Are Females at Greater Risk for Revision Surgery After Hip Resurfacing Arthroplasty With the Articular Surface Replacement Prosthesis?

Abstract

Background Female patients undergoing hip resurfacing arthroplasties may be at greater risk of revision surgery than males, but it is unclear whether this is related to sex or other factors. We focused our analysis on data from a prospective multicenter cohort study monitoring the ASR TM hip resurfacing arthroplasty prosthesis on the potential association of sex on patient-reported outcome measures (PROMs), metal ion levels, revision surgery, and presence of adverse local tissue reaction. As thousands of patients with the ASR TM prosthesis are still undergoing followup it is critical to optimize the protocol for monitoring these patients.Questions/purposes We wished (1) to assess the associations between sex and implant survival, and adverse local tissue reaction; and (2) to report the differences between sexes in metal ion levels and patient-reported outcome measures. Methods One thousand two hundred fifty-two patients (1390 hips) who underwent hip resurfacing arthroplasty with implantation of the ASR TM prosthesis from April 2003 to July 2010 were eligible for enrollment in a multicenter followup study of the ASR TM Hip Resurfacing System after the voluntary recall of this device was initiated by DePuy in 2010. Nine hundred seventy patients (1098 hips) were enrolled at a mean of 7 years after surgery, with a mean followup of 2 years (range, 1-3.5 years). One of the authors (OM), or a member of his 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 (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), Mako Surgical Corp, Cambridge Polymer Group (Boston, MA, USA), and Orthopedic Technology Group (Boston, MA, USA). One of the authors (HM), or a member of his 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 Nine hundred fifty-eight patients (1084 hips) met the inclusion criteria: ability to provide informed consent, complete PROMs, and continued routine followup. A subset of patients (150 patients, 171 hips), who all were from one center, with annual metal artifact reduction sequence MRI were analyzed. Ninety-three percent of patients from this center had routine MRI performed. The EuroQoL (EQ-5D), Harris hip score (HHS), University of California Los Angeles (UCLA) activity score, VAS pain, radiographs, patient and surgery details, and blood cobalt and chromium levels were obtained. Cox regression analysis was conducted to identify factors associated with implant survival, using any revision as the end point, and presence of adverse local tissue reaction. Results In patients who had unilateral surgery, the only variable found to be associated with revision surgery was HHS (hazard ratio [HR], 0.96; 95% CI, 0.9...

Mid-term changes in blood metal ion levels after Articular Surface Replacement arthroplasty of the hip

“…For women, the change was 2.7 ppb, and for men it was 0.5 ppb. This A disparity between the genders in the levels of Co ions has been confirmed by some authors 19,20 although there is some contradictory evidence. 18 No studies to our knowledge have reported a significant increase in the levels of Co ions over time for patients with a MoM HRA implant.…”

“…The change for women was 1.0 ppb over two years, while for men it was only 0.3 ppb during this time. Several studies have shown a difference between the genders in levels of Cr ions at a single time point, [18][19][20] but none to our knowledge have shown such a difference in the later stages of follow-up. This finding is of particular interest in the light of recently published findings that women with increased level of Cr ions have worse health-related quality of life and hip function.…”

Obesity is not associated with hip failure in patients with articular surface replacement of the hip

“…Details of this study are explained in previous literature. 12,13 BMI was not required data in the follow-up study of the ASR hip system but was reported nonetheless by many sites. We only included data from centres that reported BMI data on 90% or more of the patients in our analyses in order to eliminate selection bias.…”

Total Hip Arthroplasty for the Sequelae of Femoral Neck Fractures in the Pediatric Patient

“…These modalities include femoral head core decompression, osteotomy, electrical stimulation, and bone grafting with muscle-pedicle bone grafts, vascular-pedicle bone grafts, and free vascularized bone grafts [10,[19][20][21]. If hip joint reconstruction is deemed necessary, hip resurfacing (HR) and THA remain the primary treatment modalities [56][57][58][59][60][61]. HR has had poor results historically [56,61], but more recent studies using meticulous patient selection in young adults have demonstrated satisfactory short-to medium-term outcomes.…”

“…However, there is conflicting evidence regarding whether patients undergoing HR for femoral head ON have similar outcomes to those undergoing HR for osteoarthritis [21,62,63]. Furthermore, it is worth noting that females may be at increased risk of revision after HR [57,58]. With respect to pediatric THA, emerging evidence demonstrates favorable medium-to long-term outcomes when using cementless techniques and modern implant designs [12,38,[40][41][42].…”