Medium-term results of hip arthroplasty with ASR XL (DePuy)

Cover Page

Cite item


The purpose - to identify factors affect on instability and to access the medium-term survivorship of metal-on-metal X-large heads total hip prostheses. Material and methods. From January 2007 March 2009 we performed 134 ASR XL head - Corail total hip arthroplasties in 119 patients. The medium-term results were studied in 94 (105 hips). Mean follow-up was 76±3 months. Radiological evaluation was carried out in standard views. Clinical and functional results were accessed with Harris Hip Score. We determined metal ions concentration in whole blood with atomic absorption spectrometry (AAS) and mass spectrometry in the induced coupled plasma (ICP-MS). Changes in periprosthetic tissues were studied at high field magnetic resonance imaging (MRI) with subsequent histological confirmation. “Gamma test” was applied for statistic analysis revision risk factors. Results. Medium-term survivorship of studied implants amounted to 85.5% (95% CI 78.7% to 92.3%). Average ions concentration in the whole blood of amounted to 3.2 ppb and 2.9 ppb foe Co and Cr respectively Specific risk factors of instability were gender (female), small size of the cups, and high angle of abduction (>45°). The main reason for revision was cup loosening (over 50%). Conclusions. Patients in this cohort are in a great danger of early aseptic loosening, especially in the presence of specific risk factors. So the annual monitoring is considered mandatory for them. The indications for revision surgery are not only the evident implant instability, but also the pathological changes in periprosthetic tissues associated with high ions level in whole blood.

About the authors

V. V. Danilyak

Yaroslavl Regional Hospital for Wars Veterans - International Centre for the elderly «Healthy Longevity»

Author for correspondence.
Russian Federation

A. A. Vergay

Yaroslavl State Medical Academy

Russian Federation

V. V. Kluchevskiy

Yaroslavl State Medical Academy

Russian Federation

M. A. Molodov

Yaroslavl Regional Hospital for Wars Veterans - International Centre for the elderly «Healthy Longevity»

Russian Federation


  1. Вергай А.А., Даниляк В.В., Ключевский В.В., Гильфанов С.И., Ключевский Вас.В., Молодов М.А., Шпунт И.Е. Возможности магнитно-резонансной томографии в диагностике осложнений тотальной артропластики тазобедренного сустава с парой трения металл-металл. Травматология и ортопедия России. 2013; (3):96-102.
  2. Куропаткин Г. В. Поверхностное эндопротезирование тазобедренного сустава - первые впечатления и новые возможности. Травматология и ортопедия России. 2010; (2):18-21.
  3. Молодов М.А., Даниляк В.В., Ключевский В.В., Гильфанов С.И., Ключевский Вас.В., Вергай А.А. Факторы риска вывихов тотальных эндопротезов тазобедренного сустава. Травматология и ортопедия России. 2013; (2):23-30.
  4. Australian Orthopaedic Association, National Joint Replacement Registry, annual report 2009. AOA 2009. documents/10180/42728/Annual%20Report%20 2009?version=1.1&t=1349406243327
  5. Australian Orthopaedic Association, National Joint Replacement Registry, annual report 2010. AOA 2010. documents/10180/42844/Annual%20Report%20 2010?version=1.1&t=1349406187793
  6. Australian Orthopaedic Association, National Joint Replacement Registry, annual report 2013. AOA 2013;Metal on Metal Total Conventional Hip Arthroplasty. documents/10180/127369/Metal%20on%20Metal%20 Total%20Conventional%20ffip%20Arthroplasty
  7. Bozic K.J., Kurtz S., Lau E., Ong K., Chiu V., Vail T.P., Rubash H.E., Berry D.J. The epidemiology of bearing surface usage in total hip arthroplasty in the United States. J Bone Joint Surg Am. 2009; 91-7:1614-1620.
  8. British Hip Society Annual Conference; Large Diameter Metal on Metal Bearing Total Hip Replacements. March 2nd-4th 2011. BHS_MOM_THR.pdf
  9. Delaunay C., Petit I., Learmonth I.D., Oger P., Vendittoli P.A. Metal-on-metal bearings total hip arthroplasty: the cobalt and chromium ions release concern. Orthop Traumatol Surg Res. 2010; 96(8):894-904.
  10. De Puy a JOHNSON & JOHNSON COMPANY. Urgent field safety notice. 24 august 2010. http://www.colbachlaw com/blog/DePuy%20Recall%20Letter.pdf
  11. De Smet K. Birmingham hip resurfacing versus conserve plus metal-on-metal hip resurfacing. Ghent, Belgium; 2008. BHRCONSERVEFINAL_LOWRES.PDF?phpMyAdm in=8d8fa970cf01362ac617f05cfca3169d
  12. Dowson D., Hardaker C., Flett M., Isaac G.H.A. Hip joint simulator study of the performance of metal-on-metal joints. Part 1. The role of materials. J Arthroplasty. 2004; 19(8 suppl 3): 118-123.
  13. Dowson D., Hardaker C., Flett M., Isaac G.H.A. Hip joint simulator study of the performance of metal-on-metal joints. Part 2. Desing. J Arthroplasty. 2004; 19(8 suppl 3); 124-130.
  14. FDA. Concerns about Metal-on-Metal Hip Implants. 2013. http:// implantsandprosthetics/metalonmetalhipimplants/ ucm241604.htm
  15. Glyn-Jones S., Pandit H., Kwon Y.M., Doll H., Gill H.S., Murray D.W. Risk factors for inflammatory pseudotumour formation following hip resurfacing. J Bone Joint Surg. 2009; 91-B: 1566-1574.
  16. Günther K.P., Schmitt J., Campbell P., Delaunay C.P., Drexler H., Ettema H.B., Garcia-Cimbrelo E., Hannemann F., Hartmann A., Huberti H., Knahr K., Kunze.J, Langton D.J., Lauer W., Learmonth I., Lohmann C.H., Lützner J., Morlock M., Seidler A., Wimmer M.A., Zagra L. Consensus statement «Current evidence on the management of metal-on-metal bearings» April 16, 2012. Hip Int. 2013; 23(1):2-5.
  17. Hart A.J., Sabah S.A., Bandi A.S., Maggiore P., Tarassoli P., Sampson B., Skinner A.J. Sensitivity and specificity of blood cobalt and chromium metal ions for predicting failure of metal-on-metal hip replacement. J Bone Joint Surg Br. 2011; 93(10):1308-1313.
  18. Jin Z.M., Dowson D., Fisher J. Analysis of fluid film lubrication in artificial hip joint replacements with surfaces of high elastic modulus. Proc Inst Mech Eng H. 1997; 211:247-256.
  19. Langton D.J., Jameson S.S., Joyce T.J., Webb J., Nargol A.V. The effect of component size and orientation on the concentrations of metal ions after resurfacing arthroplasty of the hip. J Bone Joint Surg Br. 2008; 90(9):1143-1151.
  20. Langton D.J., Jameson S.S., Joyce T.J., Hallab N.J., Natu S., Nargol A.V. Early failure of metal-on-metal bearings in hip resurfacing and large-diameter total hip replacement: A consequence of excess wear. J Bone Joint Surg Br. 2010; 92: 38-46.
  21. Lavigne M., Belzile E.L., Roy A., Morin F., Amzica T., Vendittoli P.A. Comparison of whole-blood metal ion levels in four types of metal-on-metal large-diameter femoral head total hip arthroplasty: the potential influence of the adapter sleeve. J Bone Joint Surg Am. 2011; 93:128-136.
  22. MacDonald S.J. Metal-on-metal total hip arthroplasty: the concerns. Clin Orthop Relat Res. 2004; 429:86-93.
  23. McMinn D., Daniel J., Pradhan C., Ziaee H. Transplacental transfer of cobalt and chromium in patients with metal-on-metal bearings. In: 73rd AAOS Annual Meeting Proceedings. Chicago, IL 2006; 484.
  24. McBryde C.W., Theivendran K., Thomas A.M.C., Treacy R.B.C., Pynsent P.B. The influence of head size and sex on the outcome of Birmingham hip resurfacing. J Bone Joint Surg. 2010; 92-A: 105-112
  25. MHRA: Medical Device Alert. Ref: MDA/2010/033 Issued: 22 April 2010 at 14:00. All metal-on-metal (MoM) hip replacements.
  26. MHRA: Medical Device Alert. Ref: MDA/2010/044 Issued: 25 May 2010 at 14:30. De Puy ASR™ acetabular cups used in hip resurfacing arthroplasty and total hip replacement. halso-och-sjukvard/medicinteknik/MHRA/MDA-2010-044%20Final.pdf
  27. National Joint Registry for England and Wales; 7th Annual Report. 2010. uk/njrcentre/portals/0/njr%207th%20annual%20 report%202010.pdf
  28. Pandit H., Glyn-Jones S., McLardy-Smith P., Gundle R., Whitwell D., Gibbons C.L., Ostlere S., Athanasou N., Gill H.S., Murray D.W. Pseudotumours associated with metal-on-metal hip resurfacing. J Bone Joint Surg Br. 2008; 90:847-851.
  29. Peters C.L., Clarke I.C., McPherson J.E., Donaldson T.K., McPherson J.E. Stripe wear in metal-metal THA bearing retrieval analysis of large diameter articulations. AAOS 2012. Annual meeting.
  30. Riecer C.B., Schön R., Konrad R., Leibentritt G., Gnepf P., Shen M., Roberts P., Grigoris P Influence of the clearance on in-vitro tribology of large diameter metal-on-metal articulations pertaining to resurfacing hip implants. Orthop. Clin. North Am. 2005; 36:135-142.
  31. Smith T.M., Berend K.R., Lombardi A.V. Jr., Emerson R.H. Jr., Mallory T.H. Metal-on-metal total hip arthroplasty with large heads may prevent early dislocation. Clin. Orthop. Relat Res. 2005; 441:137-142.
  32. Tower S.S. Arthroprosthetic cobaltism: Identification of the at-risk patient. Alaska Med. 2010; 52:28-32.
  33. Tower S.S. Arthroprosthetic cobaltism: neurological and cardiac manifestations in two patients with metal-on-metal arthroplasty: a case report. J Bone Joint Surg Am. 2010; 92(17):2847-2851.
  34. Vidalain J.P., Selmi T.A.S., Beverland D., Young S., Board T., Boldt J., Brumby S. The CORAIL® Hip System: a practical approach based on 25 years of experience. Berlin, Heidelberg: Sringer Verlag; 2011. 139 p.
  35. Visuri T., Borg H., Pulkkinen P., Paavolainen P., Pukkala E. A retrospective study of mortality and causes of death among patients with metal-on-metal and metal-on-polyethylene total hip prostheses in primary osteoarthritis after a longterm follow-up. BMC Musculoskelet Disord. 2010; 11:78.
  36. Willert H.G., Buchhorn G.H., Fayyzai A., Flury R., Windler M., Köster G., Lochmann C.H. Metal-on-metal bearings and hypersensitivity in patients with artificials hip joints. A clinical and hystomorphological study J Bone Joint Surg Am. 2005; 87:28-36.
  37. Wynn-Jones H., Macnair R., Wimhurst J., Chirodian N., Derbyshire B., Toms A., Cahir J. Silent soft tissue pathology is common with a modern metal-on-metal total hip arthroplasty. Acta Orthop. 2011; 82(3):301-307.

Copyright (c) 2015

СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 82474 от 10.12.2021.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies