accelerated failure of the asr xl at north tees
DESCRIPTION
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. - PowerPoint PPT PresentationTRANSCRIPT
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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 TeesUK
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Prospective study:2004 – 2008 n= 505
ASR resurfacing
N = 418
ASR XL (THR)
N = 87
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Failures due to bearing surface wear
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Failures due Taper failure of ASR THR
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Failure due to ARMD of ASR & ASR xl
ASR THR 50% failure at 75 months
ASR resurfacing
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North Tees JBJS Br August 2011
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In response to our paper in same August JBJS
Prof fisher Prof Learmonth
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Surgical error !
So what is the evidence ?
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Failures by cup size ASR v ASR xl
44 46 48 50 52 54 56 58 60 62 640
10
20
30
40
50
60
70
80
90
100
ASRASR XL
% failures
Cup size
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1. Comparison of ASR with BHR
Tony Nargol single series
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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
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Results ASR v BHRASR BHR ASR THR
No of patients
Mean F/U 3.8 yrs 5.2 yrs 4.5 yrs
ARMD Females
ARMD Males
ARMD Total
ARMD Rate 5.9 % 0 % 11.4 %
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Cup position error ?
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What was Depuy advice or warning on cup position ?
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Whole Blood Metal Ion Levels and Component Positioning after Surface Replacement of the Hip: Early Results
American Hip and Knee and knee Society (AHKS)3rd Nov 2007
GH Isaac A Cobb
R McLennan-SmithR OakeshottT O’Sullivan
T SiebelT Schmalzried
TP Vail
UK, S Africa, Australia, Germany, USA
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Metal Ion Data, Effect of Implant InclinationConsecutive patients, 4 centres, N= 50(24m)
24m Ion Level v Inclination Group
2.3
12.6
2.5
24.1
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
35-55 (42) 55+ (8)
Inclination Group (deg)
Ion
Le
ve
l (u
g/l
) Cr (ug/l)
Co (ug/l)
....... a standard cup angle (<55 degrees )
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Recommended cup positions for resurfacing
• Depuy inclination up to 55 degrees (AAHKS 2007)
• Oxford : Safer zone (JBJS 92B )– 35-55 inclination– 10-30 anteversion
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Failure numbers ASR and ASR xl by cup inclination Tony Nargol (TN)
< 35 35-40 40-45 45-50 50-55 55-60 >600
5
10
15
20
25
30
ASR & ASR xl
Cup inclination
No of cases
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Failure numbers ASR and ASR xl by cup inclinationTony Nargol
< 35 35-40 40-45 45-50 50-55 55-60 >600
5
10
15
20
25
30
ASR & ASR xl
Cup inclination
No of cases
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Number of failures below and above 55 cup inclination
greater than 55
less than 55
-80 -60 -40 -20 0 20 40
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Number of failures below and above 55 cup inclination
greater than 55
less than 55
-80 -60 -40 -20 0 20 40
72 cases
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Tony Nargol (TN) all ASR CUP POSITIONS
all >20070
10
20
30
40
50
60
70
45.740.7
INCLINATION
Mean cup inclination
25th-75th centiles
spread
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TN all ASR cup position compared to other centres
all TN TN >2007 Hart Wrightington Oxford Treacy 0
10
20
30
40
50
60
70
80
45.740.7
49 5046.6
49
INCLINATION
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ASR xl failures inclination & anteversion
20 25 30 35 40 45 50 55 60 650
10
20
30
40
50
Anteversion
inclination
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ASR xl failures inclination & anteversion
20 25 30 35 40 45 50 55 60 650
10
20
30
40
50
Anteversion
inclination
18 failures inside zone 11 failures outside zone
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ASR xl failures inclination & anteversion
20 25 30 35 40 45 50 55 60 650
10
20
30
40
50
Anteversion
inclination
18 failures inside zone 11 failures outside zone
Depuy 2010 target
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ARMD failure of ASR
Inclination 44.4*
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ARMD failure of ASR
45.0*
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ARMD failure of ASR
41.5*
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ARMD failure of ASR
41 *
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ARMD failure of ASR
42 *
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ARMD failure of ASR THR
40 *
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ASR Xl mean cup inclinations
Failed
46.7 degrees
(NS difference)
non-failed
46.5 degrees
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Other centres failure of ASR XL
• S Jones (Cardiff)• D Beverland• York• Norfolk & Norwich
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Conclusion
• ASR Xl failing at 50% at 7 yrs • Majority are in safe zone
• Taper failure has no relationship to cup position
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UK National joint registry for ASR XL
• 2010 5yr 12% failure of ASR XL
• 2011 6yr ? Double to 24%
• 2012 7r ?? Double again 50%
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Message to Depuy
I implanted 87 ASR xl so I am not influencing the NJR figures