Simulator Wear Testing Protocols to Avoid Clinical Disaster

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| The ASR (articular surface replacement) systems made by DePuy Orthopaedics are metal-on-metal (MM) hip implants that consist of a thin-walled cup with a porous coated back surface for bone ingrowth. The cup articulates with a large diameter head that is directly attached to the femur (thigh bone) as a resurfacing component or taper locked to a stem that is attached to the femur. The ASR implant systems were used on 93,000 patients worldwide and the failure level at 5 years has exceeded 10% and is climbing higher as more early failures are being reported. The failure level for other similar MM hip implants at 5 years is about 1% and thus DePuy has recalled the ASR. This is perhaps the most extensive orthopaedic implant disaster in history and seems to be a consequence of excessive wear at the contacting metal surfaces of the implant.