Background Adverse local tissue reactions (ALTRs) around hip arthroplasties are an important reason for failure of metal-on-metal (MoM) hip implants. Little is known about capsular dehiscence patterns as ALTRs decompress from the hip into the surrounding tissue planes; these patterns may also influence the onset and severity of patient symptoms. Questions/purposes Through a multicenter study approach, we asked: (1) Is ALTR location related to the surgical approach used for arthroplasty in patients who underwent hip arthroplasty (resurfacing or THA) with a single, recalled hip arthroplasty system? (2) Do ALTR severity and location affect patient-reported outcomes in these patients? (3) The institution of one of the authors (HGP) has received, during the study period, funding from GE Healthcare (Waukesha, WI, USA). One of the authors (CB), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000 from Zimmer Inc. One of the authors (OM), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of less than USD 10,000 from Corin (Cirencester, UK), Iconacy (Warsaw, IN, USA), Renovis (Redlands, CA, USA), Conformis (Burlington, MA, USA), Aston Medical (Saint-É tienne, France), Meril Healthcare (Vapi, Gujarat, India), Arthex (Naples, FL, USA), Orthopaedic Technology Group (Boston, MA, USA); USD 10,000 to USD 100,000, from Mako Surgical Corp; USD 100,000 to USD 1,000,000 from Zimmer Inc; and more than USD 1,000,000 from Biomet and Cambridge Polymer Group (Boston, MA, USA). One of the authors (HM), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000, from Zimmer Inc, Biomet, Corin, and RSA Biomedical (Umeå, Sweden).
Clinical Orthopaedics and Related Research ®A Publication of The Association of Bone and Joint Surgeons® 288 patients (333 hips) from two centers had a metal artifact reduction sequence MRI of the hip performed at a mean time of 6 years postsurgery. Procedures included 166 hips (50%) with ASR resurfacing and 167 hips (50%) with ASR XL THA performed between 2004 and 2010. One hundred twenty-nine hips (39%) had been operated on using a direct lateral approach and 204 using a posterior approach (61%). The EQ-5D, Harris hip score, UCLA activity score, and visual analog scale pain score were obtained for each patient. ALTRs were classified using the Anderson ALTR grading system, and the location, synovial thickness, and diameter of the ATLRs were assessed. The relationship between ALTR location and surgical approach as well as for ALTR severity and patient-reported outcomes were evaluated, and logistic regression was used to identify predictors for moderate-to-severe ALTRs. Results Moderate or severe ALTRs were identified in 79 hips (24%); 41 of these hips had been operated on using the direct lateral approach and 38 using the posterior approach. In patients...
