Lessons learned from early clinical experience and results of 300 ASR® hip resurfacing implantations

Abstract

Between August 2003 and April 2005, 300 ASR metal-on-metal resurfacing hip endoprostheses were implanted by the first author and a fellow surgeon. The mean age at surgery was 56.8 years (18-75.9 years) and mean body mass index was 27.6 kg/m2 (range, 19-41 kg/m2). The mean follow-up time was 202 days. The mean Harris hip score improved from 44 pre-operatively to 89 at 3 months post-operatively. In total, eight (2.7 per cent) cases [five neck fractures (1.66 per cent) and three cup revisions (1 per cent)] were revised. Two neck fractures occurred within a group of seven cases of femoral neck notching detected postoperatively; one neck fracture occurred out of two cases of incomplete seating of the femoral implant. A significantly higher (p < 0.001) failure rate was observed for patients who had undergone a previous osteosynthesis of the proximal femur (three revisions in a group of 15 patients). Revision cases had a significantly greater body mass index (p = 0.031). A learning curve was evident from the reduction in revisions from 5 in the first 100 surgical procedures to 2 in the next 100 and 1 in the last 100. These results show the importance of accurate surgical technique and careful patient selection for fourth-generation hip resurfacing implants,

Surgical management of hip osteoarthritis

“…[50][51][52][53][54][55][56][57][58][59] However, complications particular to this procedure have been identified (as stated previously), and emphasis is placed on patient selection, component selection and surgical technique to avoid poor and adverse outcomes and short-term failures. 44,47,[60][61][62][63][64][65][66][67][68][69][70] Many surgeons avoid resurfacing in postmenopausal women because of an increased risk of femoral neck fracture, and in those with known renal insufficiency owing to the potential for metal ion accumulation.…”

Hip resurfacing arthroplasty: current status and future perspectives

“…Several case series indicate that improvement in technique and increased experience resulted in a decrease in revision rates and better functional outcome scores (Siebel et al, 2006;Mont et al, 2007;Amstutz et al, 2007;Amstutz et al, 2011). However, this was not found in another large series (McBryde et al, 2010).…”

“…More recently, MoM related issues such as pseudotumors (Figs. 2 and 3), high blood ion levels and allergy towards Co-Cr ions have raised additional concerns against the use of HRA (Davies et al, 2005;Willert et al, 2005;Siebel et al, 2006;De Haan et al, 2008). Ollivere et al (2009) reported a 1.9% incidence of metallosis as the indication for the early failure in a consecutive series of 493 Birmingham HRA.…”

“…4). Probably less important prognosticators for failure are BMI and patient activity level as conflicting conclusions have been reported (Siebel et al, 2006;Le Duff et al, 2007;Amstutz et al, 2011;Banerjee et al, 2010). However, surgical bias towards these parameters should be taken into account.…”

“…2 and 3) (Gruber et al, 2007;De Haan et al, 2008;Hart et al, 2009) have been associated with MoM devices. The underlying causes of these biological responses remain unclear, but are probably induced by an accumulation of abovementioned cellular responses to metal ion releases Davies et al, 2005;Siebel et al, 2006;De Haan et al, 2008;Glyn-Jones et al, 2009;Grammatopoulos et al, 2009;Amstutz et al, 2011;Campbell et al, 2010). However, they have also been associated with a delayed immune reaction to metal ions (delayed hypersensitivity) .…”