title: Early failure of articular surface replacement XL total hip arthroplasty.
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.
authors.affiliation: OrthoCarolina, PA, Charlotte, North Carolina 28207, USA.
authors.forename: Garen D
authors.initials: GD
authors.lastname: Steele
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Fehring
authors.forename: Susan M
authors.initials: SM
authors.lastname: Odum
authors.forename: Anne C
authors.initials: AC
authors.lastname: Dennos
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Nadaud
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation* / Q000379:methods; D017760:Bone Malalignment / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D015994:Incidence; D008297:Male; D008670:Metals; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery*; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000453:epidemiology; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D008670:Metals