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. 2015 May 15:16:118.
doi: 10.1186/s12891-015-0566-6.

Femoral diameter and stem type are independent risk factors for ARMD in the large-headed ASR THR group

Aleksi Reito  1 , Petra Elo  2 , Timo Puolakka  3 , Jorma Pajamäki  4 , Antti Eskelinen  5
Affiliations

Femoral diameter and stem type are independent risk factors for ARMD in the large-headed ASR THR group

Aleksi Reito et al. BMC Musculoskelet Disord. .

Abstract

Background: 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) 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.

Methods: Large-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.

Results: Revision 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.

Conclusions: Stem 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.

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Figures

Figure 1
Figure 1
Perioperative findings in a patient undergoing revision surgery due to suspected ARMD. A) Male taper shows severe corrosion and fretting. B) Female taper shows moderate fretting and large amount of cheese-like caseotic (necrotic) tissue inside the head.
Figure 2
Figure 2
The graph shows the overall survivorship for ASR XL THR cohorts with any revision as the end point. Dotted line indicates number at risk <20.
Figure 3
Figure 3
The graph shows the overall survivorship for ASR XL THR with different femoral sizes with ARMD as the end point. Dotted line indicates number at risk <20.
See this image and copyright information in PMC

References

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    1. Medicines and Healthcare Products Regulation Agency. Medical Device Alert: All metal-on-metal (MoM) hip replacements (MDA/2012/036). 2012. https://assets.digital.cabinet-office.gov.uk/media/5485abf6ed915d4c10000....
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