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. 2013 Sep;471(9):2954-61.
doi: 10.1007/s11999-013-3023-6. Epub 2013 Apr 30.

High prevalence of adverse reactions to metal debris in small-headed ASR™ hips

Aleksi Reito  1 , Timo Puolakka, Petra Elo, Jorma Pajamäki, Antti Eskelinen
Affiliations

High prevalence of adverse reactions to metal debris in small-headed ASR™ hips

Aleksi Reito et al. Clin Orthop Relat Res. 2013 Sep.

Abstract

Background: There has been increasing concern of metal-on-metal (MOM) hip replacements regarding adverse reactions to metal debris. Information regarding prevalence and risk factors for these adverse reactions is scarce.

Questions/purposes: The primary purposes of our study were to determine (1) the prevalence of adverse reactions to metal debris among patients who received small-headed (< 50 mm) Articular Surface Replacement (ASR™) prostheses in hip resurfacing procedures or the ASR™ XL prostheses during THAs at our institution, and (2) the risk factors for adverse reactions to metal debris and if they are different in hip resurfacing replacements compared with THAs?

Methods: Small-headed ASR™ prostheses were used in 482 operations (424 patients) at our institution. After the recall of ASR™ prostheses, we established a systematic screening program to find patients with adverse reactions to metal debris. At a mean of 4.9 years (range, 0.2-8.1 years) postoperatively, 379 patients (435 hips) attended a screening program, which consisted of clinical evaluation, whole blood cobalt and chromium measurements, and cross-sectional imaging.

Results: At followup, 162 hips (34%) have been revised. The majority (85%) were revised owing to causes related to adverse reactions to metal debris. The 7-year survivorship was 51% for the ASR™ hip replacement cohort and 38% for the ASR™ XL THA cohort, respectively. Reduced cup coverage was an independent risk factor for adverse reactions to metal debris in both cohorts. High preoperative ROM, use of the Corail(®) stem, and female gender were associated with an increased risk of adverse reactions to metal debris only in patients undergoing THA.

Conclusions: Adverse reactions to metal debris are common with small-headed ASR™ prostheses. Risk factors for these adverse reactions differ between hip resurfacing procedures and THAs. Our results suggest a more complicated failure mechanism in THAs than in hip resurfacing procedures.

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Figures

Fig. 1
Fig. 1
The study flow chart is shown. Eight patients† were excluded from the study. One patient had bilateral implants, of which one hip was revised before screening* and the contralateral hip was available for screening.
Fig. 2
Fig. 2
The graph shows the overall survivorship for ASR™ hip resurfacing (HR) and THA cohorts with any revision as the end point.
See this image and copyright information in PMC

Comment in

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