Uncemented third-generation ceramic-on-ceramic total hip arthroplasty using metal acetabular shell with direct taper locking liner

Uncemented total hip arthroplasty using alumina ceramic bearings at a minimum of 14 years of follow-up

INTRODUCTION

The effectiveness of modern ceramic bearings has been well established in reducing the osteolysis associated with wear of the bearing surfaces in total hip arthroplasty (THA). However, there are limited mid- to long-term follow-up data for complications associated with ceramic bearings.

MATERIALS AND METHODS

This case series analyzed 124 consecutive primary uncemented THAs in 108 patients with a mean age of 61 years using alumina ceramic-on-alumina ceramic bearing couples. Seventy THAs (56%) were evaluated at a minimum 14 years of follow-up; the mean follow-up period was 16 ± 1 years (14-20 years). Kaplan-Meier survivorship was determined with revision surgery for any reason as the end point. Complications were recorded focusing on osteolysis, ceramic fracture, and abnormal sounds until the final follow-up. Clinical data were scored according to the Merle d'Aubigne and Postel hip score at 14 years after THA.

RESULTS

The survivorship was 93.5% (95% CI 86.7-97.0%) at 14-years postoperatively. Five patients (4.0%) underwent revision surgery due to instability or infection before 1-year postoperatively. Two patients (1.6%) underwent revision surgery due to ceramic liner fracture at 9- and 12-years postoperatively, respectively. There was no radiographic evidence of osteolysis. A total of 27 complications occurred: dislocations (n = 7/124), squeaking sounds (n = 3/124), clicking sounds (n = 6/124), ceramic liner fractures (n = 2/124), periprosthetic fractures (n = 4/124), deep infections (n = 2/124), transient sciatic nerve palsy (n = 2/124), and femoral stem breakage (n = 1/124). The Merle d'Aubigne and Postel hip score was 16.8 ± 1.4 points.

CONCLUSIONS

The survivorship analysis demonstrates the uncemented THA using alumina ceramic bearings may provide favorable clinical outcome and can offer minimal wear at a minimum 14-year follow-up. Revision surgery was mostly required due to instability and infection in the short-term, and implant breakage in the mid- to long-term.

A Case Series of Total Hip Arthroplasty Using Cementless Hip Stem Customized for Patients of a Specific Race: 10- to 15-Year Results

We report a minimum of 10-year results of patients undergoing total hip arthroplasty (THA) using the cementless BiCONTACT N stem, which was developed to fit the femur in a specific race in which the predominant etiology of hip diseases was developmental dysplasia. A total of 108 hips were evaluated with a mean follow-up of 11.9 ± 1.4 years. The etiology for THA was secondary osteoarthritis due to developmental dysplasia in 90.3% of patients. No evidence of aseptic loosening of the BiCONTACT N stem was observed. The survivorship with the end point as revision surgery for any reason was 94.4% (95% confidence interval 88.7%-97.3%) at 15.0 years postoperatively. BiCONTACT N stem may be an effective alternative for patients with developmental dysplasia of the hip.

Lower Dislocation Rate Following Total Hip Arthroplasty via Direct Anterior Approach than via Posterior Approach: Five-Year-Average Follow-Up Results

Objective:

The aim of the study was to compare the dislocation rate between total hip arthroplasty (THA) via direct anterior approach (DAA) and via posterior approach (PA).

Methods:

We compared a consecutive series of 139 THAs via DAA with 177 THAs via PA. All study patients received ceramic-on-ceramic bearing surfaces and similar uncemented prostheses. Dislocation-free survival after THA was estimated using the Kaplan–Meier survival method and compared between groups using the log-rank test.

Results:

In the DAA group, none of 139 hips experienced dislocations in five-year-average follow-up. In the PA group, seven hips experienced dislocations among 177 hips (4 %). The dislocation was significantly less in the DAA group compared to the PA group (p = 0.033).

Conclusion:

The dislocation rate of THA via DAA was significantly less than that of THA via PA.

Meta-analysis of the Incidence and Risk Factors for Squeaking after Primary Ceramic-on-ceramic Total Hip Arthroplasty in Asian Patients

Purpose

The purpose of this study was to assess the squeaking incidence and risk factors after primary ceramic-on-ceramic total hip arthroplasty (THA) in Asian patients using meta-analysis.

Materials and Methods

We performed a meta-analysis of published data on the squeaking incidence and risk factors from 2000 to 2013. Eight studies in Asians were analyzed for both squeaking incidence and risk factors and 25 studies in Western patients were analyzed for squeaking incidence. The data collected were: patient factors, surgical factors and implantation factors.

Results

The overall incidence of hip squeaking was 2.7% in Asians and 3.1% in Westerners. This difference was not statistically significant. The only significant risk factor was an increase in the acetabular cup abduction angle. Of the factors, the cup abduction angle was the only significant risk factor for the occurrence rate of squeaking, and the occurrence rate tended to increase with increasing angle.

Conclusion

The incidence of squeaking in Asians after primary ceramic-on-ceramic THA is 2.7% and is similar to that in Westerners. The increased cup abduction angle is associated with squeaking; therefore, surgeons should be careful not to implant the cup at a too steep abduction angle.

Early loosening of a press-fit cup with ceramic-on-ceramic articulation: our early results

INTRODUCTION

In this study, we present the short-term results of the Selexys TH+ cup with the Ceramys inlay which is a press-fit cup with a ceramic-on-ceramic articulation. (Mathys, Bettlach, Switzerland). We compared the results with a retrospective-matched control group with a Delta PF cup (Lima, Udine, Italy), which is also a press-fit cup with a ceramic-on-ceramic articulation.

MATERIALS AND METHODS

257 elective hip arthroplasties with the Selexys TH+ cup in 250 patients placed in 2009 and 2010 were analyzed and compared with a control group retrospective analysis of the uncemented Delta PF cup (Lima, Udine, Italy) placed in 2007 and 2008 in 208 patients (222 hips). Surgical technique and surgeons were identical in both groups.

RESULTS

During a follow-up period of 3-21 months, 19 aseptic loosenings (7.4 %) were found for the Selexys TH+ cup. The survival plotted by a Kaplan-Meier curve shows a 1-year survival of 87.4 %. The Lima Delta PF cup showed a 1-year survival of 99.5 %. Failure analysis showed no clear explanation for this early loosening.

CONCLUSION

The Selexys TH+ cup combined with the Ceramys ceramic-on-ceramic inlay coupling show an unacceptable high early revision rate. Therefore, we advice against using this combination.