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Accelerated Failure of the ASR XL at North Tees

Accelerated Failure of the ASR XL at North Tees. Tony Nargol , R Sidaginamale , PKR Mereddy , JN Gandhi, T Joyce DJ Langton, R Logishetty , University Hospital of North Tees UK. Prospective study:2004 – 2008 n= 505. ASR resurfacing N = 418. ASR XL (THR) N = 87.

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Accelerated Failure of the ASR XL at North Tees

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  1. Accelerated Failure of the ASR XL at North Tees Tony Nargol, R Sidaginamale, PKR Mereddy, JN Gandhi, T Joyce DJ Langton, R Logishetty, University Hospital of North Tees UK

  2. Prospective study:2004 – 2008 n= 505 ASR resurfacing N = 418 ASR XL (THR) N = 87

  3. Failures due to bearing surface wear

  4. Failures due Taper failure of ASR THR

  5. Failure due to ARMD of ASR & ASR xl ASR resurfacing ASR THR 50% failure at 75 months

  6. North Tees JBJS Br August 2011

  7. In response to our paper in same August JBJS Prof fisher Prof Learmonth

  8. Surgical error ! So what is the evidence ?

  9. Failures by cup size ASR v ASR xl % failures Cup size

  10. 1. Comparison of ASR with BHR Tony Nargol single series

  11. The Incidence of Adverse Reactions to Metallic Debris(ARMED) with two Resurfacing devices AVF Nargol DJ Langton, SS Jameson, T Joyce American academy (AAOS) 2010 University Hospital of North Tees, Stockton-on-Tees, UK School of Mechanical & Systems Engineering, Newcastle University

  12. ResultsASRv BHR

  13. Cup position error ?

  14. What was Depuy advice or warning on cup position ?

  15. Whole Blood Metal Ion Levels and Component Positioningafter Surface Replacement of the Hip: Early ResultsAmerican Hip and Knee and knee Society (AHKS)3rd Nov 2007GH Isaac A Cobb R McLennan-SmithR OakeshottT O’SullivanT SiebelT SchmalzriedTP VailUK, S Africa, Australia, Germany, USA

  16. Metal Ion Data, Effect of Implant Inclination • Consecutive patients, 4 centres, N= 50(24m) ....... a standard cup angle (<55 degrees )

  17. Recommended cup positions for resurfacing • Depuy inclination up to 55 degrees(AAHKS 2007) • Oxford : Safer zone (JBJS 92B ) • 35-55 inclination • 10-30 anteversion

  18. Failure numbers ASR and ASR xl by cup inclination Tony Nargol (TN) No of cases Cup inclination

  19. Failure numbers ASR and ASR xl by cup inclinationTony Nargol No of cases Cup inclination

  20. Number of failures below and above 55 cup inclination

  21. Number of failures below and above 55 cup inclination 72 cases

  22. Tony Nargol (TN) all ASR CUP POSITIONS INCLINATION Mean cup inclination 25th-75thcentiles spread

  23. TN all ASR cup position compared to other centres INCLINATION

  24. ASR xl failures inclination & anteversion inclination

  25. ASR xl failures inclination & anteversion 18 failures inside zone 11 failures outside zone inclination

  26. ASR xl failures inclination & anteversion 18 failures inside zone 11 failures outside zone Depuy 2010 target inclination

  27. ARMD failure of ASR Inclination 44.4*

  28. ARMD failure of ASR 45.0*

  29. ARMD failure of ASR 41.5*

  30. ARMD failure of ASR 41 *

  31. ARMD failure of ASR 42 *

  32. ARMD failure of ASR THR 40 *

  33. ASR Xl mean cup inclinations Failed non-failed 46.5 degrees 46.7 degrees (NS difference)

  34. Other centres failure of ASR XL • S Jones (Cardiff) • D Beverland • York • Norfolk & Norwich

  35. Conclusion • ASR Xl failing at 50% at 7 yrs • Majority are in safe zone • Taper failure has no relationship to cup position

  36. UK National joint registry for ASR XL • 2010 5yr 12% failure of ASR XL • 2011 6yr ? Double to 24% • 2012 7r ?? Double again 50%

  37. Message to Depuy I implanted 87 ASR xl so I am not influencing the NJR figures

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