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Zhang Y, Gao Y, Leng Y, Zhang J, Zhang C, Qi X. Factors Influencing Noise Following Primary Ceramic-on-Ceramic Total Hip Arthroplasty. J Arthroplasty 2024; 39:416-420. [PMID: 37586597 DOI: 10.1016/j.arth.2023.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/06/2023] [Accepted: 08/08/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND The noise associated with ceramic-on-ceramic (CoC) total hip arthroplasty (THA) has been a concerning issue, while its underlying causes remain unclear. METHODS We conducted a retrospective analysis of 119 patients (174 primary CoC THAs) who had a mean follow-up of 28 months (range, 12 to 106). A questionnaire was designed to collect information on nature, frequency, onset, duration, and impact of the noise. Postoperative x-rays were evaluated. Clinical evaluations, including Harris and Oxford hip scores, were documented at follow-up time points (6 weeks, 3 months, 6 months, and 1 year). RESULTS Of the 174 hips, 31.6% reported noise, including 26 popping (14.9%), 24 clicking (12.1%), and 5 grinding (2.9%). No patients reported squeaking. Noisy hips had lower age (P = .009) and body mass index (P = .019). Among patients with developmental dysplasia of the hip, 17 of 55 hips reported noise associated with smaller cup anteversion angle (P = .004), greater body height (P = .022), and larger acetabular cup size (P = .049). Noise typically began at a mean of 193 days (range, 1 to 2,598) after surgery and disappeared spontaneously in 50.9% of hips before final follow-up, with an average disappearance time of 211 days (range, 60 to 730). Noise did not affect daily life in 74.5% of patients, while 26.9% of patients who had popping reported painful sensations. One patient experienced joint dislocation, and another experienced a ceramic liner fracture during follow-up. No statistical difference was observed in outcome scores between noise and silent groups at 4 follow-up time points. CONCLUSIONS Incidence of noise after primary CoC THA is relatively high. Smaller cup anteversion and larger acetabular cup size were associated with noise production in patients who had developmental dysplasia of the hip.
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Affiliation(s)
- Yibin Zhang
- Department of Bone and Joint Surgery, Orthopedic Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yuhang Gao
- Department of Bone and Joint Surgery, Orthopedic Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yi Leng
- Department of Bone and Joint Surgery, Orthopedic Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Jianzeng Zhang
- Department of Bone and Joint Surgery, Orthopedic Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Chengshuai Zhang
- Department of Bone and Joint Surgery, Orthopedic Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Xin Qi
- Department of Bone and Joint Surgery, Orthopedic Center, The First Hospital of Jilin University, Changchun, Jilin, China
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Nitish Prasad K, Ramkumar P. FEM wear prediction of ceramic hip replacement bearings under dynamic edge loading conditions. J Mech Behav Biomed Mater 2023; 146:106049. [PMID: 37531772 DOI: 10.1016/j.jmbbm.2023.106049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/04/2023]
Abstract
Hard-on-Hard hip implants, specifically ceramic tribo-pair, have produced the highest in-vivo wear resistance, biocompatibility, superior corrosion resistance, and high fracture toughness. However, this ceramic tribo-pair suffers from edge loading, sharply increasing wear and accelerating early implant failures due to micro-separation. Even though in-vitro studies have tested the occurrence of wear due to dynamic edge loading, the Finite Element Method (FEM) gives the advantage of accurately estimating the wear, minimizing the experimental time and cost. A new fundamental FEM model is developed to predict wear for ceramic hip replacement bearings under dynamic edge loading conditions for a fixed separation and fixed inclination angle. The model is directly validated with the existing hip simulator data up to 3 million cycles in terms of wear depth, wear scar and volumetric wear rate. The results from the model show that the accuracy in wear prediction was more than 98% for the wear depth and volumetric wear rate for the dynamic edge loading condition. A stripe wear scar is captured, depicting the edge loading conditions. The developed model from this study can predict wear under pure standard and dynamic edge loading conditions.
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Affiliation(s)
- K Nitish Prasad
- Advanced Tribology Research Lab (ATRL), Machine Design Section, Department of Mechanical Engineering, Indian Institute of Technology Madras (IITM), Chennai, India
| | - P Ramkumar
- Advanced Tribology Research Lab (ATRL), Machine Design Section, Department of Mechanical Engineering, Indian Institute of Technology Madras (IITM), Chennai, India.
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Sarrazin J, Halbaut M, Martinot P, Putman S, Migaud H, Girard J. Are CPR (Contact Patch to Rim) distance anomalies associated with the occurrence of abnormal noises from ceramic-on-ceramic THA? Orthop Traumatol Surg Res 2023; 109:103438. [PMID: 36228965 DOI: 10.1016/j.otsr.2022.103438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 05/04/2022] [Accepted: 06/07/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The ceramic-on-ceramic couple in total hip arthroplasties (THA) has the advantage of excellent wear resistance and the bioinert nature of its debris. Noise occurring from this friction torque is a common complication, the contributing factors of which are debated. The noise is caused by a lack of lubrication, due in most part to the positioning of the acetabular cup. The study of metal-on-metal couples identified that the calculation of the Contact Patch to Rim (CPR) distance provides information on lubrication defects and also that it is correlated with the wear of metal-on-metal implants. This CPR distance is not recognized to be correlated with the occurrence of noise for the ceramic-on-ceramic couple at a caliber ≤ 36mm. We therefore conducted a retrospective case-control study to assess: 1) The influence of the CPR distance on noise occurrence; 2) Whether other factors associated to noise occurrence exist? HYPOTHESIS Our hypothesis was that a low CPR distance was correlated with noise occurrence. METHOD This was a case-control study with 3 controls for each case, analyzing 21 THAs (21 patients) with noise compared to 63 THAs without noise (63 patients) matched for age, sex and body mass index. These patients were taken from a continuous retrospective series of 96 patients for 104 total hip arthroplasties (THA) with a single operator and 4th generation Biolox Delta ceramic-on-ceramic single implant, performed between 2007 and 2012. The calculation of the CPR distance was then performed for both groups using measurements of inclination angles, anteversion angles, and implant data regarding the head/insert contact angle, head/insert diameter and clearance. RESULTS At the mean follow-up of 7.1 years±1.2 [5 to 9.6], the mean CPR distance was lower in the noise group 10mm±3.3 [3.8 to 16.4] than in the control group 14.8mm±4.3 [7.3 to 24.4] (p=0.0007). The mean inclination angle was higher in the noise group 45.1°±7.8 [31 to 62] than in the control group 41.2°±7.2 [26 to 56] (p=0.04). The occurrence of noise was independent of anteversion, head caliber, cup diameter, neck length and stem size, and stem type (standard or lateralized). CONCLUSION A low CPR distance was correlated with the occurrence of noises, similarly a steep inclination was correlated with the occurrence of noises. LEVEL OF EVIDENCE III; Retrospective case-control study.
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Affiliation(s)
- Jérémy Sarrazin
- Université de Lille, Hauts de France, 59000 Lille, France; Hôpital Roger Salengro, service d'orthopédie 2, CHU Lille, place de Verdun, 59000 Lille, France.
| | - Marion Halbaut
- Université de Lille, Hauts de France, 59000 Lille, France; Hôpital Roger Salengro, service d'orthopédie 2, CHU Lille, place de Verdun, 59000 Lille, France
| | - Pierre Martinot
- Université de Lille, Hauts de France, 59000 Lille, France; Hôpital Roger Salengro, service d'orthopédie 2, CHU Lille, place de Verdun, 59000 Lille, France
| | - Sophie Putman
- Université de Lille, Hauts de France, 59000 Lille, France; Hôpital Roger Salengro, service d'orthopédie 2, CHU Lille, place de Verdun, 59000 Lille, France
| | - Henri Migaud
- Université de Lille, Hauts de France, 59000 Lille, France; Hôpital Roger Salengro, service d'orthopédie 2, CHU Lille, place de Verdun, 59000 Lille, France
| | - Julien Girard
- Université de Lille, Hauts de France, 59000 Lille, France; Hôpital Roger Salengro, service d'orthopédie 2, CHU Lille, place de Verdun, 59000 Lille, France; Université de Lille, Université de Artois, Université Littoral Côte d'Opale, EA 7369 - URePSS - unité de Recherche Pluridisciplinaire Sport Santé Société, 59000 Lille, France
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The occurrence of squeaking under wear testing standards for ceramic on ceramic total hip replacements. J Mech Behav Biomed Mater 2023; 138:105616. [PMID: 36565691 DOI: 10.1016/j.jmbbm.2022.105616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 11/22/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
Ceramic on ceramic total hip replacement clinical reports may on occasion note a noise or squeaking. There is much debate on whether this is an actual concern, but some medical centres want to avoid any possible negative impact on the patients' wellbeing due to the noise generated. The aim of this study was to determine what sound frequencies can be picked up from hip testing standards for ceramic on ceramic under different lubrication conditions. The ISO-14242-1 (35° cup angle) and ISO-14242-4 (55° cup angle with a 4 mm translational mismatch) standards were used for testing with dry, water and serum lubrication conditions up to 10000 cycles. No sound was detected for water and serum conditions under standard walking (ISO-14242-1) testing. An audible noise with a frequency range of 0.4-0.8 kHz was picked up within 600 cycles under water and edge loading (ISO-14242-4) conditions. All dry testing produced a high pitch squeak when the frequency was higher than 2 kHz. One sample under dry edge loading conditions had an audible noise of 0.8 kHz, considered not as squeaking, as it was not high pitch. Dry testing for both, standard walking (ISO-14242-1) and edge loading (ISO-14242-4) conditions, which resulted in a high pitch noise, had a frequency range of 2-8 kHz and 5-9 kHz respectively. One sample tested with edge loading and serum produced a faint squeak noise after 6000 cycles with a frequency of 7 kHz. Edge loading due to ISO-14242-4 conditions had an increased torque which may be playing a role in increased friction leading to noise. Edge loading conditions were more prone to the generation of audible noise and squeaking whilst under lubricated conditions.
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Park JW, Kim HS, Kim KC, Lee YK, Ha YC, Koo KH. A 10- to 12-year follow-up study of delta ceramic-on-ceramic total hip arthroplasty. Arch Orthop Trauma Surg 2023:10.1007/s00402-022-04758-x. [PMID: 36595032 DOI: 10.1007/s00402-022-04758-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 12/28/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND We previously reported five-to-seven-year results of total hip arthroplasty (THA) with the use of delta ceramic-on-ceramic (CoC) bearing. We conducted an extension study with a CT scan at a minimum of 10 years after surgery. METHODS From March 2009 to March 2011, 273 patients (310 hips) received cementless THA with delta CoC bearing, porous-coated cup and hydroxyapatite-coated stem. In this extended study, 252 patients (144 men and 108 women) (288 hips) with a mean age of 49.7 years (16-83) at surgery were followed for a mean of 10.4 years (10-12) with CT scans in 133 hips (46.2%, 133/288). Clinical and radiographic evaluations were made at each follow-up and Kaplan-Meier survival analysis was performed with revision and reoperation as endpoints. RESULTS There were no more ceramic fractures. Compared to mid-term results, the incidence of squeaking and RLLs increased to 3.1% (9/288) and 19.4% (56/288), respectively. The RLL progressed to focal osteolysis in 3 hips (5.4%, 3/56). No hip had detectable wear or prosthetic loosening. Two hips were reoperated due to periprosthetic joint infection and periprosthetic femoral fracture in each. The survivorship decreased to 98.3% (96.7-99.9%) at 12 years. CONCLUSION During the extended follow-up, no additional ceramic fracture occurred, and the incidence of squeak increased by 0.7%. The long-term survivorship of Delta CoC THA was encouraging. However, focal osteolysis occurred around the hydroxyapatite-coated stem in 1% (3/288). LEVEL OF EVIDENCE II (Prospective cohort study).
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Affiliation(s)
- Jung-Wee Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 166 Gumi-Ro, Bundang-gu, Seongnam, 463-707, South Korea.,Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Hong-Seok Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea.,Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Ki-Choul Kim
- Department of Orthopaedic Surgery, Dankook University Hospital, Cheonan, South Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 166 Gumi-Ro, Bundang-gu, Seongnam, 463-707, South Korea. .,Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Seoul Bumin Hospital, Seoul, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 166 Gumi-Ro, Bundang-gu, Seongnam, 463-707, South Korea.,Department of Orthopaedic Surgery, Kay Joint Center, Cheil Orthopaedic Hospital, Seoul, South Korea
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Niu E, Fu J, Li H, Ni M, Hao L, Zhou Y, Xu C, Chen J. Primary Total Hip Arthroplasty with Ceramic-on-Ceramic Articulations: Analysis of a Single-center Series of 1,083 Hips at a Minimum of 10-Year Follow-Up. J Arthroplasty 2022:S0883-5403(22)01084-1. [PMID: 36529193 DOI: 10.1016/j.arth.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND There are limited long-term results of using ceramic-on-ceramic bearings (COC) in total hip arthroplasty (THA) in a large number of patient cohorts. The purpose of this study was to evaluate the minimum 10-year clinical and radiological outcomes and survivorship in a single surgeon series of CoC-THA. METHODS Among the 1,039 patients (1,391 hips) who underwent primary THA at our institution between 2008 and 2011, 49 patients (69 hips) experienced paralysis or death, and 194 patients (239 hips, 19%) were lost to follow-up. The remaining 796 patients (1,083 hips) were assessed at a mean of 11 years (range, 10 to 13 years) using the modified Harris hip score (mHHS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and a questionnaire on articular noises. Survival analysis was used to estimate the survivorship. Radiological evaluation was performed on 869 hips at the final follow-up. RESULTS Survivorship at 11 years was 98.3% for revision or aseptic loosening, and 98.2% for re-operation. At the final follow-up, the mean mHHS and WOMAC scores were 93 (range, 12 to 100) and 14.4 (range, 3 to 66), respectively. There were 131 (12%) hips experienced squeaking, but no patient required revision. No fracture of the ceramic was observed. Radiological evaluation at the final follow-up revealed that three (0.3%) hips exhibited loosening, two (0.2%) had femoral osteolysis, 81(9.3%) acquired radiolucencies, and 35 (4%) showed heterotopic ossification. CONCLUSION This ceramic-on-ceramic bearing for THA had a high survivorship and excellent functional outcomes for at least 10 years.
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Affiliation(s)
- Erlong Niu
- Medical School of Chinese PLA, Beijing, China; 305 Hospital of PLA, Beijing, China; Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, China.
| | - Jun Fu
- Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China; Senior Department of Orthopedics, Fourth Medical Center of PLA General Hospital, Beijing, 100017, China.
| | - Hao Li
- Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China; Senior Department of Orthopedics, Fourth Medical Center of PLA General Hospital, Beijing, 100017, China.
| | - Ming Ni
- Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China; Senior Department of Orthopedics, Fourth Medical Center of PLA General Hospital, Beijing, 100017, China.
| | - Libo Hao
- Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China; Senior Department of Orthopedics, Fourth Medical Center of PLA General Hospital, Beijing, 100017, China.
| | - Yonggang Zhou
- Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China; Senior Department of Orthopedics, Fourth Medical Center of PLA General Hospital, Beijing, 100017, China.
| | - Chi Xu
- Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China; Senior Department of Orthopedics, Fourth Medical Center of PLA General Hospital, Beijing, 100017, China.
| | - Jiying Chen
- Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China; Senior Department of Orthopedics, Fourth Medical Center of PLA General Hospital, Beijing, 100017, China. %20
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Giuseppe M, Mattia B, Nadia B, Raffaele V, Pasquale R, Stefano DA, Mattia S, Vincenzo DS, Giulio M. Ceramic-on-ceramic versus ceramic-on-polyethylene in total hip arthroplasty: a comparative study at a minimum of 13 years follow-up. BMC Musculoskelet Disord 2022; 22:1062. [PMID: 35039021 PMCID: PMC8764755 DOI: 10.1186/s12891-021-04950-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nowadays hip replacement is one of the most successful surgery in terms of clinical outcome and patient's satisfaction. Therefore, the choice of biomaterials in hip replacement is increasingly important with the aim of obtaining a long-term satisfaction of patient and a greater survivorship of the implants. Ceramic-on-polyethylene (COP) and ceramic-on-ceramic (CoC) bearings are two common coupling used in total hip arthroplasty. The aim of this retrospective study was to compare clinical and radiological outcomes between patients treated using CoC and CoP THA at a mean follow-up of 15 years. METHODS 86 patients, average age 65.6, were included in the study: 43 in group A bearing CoC and 43 in group B bearing CoP. Minimum follow-up was 13 years. Primary outcome was a clinical evaluation assessed by HOOS and SF-12 questionnaires. Secondary outcome was a radiological evaluation on a A-P pelvis x-ray calculating acetabular cup inclination and anteversion and detecting osteolysis. RESULT After a multivariate analysis was performed, our results show clinical outcomes in group B significantly better than in group A: statistically significant value (p < 0,05) was found in the mean HOOS-symptoms subscale (83.0 ± 15.4 in Group A vs 90.3 ± 12.2 in group B) in the SF-12 physical component score (39.7 ± 11.0 in Group A vs 48.1 ± 10.1 in group B) and in HOOS (79.0 ± 16 in Group A vs 87.0 ± 16 in group B). 3 squeaking was found in group A. The calculated mean acetabular cup inclination value was 44,87 in group A and 44,5 in group B and the mean socket version was 17,54 in group A and 15,10 in group B. No significant statistically relationship between radiographic parameters analyzed and clinical outcomes was noted. CONCLUSION The current results provide us important information about the THA long-term outcome. CoP offered significantly better results compared with CoC at long-term follow up, and thus it should be considered in the choose of bearing in THA.
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Affiliation(s)
- Malerba Giuseppe
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Basilico Mattia
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Università Cattolica Del Sacro Cuore, Roma, Italy
| | - Bonfiglio Nadia
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Università Cattolica Del Sacro Cuore, Roma, Italy
| | - Vitiello Raffaele
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.
- Università Cattolica Del Sacro Cuore, Roma, Italy.
| | - Ruberto Pasquale
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Università Cattolica Del Sacro Cuore, Roma, Italy
| | - D' Adamio Stefano
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Università Cattolica Del Sacro Cuore, Roma, Italy
| | - Sirgiovanni Mattia
- Department of Medical Oncology and Pneumology, University Hospital Tuebingen, Tuebingen, Germany
- Cluster of Excellence iFIT (EXC 2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tuebingen, Tuebingen, Germany
| | - De Santis Vincenzo
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Università Cattolica Del Sacro Cuore, Roma, Italy
| | - Maccauro Giulio
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Università Cattolica Del Sacro Cuore, Roma, Italy
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Chatelet JC, Fessy MH, Saffarini M, Machenaud A, Jacquot L. Articular Noise After THA Using Delta CoC Bearings Has Little Impact on Quality of Life. J Arthroplasty 2021; 36:1678-1687. [PMID: 33293173 DOI: 10.1016/j.arth.2020.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/30/2020] [Accepted: 11/06/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND To report clinical outcomes and survival at a minimum of 10 years of a consecutive series of uncemented total hip arthroplasty (THA) with fourth-generation ceramic-on-ceramic (CoC) bearings and determine the incidence of articular noises, their risk factors, and impact on quality of life (QoL). METHODS From a series of 456 CoC THAs, there were 25 revisions, 38 deceased, and 36 lost to follow-up. The remaining 357 hips were assessed at 11.1 ± 0.7 years (range, 10-14) using the Forgotten Joint Score, Oxford Hip Score, and a questionnaire on articular noises. Kaplan-Meier survival was calculated, and multivariable analysis was performed to determine associations between articular noise and patient/surgical factors. RESULTS The 10-year survival was 96.3% for the cup, 96.5% for the stem, and 94.2% for all components. The Forgotten Joint Score was 79 ± 26 (range, 0-100), and Oxford Hip Score was 16 ± 7 (range, 12-60). The mean impact of articular noises on QoL was 1.8 ± 2.9 (range, 0-9): considered negligible in 60 hips (16%), moderate in 27 hips (7%), and severe in only 13 hips (4%). Multivariable analyses revealed that the incidence of articular noise decreased with age (odds ratio [OR], 0.94; P = .001), body mass index (OR, 0.85; P = .001), and in hips implanted with 32-mm (vs 36 mm) heads (OR, 0.18; P = .030). CONCLUSION Of 100 hips (28%) that reported some articular noises 10 years after CoC THA, the impact of articular noises on QoL was negligible for most patients. Although larger heads can improve mobility and reduce risks of dislocations, surgeons must be aware that increasing head size could also increase risks of articular noises, notably in young and active patients.
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Affiliation(s)
- Jean-Christophe Chatelet
- Centre de Chirurgie Orthopédique du Beaujolais, Ramsay Santé, Arnas, France; Artro Institute, Lyon, France
| | - Michel-Henri Fessy
- Artro Institute, Lyon, France; Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Chirurgie Orthopédique et Traumatologique, Pierre-Bénite Cedex, France; IFSTTAR, Laboratoire de Biomécanique et Mécanique des Chocs, Bron, France
| | | | - Alain Machenaud
- Artro Institute, Lyon, France; Department of Orthopaedic Surgery, Clinique d'Argonay, Ramsay Santé, Annecy, France
| | | | - Laurent Jacquot
- Artro Institute, Lyon, France; Department of Orthopaedic Surgery, Clinique d'Argonay, Ramsay Santé, Annecy, France
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Bellity J, Elkaïm M, Hannouche D, Nizard R. Arthroscopic evaluation and treatment of a squeaking hip. A case report. BMC Musculoskelet Disord 2020; 21:805. [PMID: 33272241 PMCID: PMC7713320 DOI: 10.1186/s12891-020-03817-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 11/22/2020] [Indexed: 11/22/2022] Open
Abstract
Background Squeaking of ceramic-on-ceramic total hip arthroplasty is an unexpected complication which occurs in 1- 30% of patients. Revision surgery is required in 0.2% of the cases, when a ceramic fracture is suspected, or in case of severe malposition of the implants, subluxation, or impingement. Hip arthroscopy may be a useful diagnostic and therapeutic option in squeaking hips. Case presentation A patient presenting with a pain-free squeaking underwent hip arthroscopy to examine the sliding surfaces and the rim of the acetabulum, and to search for signs of impingement. Thorough lavage and debridement of hip synovitis and fibrous tissue was performed. The squeaking noise immediately disappeared after the surgery. The patient was allowed to fully weight bear as tolerated with 2 crutches for 2 weeks. Two years after the arthroscopy, the patient remained symptom-free. Conclusions The potential reasons for hip squeaking in our patient are discussed. Hip arthroscopy may prove useful as a diagnostic and therapeutic option for some patients presenting with a squeaking ceramic-on ceramic hip replacement.
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Affiliation(s)
- Jonathan Bellity
- Department of Orthopaedic Surgery, Lariboisière, Hospital, Paris 7 University, Paris, France
| | - Marc Elkaïm
- Department of Orthopaedic Surgery, Lariboisière, Hospital, Paris 7 University, Paris, France
| | - Didier Hannouche
- Department of Orthopaedic Surgery, Lariboisière, Hospital, Paris 7 University, Paris, France. .,Department of Orthopaedic Surgery, Geneva University Hospitals & Faculty of Medicine, Avenue Gabrielle Perret Gentil 4, 1205, Geneva, Switzerland.
| | - Rémy Nizard
- Department of Orthopaedic Surgery, Lariboisière, Hospital, Paris 7 University, Paris, France
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Inagaki K, Iida S, Miyamoto S, Suzuki C, Nakatani T, Shinada Y, Kawarai Y, Hagiwara S, Nakamura J, Orita S, Ohtori S. Natural history of noise and squeaking in cementless ceramic-on-ceramic total hip arthroplasty. J Orthop 2020; 21:544-549. [PMID: 33029042 DOI: 10.1016/j.jor.2020.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 09/13/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction Ceramic-on-ceramic (COC) total hip arthroplasty (THA) was developed to reduce wear debris, and consequently the occurrence of osteolysis and aseptic loosening. The purpose of the present study was to determine the incidence and natural history of noise including squeaking after COC THA, and to clarify whether clinical outcomes and any demographic and implant-related factors are associated with noise from these ceramic bearings. Methods This was a retrospective observational study of 137 primary COC THAs between 2004 and 2009 at our institute. The Mean follow-up was for 10.5 years. All patients were followed up with an office visit to obtain information regarding noise, pain, and function. The correlations between the noise, and patient demographic, radiographic, and implant-related factors were evaluated. Results Noise developed in 30 hips (21.9%), specifically squeaking in 2 (1.5%) of the 137 hips during the follow-up period. Noise including squeaking was not associated with pain or functional outcomes. There was significant correlation between noise and cup anteversion, in that cup anteversion of patients with noise was smaller than that in those without noise. No significant correlation was found between noise and any other patient demographic including age, sex, height, body weight, or body mass index. Kaplan-Meier survivorship analysis with revision for any reason and an aseptic loosening of either component as the end point, revealed a cumulative survival rate at 10 years of 98.4% and 99.1% respectively. Conclusion The long-term clinical and radiographic outcome of cementless COC THA is excellent, but we should be vigilant for noise from COC bearings.
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Affiliation(s)
- Kenta Inagaki
- Department of Orthopaedic Surgery, Matsudo City General Hospital. 993-1 Sendabori, Matsudo City, Chiba, 270-2296, Japan
| | - Satoshi Iida
- Department of Orthopaedic Surgery, Matsudo City General Hospital. 993-1 Sendabori, Matsudo City, Chiba, 270-2296, Japan
| | - Shuichi Miyamoto
- Department of Orthopaedic Surgery, Matsudo City General Hospital. 993-1 Sendabori, Matsudo City, Chiba, 270-2296, Japan
| | - Chiho Suzuki
- Department of Orthopaedic Surgery, Matsudo City General Hospital. 993-1 Sendabori, Matsudo City, Chiba, 270-2296, Japan
| | - Takushi Nakatani
- Department of Orthopaedic Surgery, Matsudo City General Hospital. 993-1 Sendabori, Matsudo City, Chiba, 270-2296, Japan
| | - Yoshiyuki Shinada
- Department of Orthopaedic Surgery, Matsudo City General Hospital. 993-1 Sendabori, Matsudo City, Chiba, 270-2296, Japan
| | - Yuya Kawarai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University. 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan
| | - Shigeo Hagiwara
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University. 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan
| | - Junichi Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University. 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan
| | - Sumihisa Orita
- Chiba University Center for Frontier Medical Engineering, Department of Orthopaedic Surgery, Chiba University Division of Spine Surgery, Chiba University 1-8-1 Inohana Chuo-ku, Chiba, 260-8670, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University. 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan
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