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Darwish MM, Bergman NR, Hiscock RJ. Ceramic-on-Ceramic Total Hip Arthroplasty Using a Double Tapered, Proximally Coated Stem: 15 to 24-year Clinical and Radiologic Follow-Up. J Arthroplasty 2024; 39:2323-2328. [PMID: 38649064 DOI: 10.1016/j.arth.2024.04.051] [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: 10/29/2023] [Revised: 04/13/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Total hip arthroplasty implant choice profoundly affects survivorship, complications, and failure modes. This study evaluates the long-term (average 18 year) outcomes of ceramic-on-ceramic hip arthroplasty using uncemented shells and stems. Despite an impressive 20-year cumulative percent revision of 5.9%, the hydroxyapatite proximally coated femoral components evaluated in this study have seen declining use since 2003. METHODS A review of 349 consecutive total hip arthroplasties from 1999 to 2007 was matched to 272 cases with registry data. A survivorship analysis included 274 hips (Group A) after excluding patients lost to follow-up and navigated cases. Group B comprised 135 patients who had complete datasets spanning a minimum of 15 years. RESULTS Kaplan-Meier analysis identified a 95.6% survivorship plateau at 16 to 24 years, with no significant impact from age, sex, component size, or original pathology. In Group B, EuroQol-5 Dimensions-5 Levels (EQ5D5L) scores indicated favorable outcomes in mobility, self-care, activities, pain/discomfort, and anxiety/depression, with an EQ5D visual analog score mean of 79.24. Functional scores, including the Harris Hip Score, Oxford Hip Score, and Forgotten Joint Score, showed positive outcomes. Radiologic assessments revealed no osteolysis or loose components, with a mean Engh score of 21.69. Dorr classification identified bone quality variations. Better Engh scores corresponded to higher levels of patient satisfaction. Age at surgery was correlated with better functional scores, while sex influenced various outcomes. CONCLUSIONS This comprehensive study, spanning an average of 18.23 years, combined multiple patient-reported outcome measures with extensive clinical and radiologic follow-up. It reported a notably high survivorship rate for this implant combination but highlighted the declining use of the hydroxyapatite proximally coated femoral stem used in this study, potentially facing withdrawal risks in Australia. LEVEL OF EVIDENCE Therapeutic Level IV.
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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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Park CW, Jeong SJ, Cho K, Kim SY, Lim SJ, Park YS. Bearing-Related Complications of Total Hip Arthroplasty Using Fourth-Generation Ceramic-On-Ceramic Articulations: Does Articular Noise Increase Over Time? J Arthroplasty 2024:S0883-5403(24)00454-6. [PMID: 38735552 DOI: 10.1016/j.arth.2024.05.021] [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: 11/29/2023] [Revised: 05/05/2024] [Accepted: 05/06/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND We previously reported the mean 6-year outcomes of total hip arthroplasty (THA) using fourth-generation ceramic-on-ceramic (CoC) articulations. With extended observations, this study aimed to report the mean 12-year outcomes focusing on bearing-related complications of CoC THA. METHODS We reviewed primary CoC THAs performed between May 2009 and April 2012 at a single institution. Of the 831 hips (739 patients), 716 hips (635 patients) that satisfied a minimum 10-year follow-up were included. The mean age at operation was 54 years (range, 16 to 83). The occurrence of bearing-specific complications, including ceramic fractures and noise generation, was evaluated. The mean follow-up duration was 12 years (range, 10 to 14). RESULTS A total of 2 (0.3%) ceramic liner fractures occurred, as previously reported. No additional ceramic fractures were observed during the extended follow-up period. However, the cumulative incidence of audible noise increased from 6.4 (48 of 749) to 8.2% (59 of 716). Of the 59 hips with noise, 26 (44.1%) developed noise within 1 year, whereas 13 (22.0%) presented with noise more than 5 years after THA. The noise was described as clicking in 35 hips (4.9%) and as squeaking in 24 hips (3.4%). No revision surgeries were performed for noise, except in 2 cases of concomitant liner fractures. The implant survivorship free of any revision was 98.1% at 12 years. CONCLUSIONS No additional ceramic fractures were identified in this extension study at a minimum follow-up of 10 years. However, the prevalence of articular noise has increased from 6.4 to 8.2% since the previous report. Possible late-onset noise should be considered when performing CoC THA in younger patients.
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Affiliation(s)
- Chan-Woo Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sang-Jin Jeong
- Department of Orthopedic Surgery, Myongji hospital, Hanyang University School of Medicine, Goyang, South Korea
| | - Kyungjun Cho
- Department of Orthopedic Surgery, Osan Hankook Hospital, Osan, South Korea
| | - Si Yeon Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung-Jae Lim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Youn-Soo Park
- Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
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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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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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English RT, Munro JT, Monk AP. Increasing femoral head size from 32 mm to 36 mm does not increase the revision risk for total hip replacement: a New Zealand joint registry study. Hip Int 2024; 34:66-73. [PMID: 37932243 DOI: 10.1177/11207000231210487] [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: 11/08/2023]
Abstract
BACKGROUND The use of larger femoral heads in total hip replacement (THR) has increased over the last decade. While the relationship between increasing head size and increased stability is well known, the risk of revision with increasing head size remains poorly understood. The aim of this study was to compare the outcome of total hip joint replacement with 32-mm and 36-mm heads. METHODS We carried out a 20-year retrospective analysis of prospective data from the New Zealand Joint Registry (NZJR). All primary total hip replacements registered between January 1999 and December 2018 were included. We compared the rate of revision of 32-mm and 36-mm heads in THR. Sub-group analysis included comparisons of bearing type and all-cause revision. RESULTS 60,051 primary THRs met our inclusion criteria. The revision rate per 100 component years was significantly higher with a 36-mm head than with a 32-mm head (0.649 vs. 0.534, p < 0.001). Subgroup analysis of bearing type showed no significant differences in revision rates for all combinations of 36-mm heads when compared to 32-mm (p = 0.074-0.92), with the exception of metal-on-metal (MoM); p = 0.038. When MoM was removed there was no significant difference in revision rates per 100 component years between 32-mm and 36-mm heads, 0.528 versus 0.578 (p = 0.099). CONCLUSIONS Increasing head size from 32 mm to 36 mm results in no significant increase in revision in all bearing combinations except MoM.
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Affiliation(s)
- Robert Tr English
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Jacob T Munro
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
- University of Auckland, New Zealand
| | - Andrew P Monk
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
- University of Auckland, New Zealand
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Hunger S, Seidler A, Rotsch C, Heyde CE, Drossel WG. Evaluating the Feasibility and Reproducibility of a Novel Insertion Method for Modular Acetabular Ceramic Liners. Bioengineering (Basel) 2023; 10:1180. [PMID: 37892910 PMCID: PMC10604853 DOI: 10.3390/bioengineering10101180] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/24/2023] [Accepted: 10/03/2023] [Indexed: 10/29/2023] Open
Abstract
Modern hip implants have a modular design. In case of wear or other damage it allows surgeons to change the tribological partners, i.e., the acetabular liner and femoral ball. In both revision and primary surgery, the secure joining of the implant components is important for the success of the operation. The two components, namely the ceramic liner and hip cup, are connected via a conical press connection and should be concentrically aligned to avoid chipping. Malseated liners can reduce the life span in situ. The amount of the joining force, which is usually applied via a hammer, depends on the surgeon. In this study, an alternative joining method for acetabular ceramic liners in hip cups was investigated, which intends to make the process more reproducible and thus safer. For this purpose, a handpiece was used to apply a defined force impulse of 4 kN. For the concentric alignment of a ceramic liner in the hip cup, an adapter was developed based on findings via a qualitative finite element (FE) analysis. Insertion and pushout tests of the acetabular cup-liner connection were performed in the laboratory with the new instrument (handpiece with the connected adapter) to evaluate the functionality of the instrument and the reproducibility of the new insertion method. For comparison, liners and acetabular cups were joined using a testing machine according to the standard. The presented results demonstrate the technical proof-of-concept of the new joining method under laboratory conditions. They meet the acceptance criteria of established manufacturers, which proves the equivalency to proven methods for joining modular implant components. To verify the improvement of the new joining method compared to the conventionally used joining method, an application-oriented study with different surgeons and the new joining instrument under clinical conditions is necessary.
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Affiliation(s)
- Sandra Hunger
- Fraunhofer Institute for Machine Tools and Forming Technology IWU, 01187 Dresden, Germany; (A.S.); (C.R.); (W.-G.D.)
- Department of Orthopaedic, Trauma and Plastic Surgery Clinic, University of Leipzig Medical Center, 04103 Leipzig, Germany;
| | - Alexander Seidler
- Fraunhofer Institute for Machine Tools and Forming Technology IWU, 01187 Dresden, Germany; (A.S.); (C.R.); (W.-G.D.)
- Institute of Machine Elements and Machine Design, Faculty of Mechanical Science and Engineering, Dresden University of Technology, 01062 Dresden, Germany
| | - Christian Rotsch
- Fraunhofer Institute for Machine Tools and Forming Technology IWU, 01187 Dresden, Germany; (A.S.); (C.R.); (W.-G.D.)
- Department of Orthopaedic, Trauma and Plastic Surgery Clinic, University of Leipzig Medical Center, 04103 Leipzig, Germany;
| | - Christoph-Eckhard Heyde
- Department of Orthopaedic, Trauma and Plastic Surgery Clinic, University of Leipzig Medical Center, 04103 Leipzig, Germany;
| | - Welf-Guntram Drossel
- Fraunhofer Institute for Machine Tools and Forming Technology IWU, 01187 Dresden, Germany; (A.S.); (C.R.); (W.-G.D.)
- Institute for Machine Tools and Production Processes, Faculty of Mechanical Engineering, Chemnitz University of Technology, 09111 Chemnitz, Germany
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Hungerford M, Neubauer P, Boner A, Kowalewski A. Late Atraumatic Ceramic Head Fracture in Total Hip Arthroplasty: A Case Report. J Orthop Case Rep 2023; 13:65-68. [PMID: 37398526 PMCID: PMC10308988 DOI: 10.13107/jocr.2023.v13.i06.3698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/19/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Atraumatic ceramic femoral head fracture is an uncommon but overwhelming complication of total hip arthroplasty (THA). The complication rate is low, with few reports in the literature. It is critical to continue researching late fracture risk to mitigate these instances. Case Report A 68-year-old Caucasian female presented with an atraumatic ceramic femoral head fracture in the setting of a ceramic-on-ceramic THA 17 years after primary surgery. The patient was successfully revised to a dual-mobility construct with a ceramic femoral head and a highly cross-linked polyethylene liner. The patient returned to normal function without pain. Conclusion The complication rate for fracture of the ceramic femoral head is as low as 0.001% for fourth-generation aluminum matrix composite designs, while the complication rate of late atraumatic ceramic fracture is largely unknown. We present this case to add to the current literature.
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Affiliation(s)
- Marc Hungerford
- Department of Orthopaedics and Joint Replacement Unit, Mercy Medical Center, Baltimore, Maryland
| | - Philip Neubauer
- Department of Orthopaedics and Joint Replacement Unit, Mercy Medical Center, Baltimore, Maryland
| | - Ashlie Boner
- Department of Orthopaedics and Joint Replacement Unit, Mercy Medical Center, Baltimore, Maryland
| | - Allison Kowalewski
- Department of Orthopaedics and Joint Replacement Unit, Mercy Medical Center, Baltimore, Maryland
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Ueyama H, Nakagawa S, Kishimura Y, Minoda Y, Nakamura S, Koyanagi J, Yamamura M, Kadoya Y. Long-term clinical results of alumina ceramic medial pivot total knee arthroplasty: a 10-year follow-up study. ARTHROPLASTY 2023; 5:27. [PMID: 37202793 DOI: 10.1186/s42836-023-00180-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/08/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND The newly-designed alumina ceramic medial pivot total knee prosthesis was introduced to reduce polyethylene wear and better fit the anatomical morphology of the Asian population. This study aimed to clarify the long-term clinical results of alumina medial pivot total knee arthroplasty over a minimum follow-up period of 10 years. METHODS The data of 135 consecutive patients who underwent primary alumina medial pivot total knee arthroplasty were analyzed in this retrospective cohort study. Patients were examined over a minimum 10-year follow-up period. The knee range of motion, Knee Society Score (KSS) knee score, Knee Society Score function score, and radiological parameters were assessed. The survival rate was also evaluated by using reoperation and revision as endpoints. RESULTS The mean follow-up period lasted 11.8 ± 1.4 years. Patients who were not followed accounted for 7.4% of the total cohort. Knee and function scores of KSS improved significantly following total knee arthroplasty (P < 0.001). In 27 individuals (28.1%), a radiolucent line was observed. Aseptic loosening occurred in three cases (3.1%). The survival rates for reoperation and revision were 94.8% and 95.8% 10 years after the operation, respectively. CONCLUSIONS During a minimum 10-year follow-up period, the present model of alumina medial pivot total knee arthroplasty showed good clinical outcomes and survival rates.
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Affiliation(s)
- Hideki Ueyama
- Department of Orthopedic Surgery, Osaka Rosai Hospital, 1179-3 Nagasonecho, Kita Ward, Sakai, Osaka, 591-8025, Japan.
| | - Shigeru Nakagawa
- Department of Orthopedic Surgery, Osaka Rosai Hospital, 1179-3 Nagasonecho, Kita Ward, Sakai, Osaka, 591-8025, Japan
| | - Yuichi Kishimura
- Department of Orthopedic Surgery, Hanwa Joint Reconstruction Center, 3176 Hukaikitamachi Naka Ward, Sakai, Osaka, 599-8271, Japan
| | - Yukihide Minoda
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno, Osaka, 545-8585, Japan
| | - Suguru Nakamura
- Department of Orthopedic Surgery, Osaka Rosai Hospital, 1179-3 Nagasonecho, Kita Ward, Sakai, Osaka, 591-8025, Japan
| | - Junichiro Koyanagi
- Department of Orthopedic Surgery, Osaka Rosai Hospital, 1179-3 Nagasonecho, Kita Ward, Sakai, Osaka, 591-8025, Japan
| | - Mitsuyoshi Yamamura
- Department of Orthopedic Surgery, Osaka Rosai Hospital, 1179-3 Nagasonecho, Kita Ward, Sakai, Osaka, 591-8025, Japan
| | - Yoshinori Kadoya
- Department of Orthopedic Surgery, Hanwa Joint Reconstruction Center, 3176 Hukaikitamachi Naka Ward, Sakai, Osaka, 599-8271, Japan
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10
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Di Martino A. Observations on the Present and the Future of Hip Surgery. J Clin Med 2023; 12:jcm12103464. [PMID: 37240570 DOI: 10.3390/jcm12103464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Each period in history has its own peculiar fashions and trends, and contemporary research on hip surgery is no exception [...].
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Affiliation(s)
- Alberto Di Martino
- 1st Orthopedic Department, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Department of Biomedical and Neurimotor Sciences-DIBINEM, University of Bologna, 40136 Bologna, Italy
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
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Döring J, Buchholz A, Herbster M, Gehring J, Betke U, Chodór P, Zabrzyński J, Bertrand J, Lohmann CH, Łapaj Ł. Damage analysis of retrieved Biolox Ⓡdelta components used in hard and soft bearings. Acta Biomater 2023; 158:827-842. [PMID: 36599400 DOI: 10.1016/j.actbio.2022.12.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 01/02/2023]
Abstract
This retrieval study included 43 Biolox delta explants (18 CoC, 25 CoP). Implants were examined macroscopically, whereby damage was evaluated using a semi quantitative scoring system. Confocal microscopy was used to examine wear related damage patterns of the articulating surfaces. Scanning electron microscopy (SEM) with energy-dispersive X-ray spectroscopy (EDS) was used to analyze wear marks on the implant surface and wear debris in periprosthetic tissue samples. Raman spectroscopy and X-ray diffraction (XRD) were used to quantify monoclinic zirconia fractions. On all components, in vivo wear resulted predominantly in different damage patterns caused by metal transfer. In CoC bearings stripe wear was additionally detected, and some implants underwent severe damage due to component breakage. The wear scores were higher for CoC components, with no differences between the scores for CoC heads and liners. Wear features caused comparable roughening on implants from CoC and CoP bearings. SEM studies demonstrated that most wear marks were caused by metal debris released from implant components. Grain pull-out was observed in stripe wear regions. Monoclinic phase shift was observed in a similar quantity on components from CoP and CoC bearings. The increase of monoclinic zirconia content around metal deposits was minimal and was more pronounced in areas of stripe wear. The results of this study indicate, that ZTA components in general undergo minimal wear in both, CoC and CoP bearings, however, it is more pronounced in the former. Metal deposits, as the most common wear feature, have no significant effect on monoclinic phase transition. STATEMENT OF SIGNIFICANCE: In this paper, we classify all damage patterns macroscopically according to an established scoring system and assess them regarding surface roughness (confocal microscopy) and monoclinic phase content (Raman spectroscopy) in order to derive the severity for patients. We compare hard-hard and hard-soft bearings and relate damage patterns with metal transfer based on SEM/EDS examinations. Furthermore, we work out correlations between patient-specific data, cause of revision and the physical condition of each individual sample Our cohort consists of 43 Biolox delta retrievals, a comparatively large quantity. In addition, we address current topics such as metal transfer and, based on the classification of damage patterns, provide incentives and/or meaningful focal points for further research.
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Affiliation(s)
- Joachim Döring
- Department of Orthopaedic Surgery, Otto-von-Guericke-University, Magdeburg, Germany.
| | - Adrian Buchholz
- Department of Orthopaedic Surgery, Otto-von-Guericke-University, Magdeburg, Germany
| | - Maria Herbster
- Institute of Materials and Joining Technology, Otto-von-Guericke-University, Magdeburg, Germany
| | - Jennifer Gehring
- Department of Orthopaedic Surgery, Otto-von-Guericke-University, Magdeburg, Germany
| | - Ulf Betke
- Institute of Materials and Joining Technology, Otto-von-Guericke-University, Magdeburg, Germany
| | - Paweł Chodór
- Department of General Orthopaedics, Musculoskeletal Oncology and Trauma Surgery, Poznań, Poland
| | - Jan Zabrzyński
- Faculty of Medicine, Nicolas Copernicus University, Toruń, Collegium Medicum in Bydgoszcz, Poland
| | - Jessica Bertrand
- Department of Orthopaedic Surgery, Otto-von-Guericke-University, Magdeburg, Germany
| | - Christoph H Lohmann
- Department of Orthopaedic Surgery, Otto-von-Guericke-University, Magdeburg, Germany
| | - Łukasz Łapaj
- Department of General Orthopaedics, Musculoskeletal Oncology and Trauma Surgery, Poznań, Poland
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12
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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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13
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Konopitski A, Okafor C, Smith B, Baldwin K, Sheth NP. Evolution of total hip arthroplasty in patients younger than 30 years of age: A systematic review and meta-analysis. Arch Orthop Trauma Surg 2023; 143:1081-1094. [PMID: 35129653 DOI: 10.1007/s00402-022-04357-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/13/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION While surgical technique and implant technology for total hip arthroplasty (THA) has improved over the years, it is unclear whether recent progress has translated to improved clinical outcomes for young patients. The goal of this study is to determine trends in (1) indications, (2) surgical technique (3) clinical and radiographic outcomes, and (4) survivorship for THA in patients younger than 30 years of age. METHODS MedLine, Cochrane, EMBASE, and Google Scholar were searched using several key phrases for articles focusing on THA performed on patients younger than 30 years of age between 1971 and 2020. A total of 34 qualifying articles were identified and stratified into three groups according to operative years and compared to one another on the basis of (1) indications; (2) fixation technique; (3) implant design; (4) clinical and radiographic outcomes; and (7) survivorship. RESULTS The mean patient age at index THA were 20.5 (9-30), 22.1 (11-30) and 21.5 (10-30) years, respectively, for each study group. Over time, patients underwent fewer THAs for JRA (Juvenile Rheumatoid Arthritis) (p < 0.001) but more for post-treatment and iatrogenic avascular necrosis (p < 0.001; p < 0.001). Early THAs primarily used metal on UHMWPE (Ultra high molecular weight polyethylene) (71.7%, p < 0.001), modern THA predominantly use ceramic on HXLPE (Highly cross-linked polyethylene) (42.5%, p < 0.001). Early fixation methods used cement (60.4%, p < 0.001), and modern fixation primarily use press fit technology (95.9%, p < 0.001). Prevalence of radiographic loosening decreased significantly (p < 0.001) over time. There was no significant difference in clinical improvement on HHS. Lastly, fewer patients required THA revision in recent decades (p < 0.001). CONCLUSIONS Advances in surgical technique and technology have served to improve implant longevity. Surprisingly, subjective clinical scores showed no significant improvement over time, suggesting that early iterations of THA were extremely successful.
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Affiliation(s)
- Andrew Konopitski
- Department of Orthopaedic Surgery, St. Luke's University Medical Center, 801 Ostrum St., Bethlehem, PA, 18015, USA.
| | - Chielozor Okafor
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Building 421, Philadelphia, PA, 19104, USA
| | - Brendan Smith
- Department of Orthopaedic Surgery, St. Luke's University Medical Center, 801 Ostrum St., Bethlehem, PA, 18015, USA
| | - Keith Baldwin
- Penn Medicine University City, 7th Floor, 3737 Market Street, Philadelphia, PA, 19104, USA
| | - Neil P Sheth
- Pennsylvania Hospital, 1 Cathcart, 800 Spruce Street, Philadelphia, PA, 19107, USA
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Movassaghi K, Patel A, Miller I, Levine BR. An Atypical Adverse Local Tissue Reaction After Ceramic-on-Ceramic Primary Total Hip Arthroplasty. Arthroplast Today 2022; 14:71-75. [PMID: 35252509 PMCID: PMC8889265 DOI: 10.1016/j.artd.2022.01.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/11/2021] [Accepted: 01/15/2022] [Indexed: 11/14/2022] Open
Abstract
Adverse local tissue reaction is an uncommon but frequently described complication after total hip arthroplasty (THA). It is most often associated with metal-on-metal hips and less frequently with metal-on-polyethylene implants as part of a mechanically assisted crevice corrosion process. In this report, we describe a rare case of an atypical adverse local tissue reaction in a patient with a ceramic-on-ceramic THA. Abrasive backside liner wear from a prominent screw head, failure of the liner locking mechanism, and liner fragmentation secondary to component-component impingement created an atypical mass and fluid collection leading to THA failure. This case demonstrates the importance of appropriate cup-liner positioning, thorough workup of pain after THA, and the ability of ceramic debris to cause an associated, atypical adverse local tissue reaction.
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15
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Shang X, Fang Y. Comparison of Ceramic-on-Ceramic vs. Ceramic-on-Polyethylene for Primary Total Hip Arthroplasty: A Meta-Analysis of 15 Randomized Trials. Front Surg 2022; 8:751121. [PMID: 34977138 PMCID: PMC8716688 DOI: 10.3389/fsurg.2021.751121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 11/15/2021] [Indexed: 12/02/2022] Open
Abstract
Objective: This meta-analysis aimed to compare ceramic-on-ceramic (COC) components and ceramic-on-polyethylene (COP) components during total hip arthroplasty (THA). Settings: A meta-analysis of randomized controlled trials (RCTs) comparing COC and COP during primary THA was conducted. Electronic searches were current to March 2021. Participants: Trials were included for meta-analysis if they compared at least the bearing surfaces of COC and COP for patients undergoing primary THA and if they reported the outcomes of THA after a certain period of follow-up and only RCTs in English were included. Primary and Secondary Outcome Measures: The primary endpoints consist of audible noise, prosthesis fracture, and revision. Secondary endpoints include dislocation, deep infection, osteolysis, and prosthesis loosening. Extracted data were statistically analyzed with the Stata11.0. Results: A total of 15 RCTs containing 2,702 patients (2,813 hips) were included in this study. The audible noise [odds ratio (OR) = 5.919; 95% CI: 2.043, 17.146; p ≤ 0.001] and prosthesis fracture (OR = 35.768; 95% CI: 8.957, 142.836; p = 0.001) were significantly higher in the COC group. Hip function, revision rate, dislocation rate, deep infection rate, osteolysis rate, and prosthesis loosening rate were comparable between these two groups, while the wear rate was higher in the COP group. Conclusion: This study indicated comparable outcomes of COC and COP bearing surfaces in primary THA; high-quality RCTs with a long-term follow-up are still urgently needed to provide more evidence on the optimal bearing surfaces in primary THA.
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Affiliation(s)
- Xiaobin Shang
- Department of Orthopaedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Fang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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16
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Topolovec M, Milošev I, Cör A. Outcome after Two Sequential Revision Hip Arthroplasties for CoC Bearing Fracture with 10 Years Follow-up: A Case Report. J Orthop Case Rep 2021; 11:45-48. [PMID: 34790602 PMCID: PMC8576786 DOI: 10.13107/jocr.2021.v11.i07.2310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 06/20/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Revisions due to the fracture of ceramic-on-ceramic (CoC) bearing are rare, however when they occur, they represent a major challenge to an orthopedic surgeon for ensuring safe and long-term survival of the replaced bearing. Case Report We present a case of fractured ceramic liner of total hip prosthesis that underwent revision to a metal-on-polyethylene (MoP) bearing couple, with consequent huge periprosthetic metallosis. Shortly after, the second revision operation followed using the third bearing couple of ceramic-on-polyethylene (CoP). At 10 years follow-up after the operation due to ceramic fracture, the patient is now pain free with full range of motion of the revised hip. Conclusion Establishment of diagnostic routes and recommended protocols for CoC bearing fracture would allow easier recognition of potential fracture and diminish its consequences for the patients.
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Affiliation(s)
- Matevž Topolovec
- Valdoltra Orthopaedic Hospital, Jadranska c. 31, 6280 Ankaran, Slovenia
| | - Ingrid Milošev
- Valdoltra Orthopaedic Hospital, Jadranska c. 31, 6280 Ankaran, Slovenia.,Department of Physical and Organic Chemistry, Jožef Stefan Institute, Jamova 39, 1000 Ljubljana, Slovenia
| | - Andrej Cör
- Valdoltra Orthopaedic Hospital, Jadranska c. 31, 6280 Ankaran, Slovenia
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Dobria P, Patel A, Levine B. Catastrophic intraoperative failure of a ceramic femoral head. Arthroplast Today 2021; 11:234-238. [PMID: 34692961 PMCID: PMC8515067 DOI: 10.1016/j.artd.2021.08.017] [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: 06/23/2021] [Revised: 08/04/2021] [Accepted: 08/29/2021] [Indexed: 11/18/2022] Open
Abstract
Approximately 17 years after a primary metal-on-metal total hip arthroplasty, a 59-year-old female developed pain, swelling, and weakness in her right hip accompanied by laboratory findings and imaging suggestive of an adverse local tissue reaction. Acetabular revision was performed to upsize the femoral head and improve hip stability. Upon impaction of the new, non-option ceramic femoral head onto the unsleeved retained stem, the head split into two pieces without fragmentation. The surgery was completed using a cobalt-chromium head, which was impacted without issue onto the stem’s taper. Although BIOLOX delta femoral heads do not require titanium sleeves, we believe that careful consideration should be given to their use in revision total hip arthroplasty with ceramic heads, regardless of the extent of trunnion damage noted intraoperatively.
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Affiliation(s)
- Paul Dobria
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
- Corresponding author. 3333 Green Bay Rd, North Chicago, IL 60064, USA. Tel.: +1 773 750 1369.
| | - Arpan Patel
- Department of Orthopedics, Rush University Medical Center, Chicago, IL, USA
| | - Brett Levine
- Department of Orthopedics, Rush University Medical Center, Chicago, IL, USA
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18
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Oxide Bioceramic Composites in Orthopedics and Dentistry. JOURNAL OF COMPOSITES SCIENCE 2021. [DOI: 10.3390/jcs5080206] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Ceramic composites based on alumina and zirconia have found a wide field of application in the present century in orthopedic joint replacements, and their use in dentistry is spreading. The development of this class of bioceramic composites was started in the 1980s, but the first clinical applications of the total hip replacement joint were introduced in the market only in the early 2000s. Since then, several composite systems were introduced in joint replacements. These materials are classified as Zirconia-Toughened Alumina if alumina is the main component or as Alumina-Toughened Zirconia when zirconia is the main component. In addition, some of them may contain a third phase based on strontium exa-aluminate. The flexibility in device design due to the excellent mechanical behavior of this class of bioceramics results in a number of innovative devices for joint replacements in the hip, the knee, and the shoulder, as well in dental implants. This paper gives an overview of the different materials available and on orthopedic and dental devices made out of oxide bioceramic composites today on the market or under development.
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19
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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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20
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Mohan K, McGoldrick NP, O'Driscoll C, Quinlan JF. Mode I and II Wear in Ceramic on Ceramic Total Hip Arthroplasty: A Case Report. J Orthop Case Rep 2021; 11:16-20. [PMID: 34239822 PMCID: PMC8241264 DOI: 10.13107/jocr.2021.v11.i03.2068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Elective total hip arthroplasty (THA) is a common procedure and has been associated with favorable outcomes in both elderly and younger patients. A variety of implant and articular components exist so to allow surgeons to make a patient-specific choice with the intent of maximizing both patient outcomes and implant survival. The utilization of ceramic bearing surfaces during THA has become increasingly prevalent, with their tribological profile conveying favorable wear and osteolysis-resistant properties. Typically, ceramic articulating components are most susceptible to failure through brittle fracture or complications such as squeaking. Case Report: This case describes a 68-year-old Caucasian male who underwent revision of ceramic on ceramic THA due to pain, with intraoperative analysis revealing evidence of gross Mode I acetabular ceramic component wear with a resultant Mode II wear articulation between the ceramic femoral head and acetabular liner. Conclusion: Wear between ceramic implants in THA is infrequently reported, and as such awareness of this uncommon phenomena as well as its potential causative factors is important when considering either primary or revision THA involving ceramic bearing components.
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Affiliation(s)
- Kunal Mohan
- Department of Trauma and Orthopaedics, Tallaght University Hospital, Dublin D24NROA, Ireland
| | - Niall P McGoldrick
- Department of Trauma and Orthopaedics, Tallaght University Hospital, Dublin D24NROA, Ireland
| | - Conor O'Driscoll
- Department of Trauma and Orthopaedics, Tallaght University Hospital, Dublin D24NROA, Ireland
| | - John F Quinlan
- Department of Trauma and Orthopaedics, Tallaght University Hospital, Dublin D24NROA, Ireland
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21
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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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22
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Lee YK, Lim JY, Ha YC, Kim TY, Jung WH, Koo KH. Preventing ceramic liner fracture after Delta ceramic-on-ceramic total hip arthroplasty. Arch Orthop Trauma Surg 2021; 141:1155-1162. [PMID: 32529389 DOI: 10.1007/s00402-020-03515-2] [Citation(s) in RCA: 7] [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: 01/29/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The results of total hip arthroplasty (THA) with use of Delta ceramic articulation were successful at medium term follow-up. The use of this newest ceramic has markedly reduced the incidence of ceramic head fractures, but not the incidence of ceramic liner fractures. We tested a hypothesis that the ceramic fractures are prevented by use of a metal shell with 18° inner taper angle and a stem design with a reduced neck geometry. METHODS We conducted a prospective multicenter study of cementless THA with use of 32/36-mm Delta ceramic bearing, Exceed ABT metal shell and Taperloc stem. We evaluated ceramic fracture, noise, clinical results, radiological changes and survival rate at a minimum of 5-year follow-up. RESULTS From April 2010 to February 2012, 246 patients (274 THAs) were enrolled. Among them, 224 patients (130 men and 94 women, 250 hips) were followed-up for 5-8 years (mean 6.0 years). Ceramic malseating or fracture did not occur in any patient. Eight patients (8 hips, 3.2%) reported noise. Mean Harris hip score was 84 points at the latest follow-up. All acetabular and femoral components had bone-ingrown stability. Two hips were revised due to recurrent dislocation and periprosthetic fracture. The survival rate was 99.6% at 8 years postoperatively. CONCLUSION Ceramic fractures can be prevented by a use of (1) 32/36-mm Delta ceramic bearing, (2) metal shell with 18° taper angle, and (2) stem with a reduced neck geometry. However, noise remains a concern of the Delta ceramic bearing. LEVEL OF EVIDENCE Therapeutic level II.
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Affiliation(s)
- Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jae-Young Lim
- Department of Orthopaedic Surgery, Inje University Haeundae Paik Hospital, Busan, South Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea.
| | - Tae-Young Kim
- Department of Orthopaedic Surgery, Konkuk University Hospital, Seoul, South Korea
| | - Woon-Hwa Jung
- Department of Orthopaedic Surgery, Murup Hospital, Masan, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
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Artiaco S, Fusini F, Zoccola K, Massè A, Colzani G. Metallosis in Sequelae of Prosthetic Revision for Ceramic Components Fracture: A Case Report with Clinical Presentation Mimicking Periprosthetic Hip Infection. JOINTS 2021; 7:215-217. [PMID: 34235388 PMCID: PMC8253606 DOI: 10.1055/s-0041-1730981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 04/18/2021] [Indexed: 10/24/2022]
Abstract
Ceramic on ceramic total hip arthroplasties have been developed and widely used during last decades because of their long-term survival and biomechanical properties. One of the most dangerous complication of these implants is the fracture of the ceramic components. The management of this condition should be carefully planned and the choice of the new implant is crucial. We describe a rare case of severe hip synovitis due to massive metallosis in sequelae of mismanaged prosthetic revision for fracture of the ceramic acetabular liner with an unusual clinical presentation that simulate a periprosthetic infection.
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Affiliation(s)
- Stefano Artiaco
- Department of Orthopaedics and Traumatology, Orthopaedic and Trauma Center, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Federico Fusini
- Department of Orthopaedics and Traumatology, Orthopaedic and Trauma Center, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Kristijan Zoccola
- Department of Orthopaedics and Traumatology, Orthopaedic and Trauma Center, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Alessandro Massè
- Department of Orthopaedics and Traumatology, Orthopaedic and Trauma Center, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Giulia Colzani
- Department of Orthopaedics and Traumatology, Policlinico di Modena, Azienda Ospedaliera Universitaria, Modena, Italy
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Chatelet JC, Fessy MH, Saffarini M, Machenaud A, Jacquot L. Articular Noise After THA Using Delta CoC Bearings Has Little Impact on Quality of Life. J Arthroplasty 2021; 36:1678-1687. [PMID: 33293173 DOI: 10.1016/j.arth.2020.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/30/2020] [Accepted: 11/06/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND To report clinical outcomes and survival at a minimum of 10 years of a consecutive series of uncemented total hip arthroplasty (THA) with fourth-generation ceramic-on-ceramic (CoC) bearings and determine the incidence of articular noises, their risk factors, and impact on quality of life (QoL). METHODS From a series of 456 CoC THAs, there were 25 revisions, 38 deceased, and 36 lost to follow-up. The remaining 357 hips were assessed at 11.1 ± 0.7 years (range, 10-14) using the Forgotten Joint Score, Oxford Hip Score, and a questionnaire on articular noises. Kaplan-Meier survival was calculated, and multivariable analysis was performed to determine associations between articular noise and patient/surgical factors. RESULTS The 10-year survival was 96.3% for the cup, 96.5% for the stem, and 94.2% for all components. The Forgotten Joint Score was 79 ± 26 (range, 0-100), and Oxford Hip Score was 16 ± 7 (range, 12-60). The mean impact of articular noises on QoL was 1.8 ± 2.9 (range, 0-9): considered negligible in 60 hips (16%), moderate in 27 hips (7%), and severe in only 13 hips (4%). Multivariable analyses revealed that the incidence of articular noise decreased with age (odds ratio [OR], 0.94; P = .001), body mass index (OR, 0.85; P = .001), and in hips implanted with 32-mm (vs 36 mm) heads (OR, 0.18; P = .030). CONCLUSION Of 100 hips (28%) that reported some articular noises 10 years after CoC THA, the impact of articular noises on QoL was negligible for most patients. Although larger heads can improve mobility and reduce risks of dislocations, surgeons must be aware that increasing head size could also increase risks of articular noises, notably in young and active patients.
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Affiliation(s)
- Jean-Christophe Chatelet
- Centre de Chirurgie Orthopédique du Beaujolais, Ramsay Santé, Arnas, France; Artro Institute, Lyon, France
| | - Michel-Henri Fessy
- Artro Institute, Lyon, France; Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Chirurgie Orthopédique et Traumatologique, Pierre-Bénite Cedex, France; IFSTTAR, Laboratoire de Biomécanique et Mécanique des Chocs, Bron, France
| | | | - Alain Machenaud
- Artro Institute, Lyon, France; Department of Orthopaedic Surgery, Clinique d'Argonay, Ramsay Santé, Annecy, France
| | | | - Laurent Jacquot
- Artro Institute, Lyon, France; Department of Orthopaedic Surgery, Clinique d'Argonay, Ramsay Santé, Annecy, France
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Di Martino A, Coppola MAR, Bordini B, Stefanini N, Geraci G, Pilla F, Traina F, Faldini C. Clinical and radiological outcomes of total hip arthroplasty in patients affected by Paget's disease: a combined registry and single-institution retrospective observational study. J Orthop Traumatol 2021; 22:13. [PMID: 33733386 PMCID: PMC7969678 DOI: 10.1186/s10195-021-00574-y] [Citation(s) in RCA: 6] [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] [Received: 08/20/2020] [Accepted: 02/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) in patients with Paget's disease can be associated with technical difficulties related to deformities and altered mechanical bone properties, and hypervascularity leads to significative intra-operative bleeding. The purpose of this registry and single-institution study was to investigate overall survival and causes of failure of THA in pagetic patients, together with an analysis of the clinical and radiological complications. MATERIAL AND METHODS Registry-based survival and complication analysis, type of fixation, intra- and post-operative complications, clinical (pharmacological history, blood transfusions, Harris hip score [HHS]) and radiographic (cup orientation, stem axial alignment, osteolysis around the cup and the stem and heterotopic ossification [HO]) data were reviewed. RESULTS In total, 66 patients (27 males and 39 females, mean age at surgery 71.1 years for males and 74.8 years for female) from the registry study presented a 10-year survival of 89.5%. In the institutional study, involving 26 patients (14 males and 12 females, 69 years average) and 29 THAs, hip function improved significantly. Average cup orientation was 40.5°, while varus stem alignment was 13.8%. In total, 52% of hips had heterotopic ossifications. Peri-acetabular osteolysis was in 13.8% of implants and in 45% of hips was found around the stem. Allogenic and autologous blood transfusion rate were 68.2% and 31.8%, respectively, with an average transfusion of 2 units of blood (range 1-6 units). HHS improved by an average of 34 points, with excellent result in 64.3% of patients. Two implants failed, one due to traumatic ceramic head fracture 64 months after surgery, and one due to mobilization of the cup on the second post-operative day. CONCLUSION THA surgery in Paget's patients is a safe procedure, and implant survival is only partly affected by bone remodelling and choice of fixation. The post-operative functional outcome is largely similar to that of other patients. Bleeding-related complications are the main complications; a careful pharmacological strategy should be recommended to decrease the risk of transfusions and of HO development. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Alberto Di Martino
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136, Bologna, Italy.
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy.
| | | | - Barbara Bordini
- Laboratorio Di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10, 40136, Bologna, Italy
| | - Niccolò Stefanini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136, Bologna, Italy
| | - Giuseppe Geraci
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136, Bologna, Italy
| | - Federico Pilla
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136, Bologna, Italy
| | - Francesco Traina
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
- Orthopaedic-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee Implants, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136, Bologna, Italy
- University of Messina, Messina, Italy
| | - Cesare Faldini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
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The reasons for ceramic-on-ceramic revisions between the third- and fourth-generation bearings in total hip arthroplasty from multicentric registry data. Sci Rep 2021; 11:5539. [PMID: 33692436 PMCID: PMC7946907 DOI: 10.1038/s41598-021-85193-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 12/21/2020] [Indexed: 12/27/2022] Open
Abstract
This study aimed to evaluate (1) the overall reasons for first revision in CoC THAs; (2) whether the reasons for revision differ between third-generation and fourth-generation CoC THAs; and (3) the specific factors associated with bearing-related problems as the reason for revision. We retrospectively reviewed 2045 patients (2194 hips) who underwent first revision THA between 2004 and 2013, among which 146 hips with CoC bearings underwent revision. There were 92 hips with third-generation ceramic bearings and 54 hips with fourth-generation ceramic bearings. The major reasons for CoC THA revisions were ceramic fracture and loosening of the cup or stem. When ceramic fracture, squeaking, incorrect ceramic insertion, and unexplained pain were defined as directly related or potentially related to ceramic use, 28.8% (42/146) of CoC revisions were associated with bearing-related problems. Among the third-generation ceramic bearings, revision was performed in 41.3% (38/92) of cases owing to bearing-related problems whereas revisions were performed for only 7.4% (4/54) of cases with fourth-generation ceramic bearings owing to bearing-related problems (p < 0.001). Younger age, lower American Society of Anesthesiologists (ASA) grade, and preoperative diagnosis of osteonecrosis were factors related to CoC THA revisions due to bearing-related problems.
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Papaioannou I, Repantis T, Pantazidou G, Baikousis A, Korovessis P. Late Onset Atraumatic Ceramic Head Fracture of a Hybrid Ceramic Bearings Total Hip Arthroplasty. Cureus 2021; 13:e13726. [PMID: 33842105 PMCID: PMC8020614 DOI: 10.7759/cureus.13726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Ceramic head fracture is a major complication of ceramic-on-ceramic (CoC) total hip arthroplasty (THA) and though new generation ceramics have lowered the rates, although it is still a great concern. We report a case of late onset (more than 10 years after surgery) ceramic head fracture of a hybrid ceramic bearings to emphasize on its unusual clinical manifestation. Furthermore, we highlight the late onset presentation and also the rarity of this complication with this particular hybrid ceramic bearings. A relevant review of the literature revealed that hybrid ceramic bearings need to be more thoroughly studied to understand modes of their failure and to reach a consensus on how to reduce and prevent these disastrous complications.
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Affiliation(s)
| | | | - Georgia Pantazidou
- Otolaryngology - Head and Neck Surgery, General Hospital of Patras, Patras, GRC
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Kretzer JP, Uhler M, Jäger S, Bormann T, Sonntag R, Schonhoff M, Schröder S. [Tribology in hip arthroplasty : Benefits of different materials]. DER ORTHOPADE 2021; 50:259-269. [PMID: 33630110 DOI: 10.1007/s00132-021-04077-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 11/30/2022]
Abstract
When it comes to total hip replacements, choosing the suitable material combination is of clinical relevance. The present review article examines the technical differences in wear and corrosion of the relevant material combinations of ceramics, metals, ceramized metals and various types of polyethylene. The material characteristics, which were often tested under standardized conditions in the laboratory, are compared with clinical results on the basis of evidence-graded clinical studies and on the basis of register studies. This article thus represents an up-to-date snapshot of the expectations and actual clinical outcomes of the present choice of material combinations. It shows that some tendencies from the field of materials research, e.g. with regard to cross-linked polyethylene, coincide with observations from practical clinical experience, while for other materials, a proven technical superiority has not yet been confirmed as an evident advantage in clinical practice.
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Affiliation(s)
- J Philippe Kretzer
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland.
| | - Maximilian Uhler
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Sebastian Jäger
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Therese Bormann
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Robert Sonntag
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Mareike Schonhoff
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Stefan Schröder
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
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Pushing Ceramic-on-Ceramic in the most extreme wear conditions: A hip simulator study. Orthop Traumatol Surg Res 2021; 107:102643. [PMID: 32684432 DOI: 10.1016/j.otsr.2020.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 05/01/2020] [Accepted: 05/06/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Hip revision surgery for fractured ceramic components may represent the worst-case wear scenario due to the high risks of recurrent dislocations, instability, and third body wear. The ideal bearing choice for the new prosthetic articulation is still subject of debate, while alumina matrix composite (AMC) articulations offer theoretical superior performances; the present work was designed to test the wear behaviour of ceramic on ceramic articulations (liner and head) in a worst-case scenario by adding ceramic third-body particles to the test lubricant with combined walking and subluxation cycles in a hip joint simulator. Therefore, we performed an in vitro study aiming to assess how does AMC articulation perform with 1) third-body particles added to the test environment and 2) under subluxation stresses. HYPOTHESIS We hypothesised that AMC articulations offer superior performances in such worst conditions. MATERIALS AND METHODS A hip simulator test was designed to analyse how AMC articulation performs with third-body particles added to the test environment and under subluxation stresses. Two different load patterns including level walking and subluxation of the ceramic liner were applied. The test fluid lubricant was contaminated by adding coarse ceramic particles during the first 2 million cycles and fine ceramic particles from 2 to 4 million cycles. Group 1 consisted of an alumina matrix composite articulation (liner and head); group 2 consisted of an alumina liner and an alumina matrix composite head. A control group consisting of an alumina ceramic liner articulated against an alumina matrix composite head was provided and only axially loaded. The liners of groups 1 and 2 were tested at an in vivo angle of 45° in the medial lateral plane (inclinationangle), which corresponds to an angle L=30° relative to the ISO standard fixated position used for in vitro testing. All mass measurements were performed using a high precision balance (Sartorius BP211D). During each examination, images on dedicated location of the bearing surfaces were taken using a digital microscope. RESULTS Mean cumulative wear of 0.09mg per million cycles between 2 and 4 million cycles was detected in group 2, and this value was significantly lower (p=0.016) in comparison with the average value in group 1 (0.21mg per million cycle). This result can be explained in light of a possible transformation phase of zirconia in AMC liners, probably due to excessive stress during subluxation cycles. However, wear levels observed are close to the gravimetric measurement detection limit of the Sartorious Balance (about 0.1-0.2mg); therefore, wear can be considered negligible in all groups. CONCLUSION Our results confirm that AMC couplings perform very well even in the worst-case wear scenario. Since AMC articulations revealed 25% lower cumulative wear respect to AMC on cross linked polyethylene in same simulator setup, AMC articulations should be considered the bearing of choice in revision surgery in light of the high risk of recurrent dislocations, instability, and third body wear. LEVEL OF EVIDENCE III, prospective case-control study, in vitro.
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Lee S, Yoo JJ, Kim HJ. Impingement Between the Metal Stem and the Ceramic Liner in Total Hip Arthroplasty: The Neck Is Not the Only Place Where Impingement Occurs. J Bone Joint Surg Am 2021; 103:139-145. [PMID: 33269897 DOI: 10.2106/jbjs.20.00354] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND It is assumed that impingement between the ceramic liner and the stem increases the possibility of a liner fracture in total hip arthroplasty with a ceramic-on-ceramic bearing. The purpose of this study was to analyze the pattern of the impingement by evaluating the notches (U-shaped indented wear scars engraved on the stem) on radiographs to determine when and where impingement develops and to analyze the factors affecting its occurrence. METHODS Among the primary total hip arthroplasty cases using a ceramic-on-ceramic bearing performed from November 1997 to December 2003, 244 cases of 197 patients (123 male patients and 74 female patients) that had follow-up of ≥15 years were included. All of the radiographs were examined with special regard to the notches and the cup positions. RESULTS Notches were detected at 77 sites of 57 cases (23.4%) for the first time between 8 months and 14.8 years after the surgical procedure. They were located on the neck or the shoulder of the stem. Shoulder notches were detected only in the cases with a short-neck head. Shoulder notches were found in 29 cases (20.0% of short-neck cases). Cup inclination was lower (p = 0.01) and anteversion was higher (p = 0.01) in the group with notches than the group without notches. There were 5 cases of ceramic head fracture. One of them experienced another ceramic liner fracture, assumed to be caused by prosthetic shoulder impingement, after the revision surgical procedure. CONCLUSIONS The results of this study suggest that impingement between the stem and the ceramic liner occurs in a considerable proportion of patients who underwent total hip arthroplasty not only on the neck but also on the shoulder of the stem. Forceful and abrupt impingement on the stem shoulder can cause ceramic liner fracture. Impingement between the stem shoulder and the ceramic liner should be considered in designing a stem. It seems to be prudent to recommend that patients avoid squatting or sitting cross-legged on the floor as much as possible. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Sunhyung Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
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van Loon J, Hoornenborg D, van der Vis HM, Sierevelt IN, Opdam KTM, Kerkhoffs GMMJ, Haverkamp D. Ceramic-on-ceramic vs ceramic-on-polyethylene, a comparative study with 10-year follow-up. World J Orthop 2021; 12:14-23. [PMID: 33520678 PMCID: PMC7814309 DOI: 10.5312/wjo.v12.i1.14] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/04/2020] [Accepted: 11/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In press-fit total hip arthroplasty (THA) ceramic-on-ceramic (CoC) bearings are a potential for overcoming the wear that is seen in ceramic-on-polyethylene (CoPE) bearings, and can lead to wear-induced osteolysis, resulting in loosening of the implant. However, CoC bearings show disadvantages as well, such as squeaking sounds and being more fragile, which can cause ceramic head or liner fracture. Because comparative long-term studies are limited, the objective of this study was to determine the long-term difference in wear, identify potential predictive factors for wear, investigate radiological findings such as osteolysis, and evaluate clinical functioning and complications between these bearings.
AIM To determine 10-year differences in wear, predictive factors for wear, and investigate radiological findings and clinical functioning between CoC and CoPE.
METHODS This observational prospective single-center cohort study with a 10-year follow-up includes a documented series of elective THAs. Primary outcome was wear measured by anteroposterior (AP) radiographs. Secondary outcomes were potential predictive factors for wear, complications during follow-up, Harris hip score (HHS), and radiological findings such as presence of radiolucency, osteolysis, atrophy, and hypertrophy around the cup. Due to the absence of wear in the CoC group, stratified analysis to identify risk factors for wear was only performed in the CoPE group by use of univariate linear regression analysis. HHS was expressed as a change from baseline and the association with bearing type was assessed by use of multivariate linear regression analysis, adjusted for potential confounders.
RESULTS A total of 17 CoPE (63.0%) and 25 CoC (73.5%) cases were available for follow-up and showed a linear wear of respectively 0.130 mm/year (range 0.010; 0.350) and 0.000 mm/year (range 0.000; 0.005), which was significant (P < 0.001) between both groups. Wear always occurred in the cranial direction. Cup inclination was the only predictive factor for polyethylene (PE) wear. No dislocations, ceramic head, or liner fractures were seen. The HHS showed a mean change from baseline of 37.1 points (SD 18.5) in the CoPE group and 43.9 (SD 17.0) in the CoC group. This crude difference of 6.8 (range -5.2; 18.7) in favor of the CoC group was not significant (P = 0.26) and was not significant when adjusted for age, gender, and diagnosis either (P = 0.99). No significant differences in complications and radiological findings were seen between groups.
CONCLUSION CoC bearing shows lower wear rates compared to CoPE at 10-year follow-up with cup inclination as a predictive factor for wear and no differences in complications, HHS, and radiological findings.
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Affiliation(s)
- Justin van Loon
- Department of Orthopedic Surgery, Xpert Orthopedie Amsterdam/SCORE (Specialized Center of Orthopedic Research and Education), Amsterdam 1101EA, The Netherlands
- Department of Orthopedic Surgery, Amsterdam University Medical Centres, location Academic Medical Center, Amsterdam 1105AZ, The Netherlands
| | - Daniël Hoornenborg
- Department of Orthopedic Surgery, Xpert Orthopedie Amsterdam/SCORE (Specialized Center of Orthopedic Research and Education), Amsterdam 1101EA, The Netherlands
| | - Harm M van der Vis
- Department of Orthopedic Surgery, Xpert Orthopedie Amsterdam/SCORE (Specialized Center of Orthopedic Research and Education), Amsterdam 1101EA, The Netherlands
| | - Inger N Sierevelt
- Department of Orthopedic Surgery, Xpert Orthopedie Amsterdam/SCORE (Specialized Center of Orthopedic Research and Education), Amsterdam 1101EA, The Netherlands
- Department of Orthopedic Surgery, Spaarne Gasthuis, Hoofddorp 2134TM, The Netherlands
| | - Kim TM Opdam
- Department of Orthopedic Surgery, Amsterdam University Medical Centres, location Academic Medical Center, Amsterdam 1105AZ, The Netherlands
| | - Gino MMJ Kerkhoffs
- Department of Orthopedic Surgery, Amsterdam University Medical Centres, location Academic Medical Center, Amsterdam 1105AZ, The Netherlands
| | - Daniël Haverkamp
- Department of Orthopedic Surgery, Xpert Orthopedie Amsterdam/SCORE (Specialized Center of Orthopedic Research and Education), Amsterdam 1101EA, The Netherlands
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Castagnini F, Cosentino M, Bracci G, Masetti C, Faldini C, Traina F. Ceramic-on-Ceramic Total Hip Arthroplasty with Large Diameter Heads: A Systematic Review. Med Princ Pract 2021; 30:29-36. [PMID: 32756066 PMCID: PMC7923901 DOI: 10.1159/000508982] [Citation(s) in RCA: 7] [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: 04/16/2020] [Accepted: 05/26/2020] [Indexed: 02/05/2023] Open
Abstract
Ceramic-on-ceramic (COC) total hip arthroplasties (THAs) with large heads (>36 mm) were introduced to reduce dislocation rates and restore the hip anatomy as closely as possible to the native one. To date, the literature is scarce and fragmented; a review is desirable to point out the outcomes and the possible specific complications (noise, groin pain, and taperosis). A systematic review about large-diameter COC THAs was conducted according to the PRISMA guidelines. The PubMed and Cochrane databases were searched using the terms "large", "big", "head", "hip", and "ceramic." The methodological quality of the papers was assessed using the MINORS (Methodological Index for Nonrandomized Studies) score. Seven papers (level of evidence: 5 case series and 2 case-control studies) met the inclusion criteria. Clinical outcomes were excellent in >90% of the patients. Groin pain was reported in only 1 article (7%). Radiological outcomes were positive. Minimal revision rates (<2%) were reported at short- to mid-term follow-ups. Dislocation rates were usually <1%. No bearing surfaces failed. No case of trunnionitis was reported. Noise occurred in up to 30% of the patients, mostly squeaking. The noise did not influence clinical outcomes or patients' satisfaction. Noise was inconstantly associated with component positioning, younger age, high articular excursions, and larger sizes. Large-diameter heads in COC THAs (≥40 mm) showed promising clinical and radiological outcomes with minimal revision rates. Noise is a cause of concern and should be carefully evaluated at longer follow-ups and in larger, prospective, and specifically designed case series.
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Affiliation(s)
- Francesco Castagnini
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy,
| | - Monica Cosentino
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giovanni Bracci
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Masetti
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Cesare Faldini
- Clinica Ortopedica e Traumatologica I, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Università di Bologna DIBINEM, Bologna, Italy
| | - Francesco Traina
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Università di Bologna DIBINEM, Bologna, Italy
- Università di Messina, Messina, Italy
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Bellity J, Elkaïm M, Hannouche D, Nizard R. Arthroscopic evaluation and treatment of a squeaking hip. A case report. BMC Musculoskelet Disord 2020; 21:805. [PMID: 33272241 PMCID: PMC7713320 DOI: 10.1186/s12891-020-03817-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 11/22/2020] [Indexed: 11/22/2022] Open
Abstract
Background Squeaking of ceramic-on-ceramic total hip arthroplasty is an unexpected complication which occurs in 1- 30% of patients. Revision surgery is required in 0.2% of the cases, when a ceramic fracture is suspected, or in case of severe malposition of the implants, subluxation, or impingement. Hip arthroscopy may be a useful diagnostic and therapeutic option in squeaking hips. Case presentation A patient presenting with a pain-free squeaking underwent hip arthroscopy to examine the sliding surfaces and the rim of the acetabulum, and to search for signs of impingement. Thorough lavage and debridement of hip synovitis and fibrous tissue was performed. The squeaking noise immediately disappeared after the surgery. The patient was allowed to fully weight bear as tolerated with 2 crutches for 2 weeks. Two years after the arthroscopy, the patient remained symptom-free. Conclusions The potential reasons for hip squeaking in our patient are discussed. Hip arthroscopy may prove useful as a diagnostic and therapeutic option for some patients presenting with a squeaking ceramic-on ceramic hip replacement.
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Affiliation(s)
- Jonathan Bellity
- Department of Orthopaedic Surgery, Lariboisière, Hospital, Paris 7 University, Paris, France
| | - Marc Elkaïm
- Department of Orthopaedic Surgery, Lariboisière, Hospital, Paris 7 University, Paris, France
| | - Didier Hannouche
- Department of Orthopaedic Surgery, Lariboisière, Hospital, Paris 7 University, Paris, France. .,Department of Orthopaedic Surgery, Geneva University Hospitals & Faculty of Medicine, Avenue Gabrielle Perret Gentil 4, 1205, Geneva, Switzerland.
| | - Rémy Nizard
- Department of Orthopaedic Surgery, Lariboisière, Hospital, Paris 7 University, Paris, France
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Lee SJ, Yoon KS. Outcome of Ceramic-on-Ceramic Total Hip Arthroplasty with 4th Generation 36 mm Head Compared to that with 3rd Generation 28 mm Head by Propensity Score Matching. Indian J Orthop 2020; 54:848-855. [PMID: 33133408 PMCID: PMC7572915 DOI: 10.1007/s43465-020-00242-z] [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: 04/20/2020] [Accepted: 08/20/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND With the development of 4th generation ceramic bearing, the large ceramic head is available for ceramic-on-ceramic total hip arthroplasty (THA). This retrospective study aimed to compare the outcomes of ceramic-on-ceramic THA with 4th generation 36 mm head to those with 3rd generation 28 mm head using propensity score matching. METHODS We retrospectively reviewed the results of 133 ceramic-on-ceramic THAs with 4th generation 36 mm ceramic head in 129 patients and 133 ceramic-on-ceramic THAs identified from 405 ceramic-on-ceramic THAs with 3rd generation 28 mm head by propensity score matching. There were 83 males and 50 females in both groups with a mean age of 55 years. There was no significant difference in other demographic features except for follow-up period (4.2 years in the 36 mm group and 6.4 years in the 28 mm group, p < 0.001). Clinical and radiological results and occurrence of complication were compared between the two groups. RESULTS Harris Hip Score was increased significantly from 46.4 to 92.1 in the 36 mm group and from 46.7 to 93.6 in the 28 mm group. No loosening or osteolysis was observed in the 36 mm group. However, one hip showed radiologic sign of loosening in the 28 mm group. As for complication, postoperative dislocation was more frequent in the 28 mm group (6 in the 28 mm group vs. 0 in the 36 mm group, p = 0.03). Otherwise, there was no significant difference in other results including inguinal pain, squeaking or ceramic fracture. CONCLUSION Ceramic-on-ceramic THA with 4th generation 36 mm head significantly reduced postoperative dislocation rate without increasing the rate of inguinal pain, squeaking, or ceramic fracture compared to that with 3rd generation 28 mm head.
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Affiliation(s)
- Soong Joon Lee
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, 20, Boramae-ro-5-gil, Dongjak-gu, Seoul, 07061 Republic of Korea
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Kang Sup Yoon
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, 20, Boramae-ro-5-gil, Dongjak-gu, Seoul, 07061 Republic of Korea
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
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Yoon JY, Moon JK, Kim CH, Lee S, Yoon PW. Korean epidemiology and trends in hip joint replacements. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2020. [DOI: 10.5124/jkma.2020.63.8.462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This study aimed to analyze the epidemiologic characteristics of patients who underwent hip arthroplasty using the Korean nationwide database and investigate the recent trends in implant fixation methods and bearing surface selection. We aimed to compare clinical characteristics and differences with the results from the registry of other western countries. We analyzed the data collected by the Health Insurance Review and Assessment Service database of Korea from 2007 to 2011 and the Main Surgery Statistical Yearbook from 2014 to 2018, published by the National Health Insurance Service. The number and rate of patients who underwent hip joint arthroplasty per 10,000 persons have been steadily increasing since 2007. There was a big difference in mean age and preoperative diagnosis of patients between the bipolar hemiarthroplasty and total hip arthroplasty groups. Most patients underwent surgery using a cementless biological fixation method, and the cemented fixation method was selectively used for a small portion of old aged osteoporotic patients. In relation to the use of bearing surfaces, the registry data showed that ceramic-ceramic bearings were used at an overwhelmingly high rate (81%) in Korea compared to other countries. The reason was attributable to various factors, such as patient’s age or economic status, differences in the health insurance system between countries, and recently reported complications, such as ceramic fracture or noise.
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de Villiers D, Collins S. Resistance of a novel ceramic acetabular cup to critical impact loads. Proc Inst Mech Eng H 2020; 234:1122-1128. [PMID: 32633704 DOI: 10.1177/0954411920941383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A novel thin-walled direct-to-bone fixation ceramic cup was tested under critical impact loads simulating lateral fall and car crash scenarios. Three sizes of BIOLOX delta ceramic cups (total hip replacement cup with bearing diameter of 32 mm and two hip resurfacing cups with bearing diameters of 40 and 64mm) were implanted into reamed Sawbones blocks representing acetabulae. Three cups of each size were fully supported by the block and three were implanted with 15° of the cup's outer diameter unsupported by the block. All testing was conducted with the corresponding bearing diameter heads lateralised by approximately 1 mm to represent worst case subluxed hips and all then subjected to test, replicating a lateral fall impact followed by a car crash impact. All cups passed lateral fall conditions without visible damage, although some movement of the cups was measured and damage to the blocks was observed. Five out of six of each cup size survived the car crash impacts with one fracture per size. In all cases, this was in the fully supported condition representing the highest cup inclination angle. The car crash impact force was equivalent to that reported to fracture the acetabulum and in all simulated cases, the Sawbones block showed signs of damage. Survival of five cups per size suggests the pelvis is much more likely to fracture before the cup. The ability of the cups to withstand these critical impact forces indicates they are unlikely to fracture in normal clinical use and should meet the more challenging demands of active patients likely to receive this device.
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Castagnini F, Bordini B, Biondi F, Cosentino M, Stea S, Traina F. Mixed ceramic combinations in primary total hip arthroplasty achieved reassuring mid-to-longterm outcomes. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2020; 31:56. [PMID: 32594253 DOI: 10.1007/s10856-020-06393-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 06/15/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Ceramic-on-ceramic couplings demonstrated to be reliable bearings in primary total hip arthroplasty (THA), with long-term remarkable results. Like-on-like configurations were widely described. On the contrary, mixed material combinations from the same manufacturer, Delta-on-Forte or Forte-on-Delta, were poorly studied. In particular, it is unknown whether mixed ceramic combinations are more at risk of ceramic fractures. Thus, a registry study was conducted to investigate the long-term survival rates and reasons for revision of mixed ceramic combinations. A comparison with Delta-on-Delta couplings was also performed. MATERIALS AND METHODS The regional arthroplasty registry RIPO was enquired about three cohorts of ceramic bearings (head-on-liner: Delta-on-Forte, Forte-on-Delta, Delta-on-Delta). Demographics, survival rates and reasons for revision were evaluated and compared. RESULTS In total, 346 (1.5%) implants had a Delta-on-Forte coupling (mean follow-up: 6.4 years). In total, 1163 (5%) THAs had a Forte-on-Delta articulation (mean follow-up: 8.2 years). Delta-on-Delta surfaces were implanted in 21,874 (93.5%) hips (mean follow-up: 3.9 years). Mixed material combinations were implanted between 2003 and 2007. The survival rates of the three cohorts were similar and were higher than 95% at 10 years. In Forte-on-Delta group, four liners failed (0.3% of the implants), whereas ceramic fractures occurred in 15 cases (0.1%) in Delta-on-Delta couplings (3 heads and 12 liners). Considering ceramic fracture as endpoint, there was no significant difference between the three survival rates. CONCLUSIONS Mixed ceramic bearing configurations from the same manufacturer in primary THA showed mid-to-longterm dependable outcomes, not inferior to the most recent like-on-like ceramic bearings. No additional risks of ceramic fractures were evident. Thus, closer follow-ups are not required.
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Affiliation(s)
- Francesco Castagnini
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, Bologna, 40136, Italy.
| | - Barbara Bordini
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, Bologna, 40136, Italy
| | - Federico Biondi
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, Bologna, 40136, Italy
| | - Monica Cosentino
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, Bologna, 40136, Italy
| | - Susanna Stea
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, Bologna, 40136, Italy
| | - Francesco Traina
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, Bologna, 40136, Italy
- DIBINEM, University of Bologna, Bologna, Italy
- University of Messina, Messina, Italy
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Role of computed tomography in determining the choice of treatment for delayed ceramic acetabular liner fracture: A case report. Jt Dis Relat Surg 2020; 31:377-381. [PMID: 32584740 PMCID: PMC7489176 DOI: 10.5606/ehc.2020.72241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 01/11/2020] [Indexed: 11/21/2022] Open
Abstract
Ceramic acetabular liner fracture is a rare complication and requires early revision surgery to avoid abrasive damaging of metal components by ceramic particles. Chromium-cobalt femoral head can be used in revision surgery if only fractured ceramic particles are completely removed because the abrasive effect of ceramic debris is more pronounced on metal head compared to ceramic head. In this article, we report a 50-year-old male patient of delayed acetabular liner fracture in which we used a ceramic head that is more resistant to residue ceramic particles. We assessed the patient by using computed tomography (CT) to locate the ceramic particles. By using CT imaging, we can detect which ceramic particles pose high morbidity risk for debridement.
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Chang JD, Kim IS, Mansukhani SA, Sharma V, Lee SS, Yoo JH. Midterm outcome of fourth-generation ceramic-on-ceramic bearing surfaces in revision total hip arthroplasty. J Orthop Surg (Hong Kong) 2019; 26:2309499018783913. [PMID: 29945472 DOI: 10.1177/2309499018783913] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The purpose of this study is to evaluate the clinical and radiologic outcomes after revision total hip arthroplasty (THA) using fourth-generation ceramic-on-ceramic (CoC) bearing surfaces. METHODS A total of 52 revision THAs (28 men and 19 women) using the fourth-generation CoC bearing surfaces were retrospectively evaluated. Both acetabular cup and femoral stem were revised in all cases. The mean follow-up period was 7.3 years (range, 4.0-9.9 years). The clinical results with Harris hip score (HHS), Western Ontario McMaster Osteoarthritis Index (WOMAC), and radiologic outcomes were evaluated. RESULTS At the final follow-up examination, the average HHS was 90.4 (range, 67-100). The average WOMAC pain and physical function score were 2.8 (range, 0-12) and 16.4 (range, 0-42), respectively. Complications were observed in 10 hips (19.2%). However, there were no bearing surface-related complications, and no cases of dislocation and squeaking. Retroacetabular pelvic osteolysis without cup loosening was observed in one hip at the final follow-up. However, no hip showed radiographic signs of cup loosening, vertical or horizontal acetabular cup migrations, and changes of inclinations during the follow-up period. CONCLUSION Our data showed that clinical and radiologic outcomes after revision THA using fourth-generation CoC bearing were favorable. Hence, revision THA with the use of CoC bearing surfaces can be preferentially considered. Further studies with long-term follow-up data are warranted.
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Affiliation(s)
- Jun-Dong Chang
- 1 Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Gyeonggi-do, Republic of Korea
| | - In-Sung Kim
- 1 Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Gyeonggi-do, Republic of Korea
| | - Sameer Ajit Mansukhani
- 1 Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Gyeonggi-do, Republic of Korea
| | - Vishwas Sharma
- 1 Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Gyeonggi-do, Republic of Korea
| | - Sang-Soo Lee
- 2 Department of Orthopaedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Je-Hyun Yoo
- 3 Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Gyeonggi-do, Republic of Korea
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40
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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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41
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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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42
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Kocadal O, Ozler T, Bolukbasi AET, Altintas F. Non-traumatic Ceramic Head Fracture in Total Hip Arthroplasty with Ceramic-on-Ceramic Articulation at Postoperative 16th Years. Hip Pelvis 2019; 31:124-127. [PMID: 31198780 PMCID: PMC6546678 DOI: 10.5371/hp.2019.31.2.124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/08/2019] [Accepted: 05/11/2019] [Indexed: 11/29/2022] Open
Abstract
Ceramic articulation has gained popularity in total hip arthroplasty (THA); however, one of the most important concerns about the use of ceramic materials is the potential for breakage. Importantly, almost all ceramic fractures occur within the first six years after surgery. Here, we present a case report of a 52-year-old female patient who experienced an atraumatic ceramic head fracture at the 16th year after surgery. Key parameters that may be associated with ceramic head fracture are considered to be the use of a 28-mm head and high body mass index (BMI); the patient described here had a BMI of 34.3 kg/m2. Surgical treatment of the case included removal of the broken ceramic head and replacement with an alumina matrix composite ceramic head. At the 12th month follow-up visit, the patient was mobilized independently and could perform her daily activities. Ceramic head fracture after THA may occur even in late periods after surgery. For the treatment of fractures of ceramic material, the fractured component must be removed together with extensive soft tissue excision to ensure that no residual fragments are left behind.
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Affiliation(s)
- Onur Kocadal
- Department of Orthopaedics and Traumatology, Yeditepe University Faculty of Medicine, Istanbul, Turkey
| | - Turhan Ozler
- Department of Orthopaedics and Traumatology, Yeditepe University Faculty of Medicine, Istanbul, Turkey
| | - Alp Er Tunga Bolukbasi
- Department of Orthopaedics and Traumatology, Yeditepe University Faculty of Medicine, Istanbul, Turkey
| | - Faik Altintas
- Department of Orthopaedics and Traumatology, Yeditepe University Faculty of Medicine, Istanbul, Turkey
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43
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Xiang S, Zhao Y, Li Z, Feng B, Weng X. Clinical outcomes of ceramic femoral prosthesis in total knee arthroplasty: a systematic review. J Orthop Surg Res 2019; 14:57. [PMID: 30782186 PMCID: PMC6381750 DOI: 10.1186/s13018-019-1090-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 02/05/2019] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Ceramic bearings have been widely used in total hip arthroplasty (THA), which resulted in satisfactory clinical outcomes due to the excellent tribological characteristics of the implants. However, ceramic components are not commonly used in total knee arthroplasty (TKA) because of brittleness. This study aimed to gather and analyze information regarding the clinical outcomes (including survival without revision, causes of revision, functional outcome, and incidence of loosening) and reach a definitive conclusion about the use of ceramic femoral components in total knee arthroplasty. METHODS MEDLINE, EMBASE, Cochrane, and ClinicalTrials.gov databases were searched for studies that reported the clinical and/or radiological outcomes with or without survival data of ceramic TKA implants and that included more than 10 patients with a minimum of 1 year follow-up. RESULTS From an initial sample of 147, there were 14 studies that met the inclusion criteria. Overall, there was a notable enhancement of joint function after the procedure, with a satisfactory mid- and long-term survival of the ceramic components, which is comparable to that of the conventional alloy components reported previously. In addition, the revision rate was reported to be between 0% and 14.37% according to the included studies. However, revision due to aseptic loosening, wear, and component fracture appeared to be rare, demonstrating the safety of in vivo use of ceramic bearings in the TKA procedure. CONCLUSIONS Ceramic TKA implants show similar post-operative clinical results and survival rate compared to their conventional metallic counterparts. Our results confirmed the safety of in vivo use of ceramic bearings in TKA, with rare implant breakage and aseptic loosening. Considering the excellent characteristics of the tribology of ceramics, the clinical use of ceramic prostheses in TKA could be promising.
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Affiliation(s)
- Shuai Xiang
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, 100730, China
| | - Yan Zhao
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, 100730, China
| | - Zeng Li
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, 100730, China
| | - Bin Feng
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, 100730, China
| | - Xisheng Weng
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, 100730, China.
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Synthesis and Tribological Properties of Bio-Inspired Nacre-Like Composites. MATERIALS 2018; 11:ma11091563. [PMID: 30200224 PMCID: PMC6163941 DOI: 10.3390/ma11091563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 08/22/2018] [Accepted: 08/27/2018] [Indexed: 11/17/2022]
Abstract
Ceramic materials possessing the properties of high-strength and rigidity are widely used in industry. The shell nacre has a layered structure containing both macroscopic and microscopic levels and is equipped with superior qualities regarding hardness and strength. Therefore, the ceramic composites with a nacre-like layered structure have the potential to be utilized as sliding bearings employed in the harsh conditions of wells. For the purpose of this paper, a porous Al2O3 ceramics skeleton with nanometer powder is prepared using the freeze-casting method. Then the porous ceramic skeleton is filled with polymer polymethyl methacrylate (PMMA) through mass polymerization to produce a bionic Al2O3/PMMA composite with a lamellar structure. The properties of the prepared composite are determined by the analysis of micro-hardness, fracture toughness, friction coefficient, wear scar diameter, and the morphology of the worn surface. Consequent results indicate that elevation in the A12O3 powder, which acts as the initial solid phase content, prompts the ceramic slurry to exhibit an increase in viscosity and a gradual decrease in the pore size of the ceramic skeleton. The prepared layered Al2O3/PMMA composite possesses high fracture toughness, which closely resembles that of Al, is approximately four times that of the matrix of the Al2O3 ceramics and 16 times that of the PMMA. Three kinds of composites containing different solid phase content are subjected to testing involving lubrication by water-based drilling fluid to determine the friction coefficient of each. The results indicate that an increased load leads to a decreased friction coefficient while the impact of speed is not evident. Under dry conditions, the friction coefficient of three different composites tested, declines with elevated load and speed. With the use of water-based drilling fluid as lubrication, the wear scar diameter increases at higher speed, while dry conditions denote increased load. Abrasive wear is determined to be the principal form of erosion of layered Al2O3/PMMA composites.
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45
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Teeter MG, MacLean CJ, Somerville LE, Howard JL, McCalden RW, Lanting BA, Vasarhelyi EM. Wear performance of cobalt chromium, ceramic, and oxidized zirconium on highly crosslinked polyethylene at mid-term follow-up. J Orthop 2018; 15:620-623. [PMID: 29881207 DOI: 10.1016/j.jor.2018.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/06/2018] [Indexed: 10/17/2022] Open
Abstract
Patients with THA using a ceramic head and using an OxZr head were each matched to patients with a CoCr head. Mean implantation time was 5 years. There was no difference in steady state wear rate between the ceramic (0.066 ± 0.050 mm/year) and CoCr match groups (0.052 ± 0.041 mm/year), or between the OxZr (0.022 ± 0.029 mm/year) and CoCr match groups (0.048 ± 0.071 mm/year). Follow-up into the second decade will be necessary before any changes in THA wear rate from using ceramic or OxZr bearings may be appreciated clinically with available imaging techniques.
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Affiliation(s)
- Matthew G Teeter
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontari, Canada.,Surgical Innovation Program, Lawson Health Research Institute, London, Ontario, Canada.,Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada
| | - Colin J MacLean
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontari, Canada
| | - Lyndsay E Somerville
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontari, Canada
| | - James L Howard
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontari, Canada
| | - Richard W McCalden
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontari, Canada
| | - Brent A Lanting
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontari, Canada
| | - Edward M Vasarhelyi
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontari, Canada
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46
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Abstract
Total hip arthroplasty (THA) is widely considered one of the most successful surgical procedures in orthopaedics. It is associated with high satisfaction rates and significant improvements in quality of life following surgery. On the other hand, the main cause of late revision is osteolysis and wear, often a result of failure of bearing surfaces.Currently, several options are available to the surgeon when choosing the bearing surface in THA (ceramic-on-ceramic (CoC), ceramic-on-polyethylene (CoPE), metal-on-polyethylene (MoPE)), each with advantages and drawbacks.Very few studies have directly compared the various combinations of bearings at long-term follow-up. Randomized controlled trials show similar short- to mid-term survivorship among the best performing bearing surfaces (CoC, CoXLPE and MoXLPE). Selection of the bearing surface is often 'experience-based' rather than 'evidence-based'.The aim of this paper is therefore to evaluate the main advantages and drawbacks of various types of tribology in THA, while providing practical suggestions for the surgeon on the most suitable bearing surface option for each patient. Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.180300.
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Affiliation(s)
- Luigi Zagra
- Hip Department, IRCCS Istituto Ortopedico Galeazzi, Italy
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47
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A Randomized Seven-Year Study on Performance of the Stemmed Metal M2a-Magnum and Ceramic C2a-Taper, and the Resurfacing ReCap Hip Implants. J Arthroplasty 2018; 33:1412-1420. [PMID: 29276121 DOI: 10.1016/j.arth.2017.11.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 11/08/2017] [Accepted: 11/26/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The large-diameter metal-on-metal hip prostheses were expected to have low wear and reduced dislocation rate compared to the traditional metal-on-polyethylene implants. We compare 2 such prostheses, the ReCap resurfacing implant and the M2a-Magnum stemmed implant, with the C2a ceramic-on-ceramic stemmed implant as to clinical performance, serum concentrations of prosthesis metals, and the durability of the implants in a randomized, controlled clinical trial at 7 years of follow-up. METHODS All included patients had osteoarthritis. Preoperatively, the size of the implants was estimated from a magnetic resonance imaging (MRI) scan. Follow-up data included serum cobalt and chromium concentrations, Oxford and Harris Hip Scores, leg press and abduction force, 6-minute walk distance, WOMAC and SF-36 self-assessment scores, and from the 7th postoperative year also ultrasonography (US) examination of the soft tissue adjacent to the implant as well as MRI with metal artifact reduction sequence (MARS-MRI) when indicated. RESULTS One hundred fifty-two hips in 146 patients were included. The serum cobalt and chromium concentrations were significantly higher for the 2 metal-on-metal prostheses than for the ceramic-on-ceramic, with the M2a-Magnum as the highest. No significant difference was found between the groups concerning physical performance measurements and scores as well as dislocations and prosthesis survival. Five revisions were done and concerned all groups, for reasons of pain, high serum cobalt and chromium concentrations, cystic fluid collection around the joint, and infection. Metal concentrations, US, and MARS-MRI contributed to the decision making regarding prosthesis revision. CONCLUSION Metal concentrations were significantly higher for the metal-on-metal prostheses than for the ceramic-on-ceramic. The clinical performance was good in all 3 prosthesis groups. Metal concentrations, US, and MARS-MRI findings were of use to identify hips needing revision. ID Number in ClinicalTrials.gov PRS: NCT00284674.
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Abstract
The use of larger femoral head size in total hip arthroplasty (THA) has increased during the past decade; 32 mm and 36 mm are the most commonly used femoral head sizes, as reported by several arthroplasty registries.The use of large femoral heads seems to be a trade-off between increased stability and decreased THA survivorship.We reviewed the literature, mainly focussing on the past 5 years, identifying benefits and complications associated with the trend of using larger femoral heads in THA.We found that there is no benefit in hip range of movement or hip function when head sizes > 36 mm are used.The risk of revision due to dislocation is lower for 36 mm or larger bearings compared with 28 mm or smaller and probably even with 32 mm.Volumetric wear and frictional torque are increased in bearings bigger than 32 mm compared with 32 mm or smaller in metal-on-cross-linked polyethylene (MoXLPE) THA, but not in ceramic-on-XLPE (CoXLPE).Long-term THA survivorship is improved for 32 mm MoXLPE bearings compared with both larger and smaller ones.We recommend a 32 mm femoral head if MoXLPE bearings are used. In hips operated on with larger bearings the use of ceramic heads on XLPE appears to be safer. Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170061.
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Affiliation(s)
- Georgios Tsikandylakis
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden
| | - Maziar Mohaddes
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden
| | - Peter Cnudde
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden
- Department of Orthopaedics, Prince Philip Hospital, HDUHB, Wales
| | - Antti Eskelinen
- Coxa Hospital for Joint Replacement, Tampere, Finland
- Finnish Arthroplasty Register, Helsinki, Finland
| | - Johan Kärrholm
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden
| | - Ola Rolfson
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden
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Parvizi J, Sedel L, Dunbar MJ. Clinical Faceoff: Instability After THA: The Potential Role of the Bearing Surface. Clin Orthop Relat Res 2018; 476:678-683. [PMID: 29543657 PMCID: PMC6260073 DOI: 10.1007/s11999.0000000000000162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Javad Parvizi
- J. Parvizi, Professor, Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA L. Sedel, Professor Emeritus, University of Paris Denis Diderot and Service de Chirurgie Orthopedique, Hopital Lariboisiere, Paris, France M. J. Dunbar, Professor of Surgery, Department of Orthopaedic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Carli A, Koch CN, Esposito CI, Wright TM, Padgett DE. Polyethylene Wear Increases in Liners Articulating With Scratched Oxidized Zirconium Femoral Heads. Clin Orthop Relat Res 2018; 476:182-192. [PMID: 29389782 PMCID: PMC6259683 DOI: 10.1007/s11999.0000000000000040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Oxidized zirconium (OxZr) femoral heads were introduced in hip arthroplasty to reduce wear of the polyethylene compared with metallic heads and to reduce fracture risk compared with ceramic heads. Severe scratches have been reported on OxZr heads in patients undergoing revision for instability, but whether these scratches contribute to increased acetabular polyethylene wear remains unclear. QUESTIONS/PURPOSES (1) How is the polyethylene of the acetabular liner affected by damage on the opposing OxZr head? (2) How does damage to the head affect the degree of polyethylene wear? METHODS We assessed damage and deformation on all retrieved highly crosslinked liners that had articulated against OxZr heads collected at one institution between 2006 and 2013. Two observers used a visual subjective scoring system to assess polyethylene damage on the surface of the 42 retrieved liners. Polyethylene components were also laser scanned to measure dimensional changes to the liner. These outcomes were compared with the severity of scratching on the surface of the articulating OxZr head. We also used a 12-station hip simulator to measure wear over five million cycles (MCs) of pristine liners articulating against nine retrieved OxZr heads with varying degrees of scratching representing a spectrum of little to severe damage and three retrieved ceramic heads with severe metal transfer. RESULTS Seventeen of the OxZr heads showed severe damage, of which 14 heads had been revised for dislocation. The retrieved liners that had articulated with these heads had greater damage scores for abrasion (mean score 0.4 versus 1.6; p = 0.008) and embedded debris (mean score 0.4 versus 1.4; p = 0.006) compared with liners that had articulated with less damaged heads. Four severely damaged OxZr heads wore at a higher rate than the others in the study with weight loss of 37.7 mg, 30.0 mg, 14.4 mg, and 2.6 mg after the first MC and a steady increase through testing to 5 MCs. Conversely, neither OxZr heads with less damage nor ceramic heads with severe metal transfer produced appreciable wear. CONCLUSIONS Surface scratching of OxZr heads from recurrent dislocation and reduction maneuvers leads to increased wear of the crosslinked polyethylene used as a bearing surface. CLINICAL RELEVANCE Patients in whom such instability occurs in the presence of an OxZr head should be followed closely for the possibility of more severe wear.
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Affiliation(s)
- Alberto Carli
- Alberto Carli MD, Chelsea N. Koch BS, Christina I. Esposito PhD, Timothy M. Wright PhD, Douglas E. Padgett MD, Hospital for Special Surgery, New York, NY, USA
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