: patients with Co blood ion concentration over the threshold (7 μg/l) decreased from 76.5% to 0%. No pre-revision or intraoperative data influenced the revision outcomes. Conclusions: Highly porous titanium cups and Delta ceramic articulations provided reliable mid-term clinical and radiographic outcomes in isolated acetabular ASR XL revisions. Ion concentrations significantly decreased. Multicentre prospective controlled studies are required to confirm these preliminary outcomes.

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“…Higher blood metal ion values clearly correlated with a higher revision rate, ALTR prevalence, and raised blood lymphocyte levels [25, 26]. With increasing concerns regarding the high failure rate of large-head MoM THAs, it is important to identify a safe upper limit for femoral head size in MoM THA.…”

Section: Discussionmentioning

confidence: 99%

The 10-year outcomes of the ASR XL Acetabular System: a single-center experience from China

et al. 2019

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Background The revision rate of articular surface replacement (ASR) implants continues to rise in China because of metal debris. However, there are few reports on the clinical results of ASR implants with prolonged follow-up time in China. This study investigated the clinical outcomes and the risk factors of revision surgery in patients with ASR implants. Methods In total, 74 patients (74 hips) who underwent primary total hip arthroplasty (THA) with ASR implants over the past 4 to 10 years were retrospectively analyzed. Relevant clinical, radiographic, and biochemical data were examined. Results The average follow-up time was 88.46 (range 23–114) months, and the ASR implants of 18 hips (24.3%) were revised. Patients who received revision surgery had worse joint function with significantly lower Harris Hip Score and Western Ontario and McMaster Universities index than non-revision patients (61.11 ± 6.68 vs 85.30 ± 9.16, p < 0.001; 61.00 ± 3.83 vs 79.04 ± 14.49, p < 0.001; respectively). Higher acetabular abduction angle and serum Co and Cr concentration were significantly relevant to worse joint function as measured by HSS ( p = 0.018, 0.009, 0.043, respectively). ROC curve analysis was applied to categorize the optimal cutoff values of acetabular abduction angle and serum Cr and Co concentration for revision surgery, which were settled as 47.80°, 98.44 μg/L, and 6.95 μg/L, respectively. Overall survival of the prostheses with high acetabular abduction angle (> 47.80°, HR = 70.145, 95% CI 1.558–3158.213, p = 0.029), high serum Cr concentration (98.44 μg/L, HR = 58.956, 95% CI 1.294–2685.203, p = 0.036), and high serum Co concentration (> 6.95 μg/L, HR = 179.511, 95% CI 2.360–13656.941, p = 0.019) decreased significantly than the lower groups. Conclusions Evaluation of the DePuy ASR XL articulation demonstrated increased rates of revision following a longer follow-up period. High acetabular abduction angle and serum Cr and Co concentration correlated with worse clinical outcomes and high revision rate. Therefore, we advocate that patients with DePuy ASR XL implants be followed up more closely than those with other implants, especially with high acetabular abduction angle and serum Cr or Co concentration.

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Revision of Articular Surface Replacement (ASR) Total Hip Arthroplasty: Correlation of Perioperative Data and Early Post-Revision Outcome Results

Cited by 9 publications

References 37 publications

Revision surgery of metal-on-metal hip arthroplasties for adverse reactions to metal debris

Revision surgery of metal-on-metal hip arthroplasties for adverse reactions to metal debris

lsolated acetabular revisions of articular surface replacement (ASR) XL implants with highly porous titanium cups and Delta bearings

The 10-year outcomes of the ASR XL Acetabular System: a single-center experience from China

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