Australian Orthopaedic Association National Joint Replacement Registry, Discipline of Public Health, University of Adelaide, Adelaide, SA, Australia.
J Bone Joint Surg Am. 2011 Dec 21;93(24):2287-93. doi: 10.2106/JBJS.J.01727.
Articular Surface Replacement (ASR) hip prostheses, which have metal-on-metal bearing surfaces, were manufactured by DePuy Orthopaedics (Warsaw, Indiana) for use in both conventional total hip arthroplasty and hip resurfacing. Both the ASR XL Acetabular System and the ASR Hip Resurfacing System were recently recalled worldwide by the manufacturer. This report summarizes an analysis by the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) of the outcome of arthroplasties involving the ASR prostheses.
The first recorded use of the ASR XL Acetabular System in Australia occurred in 2004, and the Registry recorded 4406 procedures involving this system through December 31, 2009. The first recorded use of the ASR Hip Resurfacing System in Australia occurred in 2003, and the Registry recorded 1167 procedures through December 31, 2009. The Kaplan-Meier method and proportional-hazard modeling were used to compare the revision rate of primary total hip arthroplasties involving the ASR XL Acetabular System with that of arthroplasties involving all other conventional prostheses as well as with that of arthroplasties involving all other conventional prostheses with a metal-on-metal-articulation. In addition, the revision rate of primary arthroplasties involving the ASR Hip Resurfacing System was compared with that of arthroplasties involving all other hip resurfacing prostheses. Patient demographics, prosthesis characteristics, and information regarding the type of revision and the reason for revision were also compared.
Arthroplasties involving both ASR designs had a significantly greater revision rate compared with those involving all other prostheses. The cumulative revision rate of arthroplasties involving the ASR XL Acetabular System at five years postoperatively was 9.3% (95% confidence interval [CI], 7.3% to 11.9%) compared with 3.4% (95% CI, 3.3% to 3.5%) for total hip arthroplasties involving all other conventional prostheses. The cumulative revision rate of arthroplasties involving the ASR Hip Resurfacing System at five years postoperatively was 10.9% (95% CI, 8.7% to 13.6%) compared with 4.0% (95% CI, 3.7% to 4.5%) for arthroplasties involving all other resurfacing prostheses. Arthroplasties involving the ASR XL Acetabular System had a greater rate of revision due to implant loosening and/or osteolysis and due to metal sensitivity compared with total hip arthroplasties involving all other conventional prostheses. Arthroplasties involving the ASR XL Acetabular System also had a significantly greater revision rate compared with total hip arthroplasties involving all other conventional metal-on-metal prostheses. Arthroplasties involving the ASR Hip Resurfacing System had a greater rate of revision due to metal sensitivity compared with total hip arthroplasties involving all other resurfacing prostheses.
ASR prostheses used in conventional hip arthroplasty and in hip resurfacing exhibited a greater revision rate compared with other prostheses in the AOANJRR. These results are consistent with those derived from other registries and from published studies of individual cohorts.
采用金属对金属关节面的关节表面置换（ASR）髋关节假体由 DePuy Orthopaedics（印第安纳州华沙）制造，用于常规全髋关节置换和髋关节表面置换。制造商最近在全球范围内召回了 ASR XL 髋臼系统和 ASR 髋关节表面置换系统。本报告总结了澳大利亚矫形协会全国关节置换登记处（AOANJRR）对涉及 ASR 假体的关节置换手术结果的分析。
ASR XL 髋臼系统在澳大利亚的首次应用记录于 2004 年，截至 2009 年 12 月 31 日，该登记处记录了涉及该系统的 4406 例手术。ASR 髋关节表面置换系统在澳大利亚的首次应用记录于 2003 年，截至 2009 年 12 月 31 日，该登记处记录了 1167 例手术。使用 Kaplan-Meier 方法和比例风险建模比较了 ASR XL 髋臼系统与所有其他常规假体以及所有其他常规假体与金属对金属关节的初次全髋关节置换的翻修率。此外，还比较了 ASR 髋关节表面置换系统初次置换的翻修率与所有其他髋关节表面置换假体的翻修率。还比较了患者人口统计学、假体特征以及有关翻修类型和翻修原因的信息。
涉及两种 ASR 设计的关节置换术的翻修率明显高于涉及其他假体的关节置换术。术后五年，ASR XL 髋臼系统的累积翻修率为 9.3%（95%置信区间 [CI]，7.3%至 11.9%），而所有其他常规假体的全髋关节置换术的累积翻修率为 3.4%（95%CI，3.3%至 3.5%）。术后五年，ASR 髋关节表面置换系统的累积翻修率为 10.9%（95%CI，8.7%至 13.6%），而所有其他髋关节表面置换假体的累积翻修率为 4.0%（95%CI，3.7%至 4.5%）。与所有其他常规假体相比，ASR XL 髋臼系统的翻修率更高，原因是假体松动和/或骨溶解以及金属敏感性。与所有其他常规金属对金属假体相比，ASR XL 髋臼系统的关节置换术的翻修率也明显更高。与所有其他髋关节表面置换假体相比，ASR 髋关节表面置换系统的翻修率更高，原因是金属敏感性。
在 AOANJRR 中，用于常规髋关节置换和髋关节表面置换的 ASR 假体的翻修率高于其他假体。这些结果与其他登记处和个别队列的已发表研究结果一致。
