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Merfort R, Maffulli N, Hofmann UK, Hildebrand F, Simeone F, Eschweiler J, Migliorini F. Head, acetabular liner composition, and rate of revision and wear in total hip arthroplasty: a Bayesian network meta-analysis. Sci Rep 2023; 13:20327. [PMID: 37989863 PMCID: PMC10663607 DOI: 10.1038/s41598-023-47670-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/16/2023] [Indexed: 11/23/2023] Open
Abstract
Total hip arthroplasty (THA) is a common procedure for patients suffering from hip pain e.g. from osteoarthritis, osteonecrosis, or hip fractures. The satisfaction of patients undergoing THA is influenced by the choice of implant type and material, with one key factor being the selection of the appropriate material combination for the bearing surface. In this Bayesian network meta-analysis, we investigated the impact of material combinations for the bearing surface on the longevity of hip implants. The wear penetration rate per year and the total wear penetration in the liner resulting from different material combinations, as well as the survival rate at last follow-up, were examined. We analyzed a total of 663,038 THAs, with 55% of patients being women. Mean patient age was 59.0 ± 8.1 years and mean BMI 27.6 ± 2.6 kg/m2. The combination of an aluminium oxide (Al2O3) head and an Al2O3 liner demonstrated the lowest wear penetration at last follow-up and the lowest rate of wear penetration per year. Additionally, the combination of a crosslinked polyethylene (XLPE) liner and a zircon oxide (ZrO2) head demonstrated the lowest rate of revision at last follow-up. These findings underscore the importance of careful material selection for hip implant bearing surfaces to optimize their longevity and patient satisfaction after THA.
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Affiliation(s)
- Ricarda Merfort
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, 52074, Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine and Psicology, University La Sapienza, Rome, Italy
- Faculty of Medicine, School of Pharmacy and Bioengineering, Keele University, Thornburrow Drive, Stoke-on-Trent, England, UK
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England, UK
| | - Ulf Krister Hofmann
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, 52074, Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, 52074, Aachen, Germany
| | - Francesco Simeone
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, 39100, Bolzano, Italy
| | - Jörg Eschweiler
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, 52074, Aachen, Germany
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, 52074, Aachen, Germany.
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, 39100, Bolzano, Italy.
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Kim HS, Lee HJ, Lee SJ, Yoo JJ. Ceramic-on-Ceramic or Metal-on-Polyethylene: The Bearing of Choice after Ceramic Component Fracture in Total Hip Arthroplasty along with Concise Follow-Up of the Previous Cohort. Orthop Surg 2023; 15:2864-2871. [PMID: 37749775 PMCID: PMC10622264 DOI: 10.1111/os.13889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVE We previously reported the questionable result of reoperation using metal-on-polyethylene (MoP) bearing after the fracture of the ceramic component. After the report, we abandoned the use of MoP; instead, we used ceramic-on-ceramic (CoC) bearing. This report aimed to present the outcome of reoperation to CoC bearing after ceramic component failures along with the longer-term outcome of the previously reported cohort with an MoP bearing. RESULTS The mean follow-up of the MoP cohort was extended from 4.3 years to 8.8 years. Metallosis had occurred in three of nine patients of the previous cohort, which all required re-reoperations. Two hips from 11 patients with revision to CoC had re-reoperations due to ceramic liner fracture and non-union of the osteotomized fragment, respectively. No metallosis and wear occurred in the cohort revised with CoC articulation. Otherwise, there were no adverse changes in radiographs and no impairment in functions. METHODS We conducted an extended prospective evaluation of a previous cohort consisting of six head fractures and three liner fractures. In this cohort, the patients underwent a bearing change to metal-on-polyethylene. Additionally, we retrospectively analyzed 11 cases of third-generation ceramic bearing fractures, comprising nine head fractures and two liner fractures. These cases were subsequently treated with a bearing change to fourth-generation CoC. We assessed clinical and radiological outcomes, including complication rates, in both groups. CONCLUSION We recommend the latest CoC as the bearing of choice in reoperation after the fracture of ceramic components. In the case of an MoP bearing after the ceramic component fracture, the risk of metallosis seemed high in the early postoperative period.
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Affiliation(s)
- Hong Seok Kim
- Department of Orthopedic SurgerySeoul National University HospitalSeoulSouth Korea
- Department of Orthopedic Surgery, College of MedicineSeoul National UniversitySeoulSouth Korea
| | - Han Jin Lee
- Department of Orthopedic SurgeryHanil General HospitalSeoulSouth Korea
| | - Soong Joon Lee
- Department of Orthopedic Surgery, SMG‐SNU Boramae Medical CenterSeoul National University College of MedicineSeoulSouth Korea
| | - Jeong Joon Yoo
- Department of Orthopedic SurgerySeoul National University HospitalSeoulSouth Korea
- Department of Orthopedic Surgery, College of MedicineSeoul National UniversitySeoulSouth Korea
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Moon JK, Lee S, Kim CH, Yoon JY, Lee S, Lee KS, Yoon PW. Forte ceramic-on-delta ceramic cementless total hip arthroplasty: an 8- to 15-year follow-up study. Arch Orthop Trauma Surg 2023; 143:5475-5483. [PMID: 36871241 DOI: 10.1007/s00402-023-04793-2] [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: 09/05/2022] [Accepted: 01/22/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION Forte ceramic head on delta ceramic liner articulation showed satisfactory midterm results without ceramic-related complication. We aimed to investigate the clinical and radiological outcomes of cementless total hip arthroplasty (THA) with forte ceramic head on delta ceramic liner articulation. MATERIALS AND METHODS Overall, 107 patients (57 men, 50 women; 138 hips) who underwent cementless THA with forte ceramic head on delta ceramic liner articulation were enrolled. The mean follow-up duration was 11.6 years. For the clinical assessments, Harris hip score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), presence of thigh pain, and presence of squeaking were evaluated. Radiographs were assessed to search for osteolysis, stem subsidence, loosening of implants. Kaplan-Meier survival curves were evaluated. RESULTS The mean HHS and WOMAC improved from 57.1 and 28.1 preoperatively to 81.4 and 13.1 at the final follow-up, respectively. Nine revisions (6.5%) were performed; 5 hips for stem loosening, 1 hip for ceramic liner fracture, 2 hips for periprosthetic fracture, and 1 hip for progressive osteolysis around cup and stem. Thirty-two patients (37 hips) complained squeaking, in which 4 cases (2.9%) were identified as ceramic-related noises. After a mean follow-up period of 11.6 years, 91% (95% CI 87.8-94.2) were free from revision of both femoral and acetabular components due to any reason. CONCLUSIONS Cementless THA with forte ceramic-on-delta ceramic articulation showed acceptable clinical and radiological results. Serial surveillance of these patients should be performed due to the possibility of cerami- related complications such as squeaking, osteolysis, and ceramic liner fracture.
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Affiliation(s)
- Jun-Ki Moon
- Department of Orthopedic Surgery, College of Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University, Gwangmyeong, Republic of Korea
| | - Seonjeong Lee
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Asan Medical Center 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Chul-Ho Kim
- Department of Orthopedic Surgery, College of Medicine, Chung-Ang University Hospital, Chung-Ang University, Seoul, Republic of Korea
| | - Jae Youn Yoon
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Ilsan, Republic of Korea
| | - Sunhyung Lee
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Asan Medical Center 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Kang-Sik Lee
- Biomedical Engineering Research Center, Asan Institute For Life Sciences, Asan Medical Center, Seoul, Republic of Korea
| | - Pil Whan Yoon
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Asan Medical Center 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
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Li Z, Niu EL, Fu J, Zhou YG, Chai W, Hao LB, Chen JY, Xu C. A Nomogram That Characterizes a Patient's Odds of Developing Squeaking After Fourth-generation Ceramic-on-ceramic THA. Clin Orthop Relat Res 2023; 481:1322-1336. [PMID: 36749832 PMCID: PMC10263255 DOI: 10.1097/corr.0000000000002573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/05/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND Although ceramic-on-ceramic (CoC) bearings result in the lowest wear rate of any bearing combination, postoperative squeaking remains worrisome. However, data concerning squeaking in long-term follow-up studies are still lacking, especially for fourth-generation CoC THA. QUESTIONS/PURPOSES (1) After keeping the prosthesis in place for 10 years, what percentage of patients treated with fourth-generation CoC THA implants report squeaking, and are there points in time when squeaking occurs more frequently? (2) What are the characteristics, association with hip function, and factors associated with squeaking? (3) Can we create a nomogram that characterizes a patient's odds of experiencing squeaking based on the factors associated with it? METHODS Between January 2009 and December 2011, 1050 patients received primary THAs at our institution, 97% (1017) of whom received fourth-generation CoC THAs because this was the preferred bearing during this period. Of the 1017 eligible patients, 5% (54) underwent THAs performed by low-volume surgeons, 3% (30) were implanted with cemented prostheses, 2% (22) died, 1% (10) were immobile, 1% (six) underwent revision surgery, and 17% (169) were lost to follow-up before 10 years, leaving 726 patients for analysis here at a mean of 11 ± 1 years. In the study cohort, 64% (464) were male and 36% (262) were female, with a mean age of 44 ± 13 years at primary THA. We extracted data about articular noise from follow-up records in our institutional database and used a newly developed questionnaire to ascertain the percentage of patients who reported squeaking at the latest follow-up interval. Although not validated, the questionnaire was modeled on previous studies on this topic. The longitudinal pattern for squeaking was explored to find timepoints when squeaking occurs more frequently. Based on the questionnaire data, we calculated the percentages of frequent, reproducible, and avoidable squeaking. Hip function was evaluated with the Harris Hip Score and WOMAC score and compared between the squeaking and nonsqueaking groups. Factors associated with squeaking, which were examined in a multivariate analysis, were used to develop a nomogram. RESULTS At 10 years, 16% (116 of 726) of patients reported squeaking. Two squeaking peaks were determined, at 0 to 1 year and 8 to 10 years. Frequent, reproducible, and avoidable squeaking accounted for 42% (36 of 86), 20% (17 of 86), and 41% (35 of 86), respectively. The mean Harris Hip Score (93 ± 4 versus 94 ± 5; p = 0.81) and WOMAC score (16 ± 13 versus 15 ± 13; p = 0.23) did not differ between patients with squeaking and those without. After controlling for potential confounding variables such as etiology and head offset, we found that patients younger than 46 years (odds ratio 2.5 [95% confidence interval 1.5 to 5.0]; p < 0. 001), those who were male (OR 2.0 [95% CI 1.1 to 3.5]; p = 0.04), those having a total flexion and extension arc of less than 50° (OR 2.0 [95% CI 1.2 to 3.3]; p = 0.02), and those with the Corail hip implant (OR 4.1 [95% CI 2.1 to 7.7]; p < 0. 001) were more likely to report squeaking. We created a nomogram that can be used at the point of care that can help clinicians identify patients at a higher risk of experiencing squeaking; this nomogram had good performance (area under the receiver operating characteristic curve of 77%). CONCLUSION As a potential late complication, squeaking after fourth-generation CoC THA is of concern and may be related to increased stripe wear. We recommend that surgeons use this nomogram to assess the odds of squeaking before selecting a bearing, especially in patients at high risk, to facilitate shared decision-making and improve patient satisfaction. Future external validation of the model is still needed to enhance its applicability.Level of Evidence Level III, therapeutic study.
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Affiliation(s)
- Zhuo Li
- School of Medicine, Nankai University, Tianjin, PR China
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, PR China
| | - Er-Long Niu
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, PR China
- 305 Hospital of PLA, Beijing, PR China
| | - Jun Fu
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, PR China
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, PR China
| | - Yong-Gang Zhou
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, PR China
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, PR China
| | - Wei Chai
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, PR China
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, PR China
| | - Li-Bo Hao
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, PR China
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, PR China
| | - Ji-Ying Chen
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, PR China
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, PR China
| | - Chi Xu
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, PR China
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, PR China
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5
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Brown ML, Dunn JM, Early S, Challa S, Ezzet KA. The impact of failed novel technology and technical errors on the revision burden in total hip arthroplasty: what percentage of revision hip arthroplasty was potentially avoidable? Hip Int 2022; 32:771-778. [PMID: 33736475 DOI: 10.1177/1120700021996654] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND Despite the high success rate of total hip arthroplasty (THA), new implant technologies continue to be developed. Although potentially useful, such novel developments may result in unintended consequences, leading to revision surgery, often prematurely. In several instances, new technology that appeared promising was later found to be inferior to existing technology and resulting in early revision surgery. Additionally, technical surgical errors may also lead to early revisions. Some have argued that revisions related to such phenomena are potentially avoidable. The present analysis investigates to what extent the contribution of "failed new technology" and "technical errors" contributes to the revision burden and to the need for premature revision arthroplasty. METHODS We retrospectively analysed 432 revision THAs and categorised them as either "late revisions" based on survivorship of 10 years or "premature revisions". Among both cohorts, we determined what percentage of revisions were potentially avoidable and due to failed novel technologies and technical errors, and what percent were "unavoidable". RESULTS Of the 432 revisions, 267 (62%) were considered premature and 38% were considered late. Of the premature revisions, 108 were considered potentially avoidable (81 failed novel technologies, 27 technical errors). CONCLUSIONS Our data demonstrates that new technology and surgical techniques can result in premature failure of THA. Surgeons should take caution when incorporating new implant technology or surgical techniques into their practice.
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Affiliation(s)
- Matthew L Brown
- Department of Orthopaedic Surgery, St Luke's University Health Network, Fountain Hill, PA, USA
| | | | - Samuel Early
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA
| | - Sravya Challa
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA
| | - Kace A Ezzet
- Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA
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Kim HS, Park JW, Ha JH, Lee YK, Ha YC, Koo KH. Third-Generation Ceramic-on-Ceramic Total Hip Arthroplasty in Patients with Osteonecrosis of the Femoral Head: A 10- to 16-year Follow-up Study. J Bone Joint Surg Am 2022; 104:68-75. [PMID: 34780390 DOI: 10.2106/jbjs.20.00720] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Long-term follow-up results of ceramic-on-ceramic (COC) total hip arthroplasty (THA), specifically, in patients with osteonecrosis of the femoral head (ONFH) are unknown. We evaluated (1) clinical results and radiological outcomes, (2) ceramic-related complications: noise and ceramic fracture, (3) osteolysis, and (4) survivorship after alumina COC THA in ONFH patients with longer than 10-year follow-up. METHODS From May 2003 to June 2009, 325 ONFH patients (403 hips) underwent primary THAs at our department. Among them, 231 patients (293 THAs) were followed for 10 to 16 (mean, 12.9) years. There were 148 men and 83 women, their mean age at the time of THA was 47.2 years, and their mean body index was 24.0 kg/m2. The postoperative CT scans were done in 160 hips. RESULTS Grinding sensation or squeak was noted in 6.8% (20/293), ceramic head fracture occurred in 2.4% (7/293) and acetabular osteolysis developed in 0.7% (2/293). All 7 ceramic fractures occurred in 28-mm short-neck heads. There was no detectable wear or prosthetic loosening, and the 16-year survivorship was 96.0% (95% confidence interval; 93.8% to 98.2%). The mean Harris hip score was 91.7 (range, 84 to 100) points at the final follow-up. CONCLUSIONS The 10- to 16-year results of alumina COC THAs were encouraging with an excellent survivorship. However, ceramic fracture and noise still remain matters of concern. We recommend not to use 28-mm short-neck ceramic head to avoid ceramic head fractures. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hong Seok Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung Wee Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Joo Hyung Ha
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Orthopedic Surgery, Seoul National University College of Medicine, 166 Gumi-ro, Bundang-gu, Seongnam-si, 463-707, Republic of Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Orthopedic Surgery, Seoul National University College of Medicine, 166 Gumi-ro, Bundang-gu, Seongnam-si, 463-707, Republic of Korea
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7
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Bai R, Sun Q, He Y, Peng L, Zhang Y, Zhang L, Lu W, Deng J, Zhuang Z, Yu T, Wei Y. Ceramic Toughening Strategies for Biomedical Applications. Front Bioeng Biotechnol 2022; 10:840372. [PMID: 35330627 PMCID: PMC8940218 DOI: 10.3389/fbioe.2022.840372] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/09/2022] [Indexed: 11/21/2022] Open
Abstract
Aiming at shortage of metal materials, ceramic is increasingly applied in biomedicine due to its high strength, pleasing esthetics and good biocompatibility, especially for dental restorations and implants, artificial joints, as well as synthetic bone substitutes. However, the inherent brittleness of ceramic could lead to serious complications, such as fracture and disfunction of biomedical devices, which impede their clinical applications. Herein, several toughening strategies have been summarized in this review, including reinforcing phase addition, surface modification, and manufacturing processes improvement. Doping metal and/or non-metal reinforcing fillers modifies toughness of bulk ceramic, while surface modifications, mainly coating, chemical and thermal methods, regulate toughness on the surface layer. During fabrication, optimization should be practiced in powder preparation, green forming and densification processes. Various toughening strategies utilize mechanisms involving fine-grained, stress-induced phase transformation, and microcrack toughening, as well as crack deflection, bifurcation, bridging and pull-out. This review hopes to shed light on systematic combination of different toughening strategies and mechanisms to drive progress in biomedical devices.
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Affiliation(s)
- Rushui Bai
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology and Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Qiannan Sun
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology and Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Ying He
- National Engineering Laboratory for Digital and Material Technology of Stomatology and Beijing Key Laboratory of Digital Stomatology, Beijing, China.,Department of Geriatric Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Liying Peng
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology and Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Yunfan Zhang
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology and Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Lingyun Zhang
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology and Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Wenhsuan Lu
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology and Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Jingjing Deng
- National Engineering Laboratory for Digital and Material Technology of Stomatology and Beijing Key Laboratory of Digital Stomatology, Beijing, China.,Department of Geriatric Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Zimeng Zhuang
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology and Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Tingting Yu
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology and Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Yan Wei
- National Engineering Laboratory for Digital and Material Technology of Stomatology and Beijing Key Laboratory of Digital Stomatology, Beijing, China.,Department of Geriatric Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
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Incidence, Risk Factors, and Outcome of Ceramic-On-Ceramic Bearing Breakage in Total Hip Arthroplasty. J Arthroplasty 2021; 36:2992-2997. [PMID: 33812710 DOI: 10.1016/j.arth.2021.03.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/02/2021] [Accepted: 03/04/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Ceramic-on-ceramic bearing breakage is a rare but significant complication of total hip arthroplasty. This study aimed to identify risk factors for breakage and to determine the outcome of different revision options. METHODS All ceramic-on-ceramic primary total hip arthroplasty procedures reported to the Australian Joint Replacement Registry from September 1999 to December 2019 were included. Procedures were subdivided into alumina or mixed ceramic (alumina/zirconia). All breakages were identified. The association between ceramic type and head size was assessed. Subsequent revision rates were compared and cause of revision assessed. RESULTS There were 23,534 alumina and 71,144 mixed ceramic procedures. Breakage was the reason for 1st revision in 84 alumina (5.27% of all revisions and 0.36% of procedures) and 56 mixed ceramic procedures (2.46% of all revisions; 0.08% of procedures). Alumina had a higher breakage rate than mixed ceramic (HR 2.50 (95% CI 1.75, 3.59), P < .001), and breakage was higher for 36-38mm head sizes using alumina (HR 2.84 (1.52, 5.31), P = .001). 17.8% of 2nd revisions occur by 3 years, due to dislocation, infection, metal-related pathology, and loosening. A neck adapter sleeve did not reduce 2nd revisions. Numbers were too low to compare revision bearing surface options. CONCLUSION Ceramic breakage has reduced with mixed ceramics but has a 0.79/1000 incidence at 15-year follow-up. It is unclear what the risk factors are for modern ceramics with increasing head size a risk for alumina only. Risk of 2nd revision is high and occurs early. The optimal revision option is unknown.
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Karaismailoglu B, Karaismailoglu TN. Femoral Head Perforation After Primary Hip Arthroplasty: Unseen Complication of Ceramic-on-Ceramic Interface: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00045. [PMID: 34319929 DOI: 10.2106/jbjs.cc.20.00551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 33-year-old woman, who underwent bilateral ceramic-on-ceramic total hip arthroplasty 3 years previously, presented with right groin pain and mechanical grinding without a history of trauma. Radiographs revealed luxation of the femoral head, and computerized tomography showed perforation of the ceramic femoral head. The patient underwent revision with a metal-on-polyethylene articulation and retained femoral stem. Two years of follow-up yielded good clinical outcome with no evidence of osteolysis or polyethylene wear. CONCLUSION The perforation of a ceramic femoral head should be kept in mind as one of the possible implant failure mechanisms after primary hip arthroplasty.
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Affiliation(s)
- Bedri Karaismailoglu
- Orthopaedics and Traumatology Department, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, İstanbul, Turkey
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10
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Rankin CS, Robinson PG, Beattie N, Gaston P. Fracture of a BIOLOX Delta Ceramic Femoral Head: A Case Report and Update of the Literature. JBJS Case Connect 2019; 9:e0336. [PMID: 31592818 DOI: 10.2106/jbjs.cc.18.00336] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
CASE A 52-year-old man underwent right total hip replacement with a 32-mm BIOLOX delta ceramic head with a polyethylene liner. At 8 months, he fell onto his right hip. Radiographs at the time were unremarkable. One month later, he noticed a sharp pain and a sensation of grinding in his right hip; radiographs of the hip showed a fracture of the ceramic head. CONCLUSIONS This case further demonstrates that fourth-generation ceramic heads can fracture, and delays in catastrophic failure of ceramics in total hip arthroplasty (THA) following trauma may be secondary to the "slow crack growth" hypothesis.
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Affiliation(s)
| | - P G Robinson
- Department of Trauma and Orthopaedic Surgery, Royal Infirmary of Edinburgh, United Kingdom
| | - N Beattie
- Department of Trauma and Orthopaedic Surgery, Royal Infirmary of Edinburgh, United Kingdom
| | - P Gaston
- Department of Trauma and Orthopaedic Surgery, Royal Infirmary of Edinburgh, United Kingdom
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11
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Xing D, Yang C, Li R, Hou Y, Kou B, Li H, Lin J. Severe Wear and multiple Pseudotumor formation due to revision for ceramic head breakage after ceramic-on-ceramic Total hip arthroplasty: a case report. BMC Musculoskelet Disord 2019; 20:332. [PMID: 31315587 PMCID: PMC6637575 DOI: 10.1186/s12891-019-2722-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 07/15/2019] [Indexed: 12/03/2022] Open
Abstract
Background Head breakage is a serious complication following total hip arthroplasty when using Ceramic on Ceramic bearings surfaces. There is still in controversy about the selection of bearing surfaces when conducting revision surgery. Case presentation We describe the case of a fifty-year-old man who had undergone right total hip arthroplasty (THA) with ceramic-on-ceramic prostheses in 2011. After a fall 6 years after the primary procedures, radiographs suggested a ceramic head breakage for revision THA with exchange of metal-on-polyethylene bearing. However, 8 months later, severe metallosis and multiple pseudotumor was confirmed in pelvis and surrounding hip after re-revision THA with ceramic-on-polyethylene prostheses. Analysis of the serum metal ion indicated massive wear of the metal head and erosion of the stem neck and taper. Conclusions This case vividly demonstrates metal bearings should be avoided and revision with complete synovectomy and thorough debridement should be performed whenever possible for a fractured ceramic bearing.
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Affiliation(s)
- Dan Xing
- Arthritis Clinic and Research Center, Peking University People's Hospital, Peking University, Beijing, 100044, China.,Arthritis Institute, Peking University, Beijing, China
| | - Chaolei Yang
- Arthritis Clinic and Research Center, Peking University People's Hospital, Peking University, Beijing, 100044, China.,Arthritis Institute, Peking University, Beijing, China.,Orthopedic Department, The First People's Hospital of Pingdingshan, Henan, China
| | - Rujun Li
- Arthritis Clinic and Research Center, Peking University People's Hospital, Peking University, Beijing, 100044, China.,Arthritis Institute, Peking University, Beijing, China
| | - Yunfei Hou
- Arthritis Clinic and Research Center, Peking University People's Hospital, Peking University, Beijing, 100044, China.,Arthritis Institute, Peking University, Beijing, China
| | - Bolong Kou
- Arthritis Clinic and Research Center, Peking University People's Hospital, Peking University, Beijing, 100044, China.,Arthritis Institute, Peking University, Beijing, China
| | - Hu Li
- Arthritis Clinic and Research Center, Peking University People's Hospital, Peking University, Beijing, 100044, China.,Arthritis Institute, Peking University, Beijing, China
| | - Jianhao Lin
- Arthritis Clinic and Research Center, Peking University People's Hospital, Peking University, Beijing, 100044, China. .,Arthritis Institute, Peking University, Beijing, China.
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12
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Olmedo-Garcia NI, Zagra L. High risk of complications using metal heads after ceramic fracture in total hip arthroplasty. Hip Int 2019; 29:373-378. [PMID: 30501527 DOI: 10.1177/1120700018813978] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND There is some uncertainty about the bearing to be used to substitute a broken ceramic. Using metal components (head or liner) may lead to catastrophic wear of the metal. AIM The purpose of this article is to describe the long-term follow-up result of ceramic fracture replaced with metal-on-polyethylene (MoP). METHODS We report 3 cases of ceramic head fracture after ceramic-on-ceramic (CoC) total hip arthroplasty (THA) in which the broken ceramic was replaced with MoP. RESULTS All cases developed severe complications due to gross wear of the metal head: one developed a pseudotumour after a few months while the other 2 had significant local metallosis and toxic blood metal levels. CONCLUSIONS When there is a fracture of a ceramic component, we advise caution with the use of metal heads, as small ceramic fragments can cause 3rd-body wear with massive metal debris and severe local and general complications.
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Affiliation(s)
| | - Luigi Zagra
- 2 IRCCS Galeazzi Othopaedic Institute, Milan, Italy
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13
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Kim SC, Lim YW, Jo WL, Park HW, Han SB, Kwon SY, Kim YS. Fourth-generation ceramic-on-ceramic THA results in improvements in midterm outcomes compared to third-generation THA but does not resolve noise problems: a cohort study of a single-hip system. BMC Musculoskelet Disord 2019; 20:263. [PMID: 31142296 PMCID: PMC6542023 DOI: 10.1186/s12891-019-2641-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 05/17/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Using data from the Korean Hip Registry, we aimed to investigate mid-term clinical and radiographic outcomes, including the prevalence of periprosthetic joint infection (PJI), osteolysis, and component loosening or dislocation, and to analyze the incidence of bearing-related complications following modern ceramic-on-ceramic (COC) total hip arthroplasty (THA) using a single cementless hip system. METHODS Four hundred eighty-two patients (602 hips) who underwent Forte or Delta COC THAs with a single hip system and had a minimum 5-year follow-up were identified. The sample included 243 (50.4%) women and 239 (49.6%) men with a mean age of 50.6 years (range: 18-83 years). The Forte group comprised 310 hips, and the Delta group comprised 292 hips. The mean follow-up was 6.1 years (range: 5-10.2 years). RESULTS Cup orientation did not differ between groups. No hip had a PJI or osteolysis in either group. All acetabular components and all but two femoral components (in the Delta group) were well fixed. Dislocations occurred in six (1.9%) hips in the Forte group and one (0.3%) hip in the Delta group (p = 0.124). A total of nine (1.5%) revisions were performed. The 5-year survival rates for all-cause revisions were 98.4 and 98.6%, respectively. One (0.3%) ceramic head fracture occurred in the Forte group. Sixteen (5%) hips exhibited clicking and 6 (2%) hips had squeaking in the Forte group; 16 (6%) hips exhibited clicking and 5 (2%) hips had squeaking in the Delta group. Multiple regression analysis revealed that noise generation was unassociated with any factor. CONCLUSIONS From the Korean Hip Registry data, THA with modern ceramic bearings showed encouraging results, with lower risks of PJI, osteolysis, and component loosening. In particular, Delta COC THA resulted in no PJI or ceramic fracture and had a reduced dislocation risk. However, associated noise remains a concern.
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Affiliation(s)
- Seung-Chan Kim
- Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Young-Wook Lim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Banpo-daero 222, Seocho-gu, Seoul, 137-701, South Korea
| | - Woo-Lam Jo
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Banpo-daero 222, Seocho-gu, Seoul, 137-701, South Korea
| | - Hyun-Woo Park
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Banpo-daero 222, Seocho-gu, Seoul, 137-701, South Korea
| | - Sung-Bin Han
- Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Soon-Yong Kwon
- Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yong-Sik Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Banpo-daero 222, Seocho-gu, Seoul, 137-701, South Korea.
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14
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Revision total hip arthroplasty with metal on metal bearing for ceramic bearing fractures. J Orthop Sci 2019; 24:452-457. [PMID: 30415823 DOI: 10.1016/j.jos.2018.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 09/28/2018] [Accepted: 10/11/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Due to concern of potential metallosis caused by residual microscopic ceramic particles, metal-on-metal (MoM) bearing is deemed undesirable in revision total hip arthroplasty (THA) for ceramic bearing fracture. We determined whether MoM bearing is suitable to be used in revision THA for ceramic fractures and also evaluated whether this treatment increases serum iron levels compared with MoM bearing revision THA for polyethylene failure. METHODS Between 2006 and 2012, 22 patients underwent revision surgery using MoM bearing (28 mm femoral head in 18 hips and 32 mm in 4 hips) for ceramic bearing fracture and followed average 52.1 months. We assessed radiological parameter and functional outcome using Harris hip score (HHS) and WOMAC score. Also, serum cobalt (Co) and chromium (Cr) blood tests were performed and compared with the result obtained from age, sex- and follow-up duration-matched patients with MoM revision THA for failed polyethylene bearing. RESULTS The mean HHS improved from 60.6 preoperatively to 90.3 at final follow-up. There were no changes in cup position, progression of osteolytic lesions, and measurable wear of MoM bearing articulation at final follow-up radiographs. There was one case of recurrent dislocation after surgery, which was treated with greater trochanter distal advancement and one case of deep infection, which underwent two-stage revision. Mean serum Co level (1.7 vs. 1.4 μg/dl; p = 0.211) and Cr level (0.70 vs. 1.01 μg/dl; p = 0.327) showed no significant difference. CONCLUSIONS MoM articulation with liner cementation into the acetabular cup along with total synovectomy can be chosen in revision surgery for ceramic fracture with good midterm follow-up. However, the use of MoM bearing is indicated when the stem and metal shell can be retained and ceramic on ceramic or ceramic on polyethylene bearing cannot be selected. Also long-term outcome needs to be further evaluated.
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15
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Baek SH, Kim JY, Han JW, Kim SY. Potential risk of AMC ceramic liner for dissociation after square seating. J Orthop Sci 2018; 23:600-603. [PMID: 27452737 DOI: 10.1016/j.jos.2016.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 05/26/2016] [Accepted: 07/04/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Seung-Hoon Baek
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, South Korea
| | - Jun Young Kim
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, South Korea
| | - Jung Won Han
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, South Korea
| | - Shin-Yoon Kim
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, South Korea.
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16
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Lee YK, Ha YC, Yoo JI, Jo WL, Kim KC, Koo KH. Mid-term results of the BIOLOX delta ceramic-on-ceramic total hip arthroplasty. Bone Joint J 2017; 99-B:741-748. [DOI: 10.1302/0301-620x.99b6.bjj-2016-0486.r3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 01/18/2017] [Indexed: 11/05/2022]
Abstract
Aims We conducted a prospective study of a delta ceramic total hip arthroplasty (THA) to determine the rate of ceramic fracture, to characterise post-operative noise, and to evaluate the mid-term results and survivorship. Patients and Methods Between March 2009 and March 2011, 274 patients (310 hips) underwent cementless THA using a delta ceramic femoral head and liner. At each follow-up, clinical and radiological outcomes were recorded. A Kaplan-Meier analysis was undertaken to estimate survival. Results Four patients (four hips) died and 18 patients (20 hips) were lost to follow-up within five years. The remaining 252 patients (286 hips) were followed for a mean of 66.5 months (60 to 84). There were 144 men (166 hips) and 108 women (120 hips) with a mean age of 49.7 years (16 to 83) at surgery. The mean pre-operative Harris Hip Score of 47.1 points improved to 93.8 points at final follow-up. Six patients reported squeaking in seven hips; however, none were audible. Radiolucent lines involving Gruen zones one and/or seven were seen in 52 hips (18.2%). No hip had detectable wear, focal osteolysis or signs of loosening. One hip was revised because of fracture of the ceramic liner, which occurred due to an undetected malseating of the ceramic liner at the time of surgery. One hip was revised for a periprosthetic fracture of the femur, and one hip was treated for periprosthetic joint infection. The six-year survivorship with re-operation for any reason as the endpoint was 99.0% (95% confidence interval 97.8% to 100%). Discussion The rate of delta ceramic fracture was 0.3% (one of 286). While ceramic head fracture was dominant in previous ceramic-on-ceramic THA, fracture of the delta ceramic liner due to malseating is a concern. Cite this article: Bone Joint J 2017;99-B:741–8.
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Affiliation(s)
- Y. K. Lee
- Seoul National University Bundang Hospital, 82
Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do
463-707, South Korea
| | - Y. C. Ha
- Chung-Ang University College of Medicine, 102
Heukseok-ro, Dongjak-ku, Seoul
156-755, South Korea
| | - J-I. Yoo
- Gyeongsang National University Hospital, 90
Chilamdong, Jinju, Gyeongnamdo
660-702, South Korea
| | - W. L. Jo
- St. Mary’s Hospital, 222, Banpo-daero, Seocho-gu, Seoul, 06591, South
Korea
| | - K-C. Kim
- Dankook University Hospital, 119
Dandae-ro, Dongnam-gu, Cheonan
si, Chungnam 31116, South
Korea
| | - K. H. Koo
- Seoul National University Bundang Hospital, 82
Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do
463-707, South Korea
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17
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Rambani R, Kepecs DM, Mäkinen TJ, Safir OA, Gross AE, Kuzyk PR. Revision Total Hip Arthroplasty for Fractured Ceramic Bearings: A Review of Best Practices for Revision Cases. J Arthroplasty 2017; 32:1959-1964. [PMID: 28189439 DOI: 10.1016/j.arth.2016.12.050] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 11/27/2016] [Accepted: 12/28/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Total hip arthroplasty revision for a fractured ceramic bearing is rare but offers unique challenges. The purpose of this review was to provide a summary of existing literature on fractured ceramic bearings. METHODS Two authors performed a literature search of the MEDLINE OVID and PubMed databases with the following search terms: ceramic, fracture, total hip arthroplasty, and revision. RESULTS The search identified 228 articles of which 199 were selected for review. CONCLUSIONS It is mandatory to perform a complete synovectomy and thorough debridement of the fractured ceramic fragments. A well-fixed acetabular component should be removed if either the locking mechanism is damaged or the component is malpositioned. If the femoral stem taper is damaged, the femoral stem should be removed. However, if minimal damage is present, the femoral stem may be retained and revised using a fourth generation ceramic head with a titanium sleeve. Metal bearings should be avoided and revision with ceramic bearings should be performed whenever possible.
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Affiliation(s)
- Rohit Rambani
- Department of Orthopaedics, United Lincolnshire Hospital NHS Trust, Boston, Lincolnshire, UK
| | - David M Kepecs
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Mount Sinai Hospital, Toronto, ON, Canada
| | - Tatu J Mäkinen
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Mount Sinai Hospital, Toronto, ON, Canada
| | - Oleg A Safir
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Mount Sinai Hospital, Toronto, ON, Canada
| | - Allan E Gross
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Mount Sinai Hospital, Toronto, ON, Canada
| | - Paul R Kuzyk
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Mount Sinai Hospital, Toronto, ON, Canada
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18
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Antoniac I, Negrusoiu M, Mardare M, Socoliuc C, Zazgyva A, Niculescu M. Adverse local tissue reaction after 2 revision hip replacements for ceramic liner fracture: A case report. Medicine (Baltimore) 2017; 96:e6687. [PMID: 28489745 PMCID: PMC5428579 DOI: 10.1097/md.0000000000006687] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION In younger patients, ceramic-on-ceramic (CoC) bearing surfaces are usually recommended for total hip replacement (THR) because of their low wear rate and longer expected functional life. Although technical advancements have reduced the risk of ceramic bearings fracture, this complication remains a major concern. CASE DESCRIPTION We present the case of a 56-year-old patient undergoing 3 revision hip arthroplasties of the right hip due to ceramic liner fractures. Initial THR (2008) was performed with a CoC bearing, followed by liner fracture due to trauma a year later. The acetabular component and liner were replaced, with a minor incongruence between the old head and new insert. The 2nd ceramic insert fractured 3.5 years later, following minor trauma. Upon revision, the bearing surface was changed to metal-on-polyethylene (MoP). The performed retrieval analysis demonstrated stripe and rim wear, and evidence of adhesive wear. The patient was referred to us a month later, with a fistula on the lateral side of the hip, discharging black, petroleum-like liquid. Radiology showed well-fixed implants, no dislocation and no apparent polyethylene wear. Microbiological assessment of the discharge showed no infection. Intraoperatively massive metallosis was noticed, with stable acetabular and femoral components. The metal femoral head was heavily abraded, with almost 1% volumetric wear. Hematoxylin and eosin stained frozen tissue samples showed muscular and adipose tissue necrosis, while polarized light microscopy highlighted metal, polyethylene, and ceramic particles. CONCLUSION The present case is yet another report showing the adverse outcomes of using MoP bearings for revision after ceramic liner fracture in THR.
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Affiliation(s)
- Iulian Antoniac
- Biomaterials Group, Materials Science and Engineering Faculty, University Politehnica of Bucharest
| | - Mihai Negrusoiu
- Colentina Clinical Hospital, Clinic of Orthopaedics and Traumatology I, Bucharest
| | - Mihai Mardare
- Victor Babeş University of Medicine and Pharmacy, Timişoara
| | - Claudiu Socoliuc
- Department of Pathology, Colentina Clinical Hospital
- Department of Anatomical Pathology, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest
| | - Ancuţa Zazgyva
- Department of Cell and Molecular Biology, University of Medicine and Pharmacy Tîrgu Mureş, Tîrgu Mureş
| | - Marius Niculescu
- Colentina Clinical Hospital, Clinic of Orthopaedics and Traumatology I, Bucharest
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Titu Maiorescu University, Bucharest, Romania
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19
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Lee YK, Kim KC, Jo WL, Ha YC, Parvizi J, Koo KH. Effect of Inner Taper Angle of Acetabular Metal Shell on the Malseating and Dissociation Force of Ceramic Liner. J Arthroplasty 2017; 32:1360-1362. [PMID: 28007373 DOI: 10.1016/j.arth.2016.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 10/26/2016] [Accepted: 11/01/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Malseating of ceramic liner appeared as a matter of concern in multibearing metal, although multibearing cup can be coupled with hard liners as well as polyethylene liner. In this metal shell, the inner taper angle should be 10° for the modularity, while standard metal shells for ceramic liner have an inner taper angle of 18°. However, there has been no study in the effect of taper angle to the risk of malseating. We evaluated whether the taper angle of metal shell might affect the malseating of ceramic liner, and dissociation force of ceramic liner from metal shell. METHODS Three surgeons manually inserted ceramic liners into two designs of metal shell with different tapers angles (10° and 18°). We compared malseating rates of ceramic liners and push-out strengths, which means dissociation force of the ceramic liner from the metal shell, between these two metal shell designs. RESULTS The malseating rates in 10° metal shell were higher than those in 18° metal shell (23.3% vs 0%, P < .05). The mean dissociation force (1148.8 ± 46.7 N) in 10° taper cup was higher than that (389.7 ± 108.3 N) in 18° taper cup (P < .01). CONCLUSION Our results suggest that surgeon should be cautious about malseating of ceramic liner when using multi-bearing metal shell with inner taper angle of 10°. CLINICAL RELEVANCE When surgeon use multi-bearing metal shell with inner taper angle of 10°, our results suggest that surgeon should be cautious about malseating of ceramic liner.
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Affiliation(s)
- Young-Kyun Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ki-Chul Kim
- Department of Orthopedic Surgery, Dankook University Hospital, Cheonan, Chungcheongnam-do, Republic of Korea
| | - Woo-Lam Jo
- Department of Orthopedic Surgery, Catholic University of Korea School of Medicine, Seoul, Seoul, Republic of Korea
| | - Yong-Chan Ha
- Department of Orthopedic Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Javad Parvizi
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kyung-Hoi Koo
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
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20
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Panagopoulos A, Tatani I, Megas P. Long Term Survivorship of a Severely Notched Femoral Stem after Replacing the Fractured Ceramic head with a Cobalt-Chromium Head. Open Orthop J 2017; 10:779-784. [PMID: 28217203 PMCID: PMC5299559 DOI: 10.2174/1874325001610010779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 11/13/2016] [Accepted: 12/07/2016] [Indexed: 11/25/2022] Open
Abstract
Background: Although ceramic head fracture occurs infrequently today, in the event of a fracture, the resulting revision surgery can prove very challenging, since the ceramic particles lodge into the surrounding soft tissue and can cause rapid implant failure Case Presentation: A case of long term survivorship of a severed notched femoral stem after replacing the fractured femoral head with a cobalt-chromium one is reported in a 40-year old woman with hip dysplasia who underwent an uncomplicated total hip arthroplasty. The incident of ceramic femoral head fracture occurred 14 months postoperatively without reporting any significant trauma. Intraoperative findings at revision were a multifragmented femoral head and a damaged polyethylene insert along with diffuse metallosis and excessive wear of the cone of the stem. Both the stem and the acetabular component were stable. After removal of ceramic fragments, metallotic tissue excision and careful lavage of the joint, the inlay was replaced by a similar one and a cobalt-chromium femoral head was placed to the existing notched taper of the firmly incorporated stem. At the 13th year follow up examination, the patient had no pain, used no walking aids, and had normal activity with no signs of wearing or loosening in the plain x-rays. Conclusion: Despite current recommendations of using ceramic femoral heads in cases of fracture or to revise the severely damaged stems we were able to provide a long term survivorship up to 13 years postoperatively of a cobalt-chromium femoral head applied to a severe damaged stem.
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Affiliation(s)
- Andreas Panagopoulos
- University Hospital of Patras, Adult Reconstructive Surgery Patras, Achaia, Greece
| | - Irini Tatani
- University Hospital of Patras, Adult Reconstructive Surgery Patras, Achaia, Greece
| | - Panagiotis Megas
- University Hospital of Patras, Adult Reconstructive Surgery Patras, Achaia, Greece
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21
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Abstract
There is no consensus on the bearing of choice in revision for ceramic fracture after total hip arthroplasty (THA). The aim of this study was to evaluate the outcomes using ceramic-on-polyethylene (CoP) articulation in revision for ceramic breakage. Twelve patients who underwent revision hip surgery between 2002 and 2013 were followed-up. Appropriate surgical technique, including accurate synoviectomy, was used. The cup and the head were changed in four patients and only the liner and the head were replaced in the remaining eight patients. At the final follow-up there were no cases of re-revision due to tribological reasons, and only one case of polyethylene (PE) wear and osteolysis was scheduled for a new revision because of clear cup malposition. Complications were four cases of dislocation, one case of loosening and one case of infection. Revision of fractured ceramic is a challenging situation with a high risk of early complications. Using CoP liners with accurate synoviectomy and correction of misalignment can be considered a valuable bearing option at medium-term follow-up.
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22
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Do the Reasons for Ceramic-on-ceramic Revisions Differ From Other Bearings in Total Hip Arthroplasty? Clin Orthop Relat Res 2016; 474:2190-9. [PMID: 27255729 PMCID: PMC5014815 DOI: 10.1007/s11999-016-4917-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Despite widespread use of ceramic-on-ceramic (CoC) in total hip arthroplasty (THA) during the past 10 years, little is known about why revisions are performed in hips with this bearing or the time elapsed before revision. QUESTIONS/PURPOSES The purposes of this study were: (1) Do the reasons for first revision differ between CoC bearings and other bearing couples? (2) Does the time to revision differ between CoC and other bearing couples? (3) Are there unique reasons for revisions of CoC bearings? METHODS All members of the Société Française de Chirurgie Orthopédique et Traumatologique (SoFCOT) who performed ≥ 30 revisions per year were invited to participate in this multicenter, prospective, observational study. Our data represent 12% of the revision procedures performed in France. A total of 2107 first revisions of THA (from January 2010 to December 2011) were done in 2107 patients (1201 females [57%] and 906 males [43%]; median age, 73 years; age range, 17-104 years) at the time of surgery after a median of 11 years (range, 0 day-42 years) after the primary THA. There were 238 of 2107 (11%) CoC, 148 of 2107 (7%) metal-on-metal (MoM), and 1721 of 2017 (82%) metal-on-polyethylene (MoP) bearings. RESULTS The reasons for reoperation differed according to the bearing component: (1) for the MoP reference bearing (odds ratio [OR]; 95% confidence interval), cup loosening occurred in 698 of 1721 hips (41%), periprosthetic fracture in 220 of 1721 hips (13%), and osteolysis in 213 of 1721 hips (12%); (2) for CoC, cup loosening occurred in 41 of 238 hips (17%) (OR, 0.31 [0.22-0.43; p < 0.001), infection in 39 of 238 hips (16%) (OR, 1.63 [1.12-2.37]; p = 0.01), and dislocation in 23 of 238 hips (10%) (OR, 0.9 [0.57-1.42]; p = 0.9); (3) for MoM, cup loosening occurred in 28 of 148 hips (19%) (OR, 0.34 [0.22-0.52]; p < 0.001), adverse reaction to metallic debris in 26 of 148 hips (18%) (OR, 18.12 [9.84-33.4]; p < 0.001), and infection in 16 of 148 hips (11%) (OR, 1 [0.59-1.73]; p = 0.9). In comparison with MoP, osteolysis was rarely the reason for revision in CoC (four of 238 hips [2%]; OR, 0.12 [0.05-0.33]; p < 0.001), but this bearing was frequently revised because of iliopsoas irritation (18 of 238 hips [8%]; OR, 4.9 [2.7-9]; p < 0.001). The time elapsed before revision differed between bearings: median of 3 years (range, 3 days to 28 years) for CoC and 4 years (range, 14 days to 37 years) for MoM versus a median 13 years (range, 0 day to 42 years) for MoP (p < 0.001). Thirty-seven of the 238 revisions (16%) were directly related to ceramic use (ceramic breakage [n = 23], squeaking [n = 6], impingement [n = 7], incorrect ceramic insert insertion [n = 1]). No factors were identified that contributed to breakage of the 12 bulk ceramic components (eight heads, four inserts, four of 12 Delta ceramic). No factors were associated with squeaking, iliopsoas irritation, or impingement, but component orientation was not assessed. CONCLUSIONS The reasons and time to first revision differed between CoC and other bearings. CoC THAs are revised earlier and are sensitive to mechanical problems such as impingement, squeaking, and ceramic rupture that did not disappear with introduction of Delta ceramics and large-diameter (≥ 36 mm) bearings. CoC was rarely revised for osteolysis, but a high rate of iliopsoas irritation requires further investigation. LEVEL OF EVIDENCE Level III, therapeutic study.
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Results of revision of total hip arthroplasty for alumina ceramic-on-ceramic bearing fracture. Hip Int 2016; 26:237-43. [PMID: 27102552 DOI: 10.5301/hipint.5000340] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of this study was to compare the results of revision total hip arthroplasty after fracture of primary ceramic components using different type of revision bearing surfaces. METHODS We analysed the results of 16 patients with a follow-up more than 3 years after first revision. 6 were revised to ceramic-on-ceramic (CoC) bearing, 9 to metal-on-polyethylene (MoP) and 1 to ceramic-on-cross-linked polyethylene (CoXLP) bearing. RESULTS The mean follow-up was 87 months. Patients with revision to CoC had higher Harris Hip Score (HHS) of 89 points in comparison to the patients with revision to MoP with 84 points. Radiographic examinations revealed visible eccentric polyethylene wear with osteolysis in 3 out of 9 patients revised to MoP. There were no detrimental x-ray changes in patients revised to CoC components. CONCLUSIONS We consider CoC as the best option at revision operation for ceramic component fracture.
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Lee SJ, Kwak HS, Yoo JJ, Kim HJ. Bearing Change to Metal-On-Polyethylene for Ceramic Bearing Fracture in Total Hip Arthroplasty; Does It Work? J Arthroplasty 2016; 31:204-8. [PMID: 26404851 DOI: 10.1016/j.arth.2015.08.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/28/2015] [Accepted: 08/07/2015] [Indexed: 02/01/2023] Open
Abstract
We evaluated the short-term to midterm results of reoperation with bearing change to metal-on-polyethylene (MoP) after ceramic bearing fracture in ceramic-on-ceramic total hip arthroplasty. Nine third-generation ceramic bearing fractures (6 heads and 3 liners) were treated with bearing change to MoP. Mean age at reoperation was 52.7 years. Mean follow-up was 4.3 years. During follow-up, 2 of 3 liner-fractured hips and 1 of 6 head-fractured hips showed radiologic signs of metallosis and elevated serum chromium levels. Re-reoperation with bearing rechange to a ceramic head was performed for the hips with metallosis. One liner-fractured hip had periprosthetic joint infection. Dislocation occurred in 3 hips. From our experience, bearing change to MoP is not a recommended treatment option for ceramic bearing fracture in total hip arthroplasty.
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Affiliation(s)
- Soong Joon Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hong Suk Kwak
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong Joon Yoo
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hee Joong Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea; Medical Research Center, Seoul National University, Seoul, Republic of Korea
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Pomeroy E, Rowan F, Masterson E. Atraumatic Fracture of a BIOLOX Delta Ceramic Femoral Head Articulating with a Polyethylene Liner: A Case Report. JBJS Case Connect 2015; 5:e112. [PMID: 29252818 DOI: 10.2106/jbjs.cc.o.00146] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
CASE We describe the case of a forty-one-year-old man who underwent total hip arthroplasty with a 32-mm BIOLOX delta ceramic head articulating with a polyethylene liner. The patient did not suffer any trauma postoperatively, and his only symptom was of a "clicking" noise from the operatively treated hip. At his six-week postoperative review, fracture of the femoral head was diagnosed. CONCLUSION Fracture of a ceramic femoral head is a rare but catastrophic complication. This case report highlights the importance of vigilance on the part of the surgeon when reviewing patients after hip arthroplasty with ceramic-on-polyethylene bearing couples, even with limited symptoms associated with the hip and no reported trauma.
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Affiliation(s)
- Eoghan Pomeroy
- Department of Trauma and Orthopaedics, Croom Orthopaedic Hospital, County Limerick, Ireland
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Varnum C, Pedersen AB, Kjærsgaard-Andersen P, Overgaard S. Comparison of the risk of revision in cementless total hip arthroplasty with ceramic-on-ceramic and metal-on-polyethylene bearings. Acta Orthop 2015; 86:477-84. [PMID: 25637339 PMCID: PMC4513604 DOI: 10.3109/17453674.2015.1012975] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 12/30/2014] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Ceramic-on-ceramic (CoC) bearings were introduced in total hip arthroplasty (THA) to reduce problems related to polyethylene wear. We compared the 9-year revision risk for cementless CoC THA and for cementless metal-on-polyethylene (MoP) THA. PATIENTS AND METHODS In this prospective, population-based study from the Danish Hip Arthroplasty Registry, we identified all the primary cementless THAs that had been performed from 2002 through 2009 (n = 25,656). Of these, 1,773 THAs with CoC bearings and 9,323 THAs with MoP bearings were included in the study. To estimate the relative risk (RR) of revision, we used regression with the pseudo-value approach and treated death as a competing risk. RESULTS 444 revisions were identified: 4.0% for CoC THA (71 of 1,773) and 4.0% for MoP THA (373 of 9,323). No statistically significant difference in the risk of revision for any reason was found for CoC and MoP bearings after 9 years of follow-up (adjusted RR = 1.3, 95% CI: 0.72-2.4). Revision rates due to component failure were 0.5% (n = 8) for CoC bearings and 0.1% (n = 6) for MoP bearings (p < 0.001). 6 patients with CoC bearings (0.34%) underwent revision due to ceramic fracture. INTERPRETATION When compared to the "standard" MoP bearings, CoC THA had a 33% higher (though not statistically significantly higher) risk of revision for any reason at 9 years.
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Affiliation(s)
- Claus Varnum
- Department of Orthopedic Surgery and Traumatology , Odense University Hospital , Odense
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Yun HH, Yoon JR, Yu JJ, Seo HS. Navigated Acetabular Cup Fixation for Acetabular Deformity or Revision Total Hip Arthroplasty. Hip Pelvis 2014; 26:150-6. [PMID: 27536573 PMCID: PMC4971140 DOI: 10.5371/hp.2014.26.3.150] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 08/12/2014] [Accepted: 08/18/2014] [Indexed: 12/19/2022] Open
Abstract
Purpose To evaluate the usefulness of navigated acetabular cup fixation for total hip arthroplasty in patients with acetabular deformity or revision total hip arthroplasty. Materials and Methods This study enrolled 28 patients with at least 12 months' follow-up. The safe zone of the acetabular cup was defined as 40°±10°in inclination and 15°±10°in anteversion. The authors used the navigation and radiographic data to determine whether the acetabular cup was located within the safe zone or not. To evaluate the clinical outcomes, preoperative and last follow-up Harris hip scores were checked, and the occurrence of complications was evaluated. Results According to the navigation data, the mean inclination and anteversion were 38.5°±4.7°(range, 32°-50°) and 16.6°±4.0°(range, 8°-23°), respectively. According to the radiographic data the mean inclination and anteversion were 40.5°±4.6°(range, 32°-50°) and 19.4°±4.2°(range, 8°-25°), respectively. In both cases, all values were within the safe zone. Harris hip score was improved in all patients from preoperative 52.3±14.4 points (range, 29-87 points) to 88.0±9.0 points (range, 65-99 points) at the last follow-up. There was no dislocation or loosening of both cases. Conclusion Navigated acetabular cup fixation is a useful technique for total hip arthroplasty in patients with acetabular deformity or revision total hip arthroplasty because it prevents the malposition and related complications.
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Affiliation(s)
- Ho Hyun Yun
- Department of Orthopedic Surgery, Seoul Veterans Hospital, Seoul, Korea
| | - Jung-Ro Yoon
- Department of Orthopedic Surgery, Seoul Veterans Hospital, Seoul, Korea
| | - Jung Jin Yu
- Department of Orthopedic Surgery, Seoul Veterans Hospital, Seoul, Korea
| | - Hyo-Sung Seo
- Department of Orthopedic Surgery, Seoul Veterans Hospital, Seoul, Korea
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Hill DS, Hill J. Pseudo-Pelvic Mass. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2014. [DOI: 10.1177/8756479314539391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Joint replacement is becoming a more common surgical procedure, and it may have unusual or unexpected postoperative complications. This case report discusses the evaluation of a large pelvic mass first noted on physical examination and ultimately diagnosed by sonography and computed tomography as a chronic hematoma resulting from a failed total left hip arthroplasty.
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Shin JJ, Shin JS, Kim JH, Hwang SK. Experience with sandwich liner and its high rate of failure. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2014; 25:233-42. [DOI: 10.1007/s00590-014-1503-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 06/23/2014] [Indexed: 10/25/2022]
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