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Rodríguez-Pérez D, Carnaval T, Rodríguez MDC, Coscujuela-Maña A, Agulló JL, Videla S. Long-term follow-up of total hip arthroplasty using polyethylene-ceramic composite (sandwich) liner. Hip Int 2024; 34:467-475. [PMID: 38529883 DOI: 10.1177/11207000241239624] [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] [Indexed: 03/27/2024]
Abstract
INTRODUCTION Ceramic-on-ceramic bearings have been widely used since their introduction in the 1970s. First-generation ceramics have very high fracture (breakage) rates. To overcome this, in the 1990s, modular cotyloid insert designs were developed, consisting of a ceramic and polyethylene composite (sandwich-type) liner; however, high implant fracture rates were observed in the medium term. We aimed to estimate the cumulative incidences of revision surgery (implant failure) and implant failure due to fractures, survival rates (time-to-revision surgery and time-to-fracture), and the long-term clinical and radiological outcomes in our series. METHODS This was an observational, longitudinal, ambispective, single-centre study based on patients who underwent primary total hip arthroplasty (THA) using a sandwich-type liner (Cerasul), only available in our tertiary hospital between January 1999 and December 2002. Cumulative incidences were estimated and the 95% confidence interval (95% CI) was calculated. The Kaplan-Meier method was used to assess the time-to-revision surgery and time-to-fracture. RESULTS 54 patients (49 men) were included, accounting for 59 sandwich-type linear implants. The mean (range) age was 47.4 (22-57) years. The primary THA indications were osteoarthritis (28 patients), osteonecrosis (14), childhood pathology sequelae (11), and inflammatory arthritis (6). The cumulative incidence of revision surgery by implants was 8.5% (5/59, 95% CI, 3.5-19.2%), 9.3% by patients (5/54, 95% CI, 4.0-19.9%), and 5.1% by implant fractures (3/59, 95%CI, 1.7-13.9%). The median (Interquartile Range, IQR) time-to-revision surgery was 158 (72.5-161) months, and the time to fracture was 182 (138-215) months. All primary THAs had good clinical and long-term survival outcomes. All implants had signs of solid fixation. CONCLUSIONS After a 20-year follow-up period, the polyethylene-ceramic sandwich-type liner showed a long survival rate and low cumulative incidence of implant fracture; however, implant fractures remain the main complication. Orthopaedic surgeons should be aware that some patients still have this type of prosthesis and must be capable of responding quickly if a fracture occurs.
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Affiliation(s)
- Daniel Rodríguez-Pérez
- Orthopaedic Surgery and Traumatology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Thiago Carnaval
- Clinical Research Support Unit (HUB-IDIBELL: Bellvitge University Hospital & Bellvitge Biomedical Research Institute), Clinical Pharmacology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
- Pharmacology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marcos-Del-Carmen Rodríguez
- Orthopaedic Surgery and Traumatology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Antonio Coscujuela-Maña
- Orthopaedic Surgery and Traumatology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - José-Luis Agulló
- Orthopaedic Surgery and Traumatology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sebastián Videla
- Clinical Research Support Unit (HUB-IDIBELL: Bellvitge University Hospital & Bellvitge Biomedical Research Institute), Clinical Pharmacology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
- Pharmacology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
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Nißler R, Totter E, Walter SG, Metternich JT, Cipolato O, Nowack D, Gogos A, Herrmann IK. Material-Intrinsic NIR-Fluorescence Enables Image-Guided Surgery for Ceramic Fracture Removal. Adv Healthc Mater 2024; 13:e2302950. [PMID: 38245823 DOI: 10.1002/adhm.202302950] [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: 09/04/2023] [Revised: 01/10/2024] [Indexed: 01/22/2024]
Abstract
Hip arthroplasty effectively treats advanced osteoarthritis and is therefore entitled as "operation of the 20th century." With demographic shifts, the USA alone is projected to perform up to 850 000 arthroplasties annually by 2030. Many implants now feature a ceramic head, valued for strength and wear resistance. Nonetheless, a fraction, up to 0.03% may fracture during their lifespan, demanding complex removal procedures. To address this, a radiation-free, fluorescence-based image-guided surgical technique is presented. The method uses the inherent fluorescence of ceramic implant materials, demonstrated through chemical and optical analysis of prevalent implant types. Specifically, Biolox delta implants exhibited strong fluorescence around 700 nm with a 74% photoluminescence quantum yield. Emission tails are identified extending into the near-infrared (NIR-I) biological transparency range, forming a vital prerequisite for the label-free visualization of fragments. This ruby-like fluorescence could be attributed to Cr within the zirconia-toughened alumina matrix, enabling the detection of even deep-seated millimeter-sized fragments via camera-assisted techniques. Additionally, fluorescence microscopy allowed detection of µm-sized ceramic particles, enabling debris visualization in synovial fluid as well as histological samples. This label-free optical imaging approach employs readily accessible equipment and can seamlessly transition to clinical settings without significant regulatory barriers, thereby enhancing the safety, efficiency, and minimally invasive nature of fractured ceramic implant removal procedures.
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Affiliation(s)
- Robert Nißler
- Nanoparticle Systems Engineering Laboratory, Institute of Energy and Process Engineering (IEPE), Department of Mechanical and Process Engineering (D-MAVT), ETH Zurich, Sonneggstrasse 3, Zurich, 8092, Switzerland
- Particles-Biology Interactions, Department of Materials Meet Life, Swiss Federal Laboratories for Materials Science and Technology (Empa), Lerchenfeldstrasse 5, St. Gallen, 9014, Switzerland
- The Ingenuity Lab, University Hospital Balgrist, University of Zurich, Forchstrasse 340, Zurich, 8008, Switzerland
| | - Elena Totter
- Nanoparticle Systems Engineering Laboratory, Institute of Energy and Process Engineering (IEPE), Department of Mechanical and Process Engineering (D-MAVT), ETH Zurich, Sonneggstrasse 3, Zurich, 8092, Switzerland
| | - Sebastian G Walter
- Department of Orthopedics, Traumatology and Reconstructive Surgery, University Hospital Cologne, Joseph-Stelzmann-Str. 24, 50931, Cologne, Germany
| | - Justus T Metternich
- Physical Chemistry, Ruhr-University Bochum, Universitätsstr. 150, 44801, Bochum, Germany
- Fraunhofer Institute for Microelectronic Circuits and Systems (IMS), Finkenstr. 61, 47057, Duisburg, Germany
| | - Oscar Cipolato
- Nanoparticle Systems Engineering Laboratory, Institute of Energy and Process Engineering (IEPE), Department of Mechanical and Process Engineering (D-MAVT), ETH Zurich, Sonneggstrasse 3, Zurich, 8092, Switzerland
- Particles-Biology Interactions, Department of Materials Meet Life, Swiss Federal Laboratories for Materials Science and Technology (Empa), Lerchenfeldstrasse 5, St. Gallen, 9014, Switzerland
- The Ingenuity Lab, University Hospital Balgrist, University of Zurich, Forchstrasse 340, Zurich, 8008, Switzerland
| | - Dimitri Nowack
- Deutsches Zentrum für Orthopädie, Department of Orthopedics and Trauma Surgery, Friedrich Schiller University Jena, Eisenberg, 07743, Jena, Germany
| | - Alexander Gogos
- Nanoparticle Systems Engineering Laboratory, Institute of Energy and Process Engineering (IEPE), Department of Mechanical and Process Engineering (D-MAVT), ETH Zurich, Sonneggstrasse 3, Zurich, 8092, Switzerland
- Particles-Biology Interactions, Department of Materials Meet Life, Swiss Federal Laboratories for Materials Science and Technology (Empa), Lerchenfeldstrasse 5, St. Gallen, 9014, Switzerland
| | - Inge K Herrmann
- Nanoparticle Systems Engineering Laboratory, Institute of Energy and Process Engineering (IEPE), Department of Mechanical and Process Engineering (D-MAVT), ETH Zurich, Sonneggstrasse 3, Zurich, 8092, Switzerland
- Particles-Biology Interactions, Department of Materials Meet Life, Swiss Federal Laboratories for Materials Science and Technology (Empa), Lerchenfeldstrasse 5, St. Gallen, 9014, Switzerland
- The Ingenuity Lab, University Hospital Balgrist, University of Zurich, Forchstrasse 340, Zurich, 8008, Switzerland
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Wu T, Guo S, Jiang Y, Shi W, Wang Y, Li T. Ceramic fragmentation after total hip arthroplasty: two case reports and literature review. Front Surg 2024; 11:1357301. [PMID: 38444899 PMCID: PMC10912464 DOI: 10.3389/fsurg.2024.1357301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 02/09/2024] [Indexed: 03/07/2024] Open
Abstract
Background Ceramic fragmentation is a rare but serious complication after total hip arthroplasty (THA). We reviewed the PubMed literature from 1990 to 2023 and found only 31 case reports of ceramic fragmentation after THA. Our case reports help to expand understanding of this rare complication. We shared our surgical experience and identified an ideal material for revision surgery, which can serve as a useful reference for other orthopedic surgeons to perform ceramic fragmentation revision surgery in the future. We also analyzed the possible causes, diagnosis, and treatment opinions of ceramic fragmentation. Case presentation This study presents two cases of ceramic fragmentation after THA. One patient had ceramic head fragmentation 10 years after the primary THA, and one patient had ceramic liner fragmentation 5 years after the primary THA. Both patients presented with pain, and one patient also reported a clicking sound in the hip. The two patients described here had BMIs of 23.7 and 23.1, respectively. Both patients' ceramic fragmentation were due to aseptic loosening, not periprosthetic joint infections, as confirmed by negative microbiological cultures. Radiographic examinations of both patients revealed radio-opaque wear debris around the hip joint prostheses and we describe the surgical protocols and intraoperative findings in both cases in detail. Conclusion Our cases and the literature suggest that ceramic fragmentation can occur at any time after THA. The most immediate symptoms are pain and noise, but some patients may be asymptomatic. Ceramic on polyethylene bearings is recommended for revision surgery whenever possible; metal bearings should be avoided.
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Affiliation(s)
- Tingyu Wu
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Sijia Guo
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yaping Jiang
- Department of Oral Implantology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Weipeng Shi
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yingzhen Wang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Tao Li
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
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Godoy M, Sipek K, Gustafson JA, Yuh C, Levine BR, Pourzal R, Lundberg HJ. Effect of Femoral Head Material, Surgeon Experience, and Assembly Technique on Simulated Head-Neck Total Hip Arthroplasty Impaction Forces. J Arthroplasty 2024; 39:507-513.e1. [PMID: 37598779 PMCID: PMC10850914 DOI: 10.1016/j.arth.2023.08.049] [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: 04/05/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND There is no standard method for assembling the femoral head onto the femoral stem during total hip arthroplasty (THA). This study aimed to measure and record dynamic 3-dimensional (3D) THA head-neck assembly loads from residents, fellows, and attending surgeons, for metal and ceramic femoral heads. METHODS An instrumented apparatus measured dynamic 3D forces applied through the femoral stem taper in vitro for 31 surgeons (11 attendings, 14 residents, 6 fellows) using their preferred technique (ie, number of hits or mallet strikes). Outcome variables included peak axial force, peak resultant force, impulse of the resultant force, loading rate of the resultant force, and off-axis angle. They were compared between femoral head material, surgeon experience level, and the number of hits per trial. RESULTS Average peak axial force was 6.92 ± 2.11kN for all surgeons. No significant differences were found between femoral head material. Attendings applied forces more "on-axis" as compared to both residents and fellows. Nine surgeons assembled the head with 1 hit, 3 with 2 hits, 14 with 3 hits, 2 with 4 hits, and 3 with ≥5 hits. The first hit of multihit trials was significantly lower than single-hit trials for all outcome measures except the off-axis angle. The last hit of multihit trials had a significantly lower impulse of resultant force than single-hit trials. CONCLUSION Differences in applied 3D force-time curve dynamic characteristics were found between surgeon experience level and single and multihit trials. No significant differences were found between femoral head material.
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Affiliation(s)
- Michael Godoy
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL USA
| | - Kirsten Sipek
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL USA
| | | | - Catherine Yuh
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL USA
| | - Brett R. Levine
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL USA
| | - Robin Pourzal
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL USA
| | - Hannah J. Lundberg
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL USA
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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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Bian Y, Wang H, Huang A. Finite Element Analysis of Acetabulum Prosthesis' Lining Damage Zone with Different Implanting Angle. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2023; 2023:9350474. [PMID: 37304323 PMCID: PMC10256448 DOI: 10.1155/2023/9350474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 03/13/2023] [Accepted: 03/20/2023] [Indexed: 06/13/2023]
Abstract
Objective Research the acetabular component's construction method of a three-dimensional finite element model in THA with different angles and study the influence of polyethylene liner wearing with finite element analysis. Methods Build a model in the 3D modeling software system HyperMesh according to the artificial hip joint prosthesis' entities and data. Using a finite element analysis system, ABAQUS 6.11 reconstitute acetabular prosthesis after hip replacement joints under different implanting position angles. Simulation and load the joint load when sheet foot touchdown state. Calculate the plastic volume strain and fatigue fracture. Results The two groups of combinations of abduction angle 50° vs. anteversion angle 10° and abduction angle 55° vs. anteversion angle 15° have been found to have relatively smaller interface plastic strain and fatigue fracture volume value (2.241 × 10-7 m3, 2.443 × 10-7 m3), respectively. Conclusion The groups of combinations of abduction angle 50° vs. anteversion angle 10° have been found to have relatively smallest interface plastic strain and fatigue fracture volume value in the total hip arthroplasty.
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Affiliation(s)
| | - Hao Wang
- Liaocheng Traditional Chinese Medicine Hospital, China
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Revision total hip arthroplasty by a ceramic bearing surface after a third- and fourth-generation ceramic head or liner fracture. INTERNATIONAL ORTHOPAEDICS 2023; 47:1197-1202. [PMID: 36808282 DOI: 10.1007/s00264-023-05705-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/16/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE Although rare, fractures of ceramic components are difficult to revise, mainly due to the presence of residual ceramic debris that can cause catastrophic wear of the replacement components. Modern ceramic-on-ceramic bearings are suggested to improve outcomes of revision total hip arthroplasty (THA) for ceramic fractures. However, there are few published reports of mid-term outcomes of revision THA using ceramic-on-ceramic bearings. We evaluated clinical and radiographic outcomes of 10 patients who received ceramic-on-ceramic bearings during revision THA for ceramic fractures. METHODS All patients but one received fourth-generation Biolox Delta bearings. Clinical evaluation was performed using the Harris hip score at latest follow-up, and all patients received a radiographic evaluation to analyze the fixation of the acetabular cup and of the femoral stem. Osteolytic lesions and the presence of ceramic debris were noted. RESULTS After a mean follow-up of 8.0 years, there were no complications or implant failures, and all patients reported satisfaction with their implant. The average Harris hip score was 90.6. There was neither osteolysis nor loosening, but despite our extensive synovial debridement, ceramic debris was noted in the radiographs of five patients (50%). CONCLUSION We report excellent mid-term outcomes, with no implant failures after eight years despite ceramic debris being found in a significant proportion of patients. We conclude that modern ceramic-on-ceramic bearings are an advantageous option for the revision of THA due to the fracture of initial ceramic components.
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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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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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Do Not Postpone Revision of Worn Conventional Liners in Ceramic-on-Polyethylene Total Hip Arthroplasty: A New Dramatic Failure. Arthroplast Today 2021; 10:108-113. [PMID: 34345640 PMCID: PMC8319508 DOI: 10.1016/j.artd.2021.06.011] [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: 05/06/2021] [Revised: 06/12/2021] [Accepted: 06/14/2021] [Indexed: 12/03/2022] Open
Abstract
Catastrophic failure of ceramic-on-polyethylene total hip arthroplasty is still occasionally described. We report on a new case of complete atraumatic penetration of an intact ceramic head through the titanium cup in a cementless total hip arthroplasty due to dramatic polyethylene and metal wear. We reviewed the literature for similar cases and analyzed potential risk factors. Most importantly, revision of radiologically worn liners should not be postponed, especially in young and active patients with conventional liners, because the time to dramatic failure could be shorter than expected.
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National Trends in Total Hip Arthroplasty Bearing Surface Usage in Extremely Young Patients Between 2006 and 2016. Arthroplast Today 2021; 10:51-56. [PMID: 34307811 PMCID: PMC8283017 DOI: 10.1016/j.artd.2021.05.017] [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: 02/11/2021] [Revised: 04/22/2021] [Accepted: 05/16/2021] [Indexed: 11/20/2022] Open
Abstract
Background Long-term implant durability is a key concern when considering total hip arthroplasty (THA) in young patients. The ideal bearing surface used in these patients remains unknown. The purpose of this study was to analyze trends in THA bearing surface use from 2006 to 2016 using a large, pediatric national database. Methods This was a retrospective review from January 1, 2006, to December 31, 2016, using the Kids’ Inpatient Database. International Classification of Diseases, 9th revision and 10th revision codes were used to identify patients who underwent THA and create cohorts based on bearing surfaces: metal-on-metal, metal-on-polyethylene, ceramic-on-polyethylene (CoP), and ceramic-on-ceramic (CoC). Annual utilization of each bearing surface and associated patient and hospital demographics were analyzed. Results A total of 1004 THAs were identified during the 11-year study period. The annual number of THAs performed increased by 169% from 2006 to 2016. The mean patient age was 17.1 years. The most prevalent bearing surface used in 2006 was CoC (37.3%), metal-on-metal (31.8%) in 2009, and CoP in 2012 and 2016 (50.6% and 64.8%, respectively). From 2006 to 2016, utilization of CoP increased from 5.0% to 64.8%, representing a 1196% increase over the study period. Conclusions The number of THAs performed in pediatric patients is increasing significantly. Although CoC was previously the most commonly used bearing surface in this patient population, CoP is currently the most common. Further investigation is needed to determine whether bearing longevity and clinical outcomes with CoP are superior to other bearing surfaces.
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