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Perka C, Mohaddes M, Zagra L, Ekkernkamp A, Keller N, Stengel D. May the 4th be with you: mixed-methods best-evidence synthesis on 4th-generation alumina-zirconia ceramic bearings in total hip arthroplasty. EFORT Open Rev 2024; 9:632-645. [PMID: 38949170 PMCID: PMC11297405 DOI: 10.1530/eor-23-0218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2024] Open
Abstract
Purpose To assess utility, benefits, and risks of 4th-generation alumina-zirconia ceramic pairings in elective total hip arthroplasty (THA). Methods A comprehensive mixed-methods best-evidence synthesis using data from systematic reviews, randomized controlled trials (RCTs), prospective and retrospective cohort studies, as well as joint replacement registries, was conducted to estimate overall revision and survival rates, periprosthetic infection, bearing fractures, and noise phenomena with 4th-generation alumina-zirconia ceramic versus other tribological couplings in elective THA. The systematic review part across multiple databases was registered with PROSPERO (CRD42023418076), and individual study data were extracted for statistical re-analysis. Results Twenty overlapping systematic reviews, 7, 17, and 8 references from RCTs, cohort studies, and joint replacement registries form the basis of this work. According to current best evidence, it is (i) 15-33 times more likely that 4th-generation alumina-zirconia pairings avoid a revision for infection than causing a revision for audible noise, (ii) 38-85 times more likely that 4th-generation alumina-zirconia pairings avoid a revision for infection than causing a revision for ceramic head fractures, and (iii) three to six times more likely that 4th-generation alumina-zirconia pairings avoid a revision for infection than cause a revision for ceramic liner fractures. Conclusion Fourth-generation alumina-zirconia pairings in THA show a favorable benefit-risk ratio, with rare compound-specific adverse events and complications significantly outbalanced by long-term advantages, such as a markedly lower incidence of revision for infection.
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Affiliation(s)
- Carsten Perka
- Center for Musculoskeletal Surgery, Charité Medical University Center, Berlin, Germany
| | - Maziar Mohaddes
- Hässleholms Hospital, Region Skåne, Hässleholm, Sweden
- Orthopedics, Faculty of Medicine, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Luigi Zagra
- Hip Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Axel Ekkernkamp
- BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
- BG Kliniken – Klinikverbund der gesetzlichen Unfallversicherung gGmbH, Berlin, Germany
| | - Niklas Keller
- Harding Center for Risk Literacy, University of Potsdam, Faculty of Health Sciences, Potsdam, Germany
| | - Dirk Stengel
- BG Kliniken – Klinikverbund der gesetzlichen Unfallversicherung gGmbH, Berlin, Germany
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Ko YS, Kang SY, Kim HS, Yoo JJ. Computed Tomography Evaluation of Alumina Ceramic-on-Ceramic Total Hip Arthroplasty With More Than 20 years of Follow-Up: Is a Follow-Up Computed Tomography Scan Necessary? J Arthroplasty 2024:S0883-5403(24)00679-X. [PMID: 38944063 DOI: 10.1016/j.arth.2024.06.058] [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: 01/08/2024] [Revised: 06/20/2024] [Accepted: 06/24/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND Ceramic-on-ceramic (CoC) bearings have been increasingly used in total hip arthroplasty (THA) because of their superior wear resistance and biocompatibility. However, there is a scarcity of reports on the computed tomography (CT) evaluation of CoC bearings with more than 10 years. The aim of this study was to evaluate the long-term CT results of THA using CoC bearings for more than 20 years of follow-up. We hypothesized that there would be no wear, osteolysis, or ceramic fracture. METHODS Between November 1997 and June 2003, 956 hips underwent THA using alumina-on-alumina bearings at a tertiary referral hospital. Among them, 107 hips were assessed, all of which underwent a CT examination more than 20 years after the index surgery. The mean age at the time of surgery was 41 years, and a CT scan was performed at an average of 22.0 years postoperatively (range, 20.0 to 25.1). The CT scans were thoroughly assessed for osteolysis, stem notching, and ceramic component fracture. RESULTS No loosening was observed in the acetabular cup or femoral stem. Stem notching was observed in 3 hips (2.8%). In the CT scan taken after a minimum of 20 years of follow-up, 1 case (0.9%) of osteolysis around the cup and 2 cases (1.9%) of osteolysis around the femoral stem were noted. Suspected chip fractures of the ceramic insert were discovered in 4 cases (3.7%). Despite these findings, the patients remained asymptomatic, and no subsequent surgical intervention was needed after close follow-up. CONCLUSIONS Routine CT examinations for patients who underwent THA using CoC bearings over 20 years ago revealed unexpected findings, such as osteolysis and suspected chip fractures of the ceramic liner. However, routine CT scans may not be universally necessary. The CT evaluation in this cohort should be selectively performed for patients who have relevant clinical symptoms. LEVEL OF EVIDENCE Level III, Therapeutic study.
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Affiliation(s)
- Young-Seung Ko
- Department of Orthopedic Surgery, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul, South Korea; Department of Orthopaedic Surgery, Hallym university Dong-Tan Sacred Heart Hospital, Hwaseong, South Korea
| | - Sang Yoon Kang
- Department of Orthopedic Surgery, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul, South Korea
| | - Hong Seok Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul, South Korea
| | - Jeong Joon Yoo
- Department of Orthopedic Surgery, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul, South Korea
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McHale SK, Whitehouse SL, Howell JR, Hubble MJ, Timperley AJ, Wilson MJ. The Exeter-Trident THA with ceramic-on-ceramic-bearings: 10-year outcomes in 275 total hip arthroplasties. Hip Int 2024; 34:187-193. [PMID: 37694894 DOI: 10.1177/11207000231198220] [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: 09/12/2023]
Abstract
AIMS This study reports on the Exeter-Trident total hip arthroplasty (THA) using an alumina ceramic-on-ceramic bearing with 10-year clinical and radiographic follow-up. PATIENTS AND METHODS Between January 2001 and January 2006, 275 THAs were performed. Mean age at surgery was 52.7 (17-86) years, with 84 patients (33.6%) aged <50 years. The primary outcome was all-cause construct survival at minimum 10 years. Secondary outcomes included functional and noise scores. Radiographs were compared between baseline and latest follow-up and assessed for component loosening, migration and lysis. RESULTS No patient was lost to follow-up. Mean follow-up for surviving patients was 12.5 (9.5-15.6) years. Kaplan-Meier survival for all-cause revision was 94.0% (95% CI, 90.5-97.5) at 14.3 years. 2 patients had a femoral component fracture. All scores improved significantly at latest follow-up. HSS-NQ for 247 hips (90.2%) at mean 9.1 (7.0-14.4) years post implantation showed most hips (93.1%) reported no more than occasional noise. At minimum 5 years, radiolucency around the acetabular component was observed in 2 hips (0.8%), and lysis at the interface in 1 hip (0.4%). On the femoral side, endosteal lysis was observed in 7 hips. CONCLUSIONS The Exeter-Trident THA with alumina ceramic-on-ceramic bearings performed well in this population. Patients are at low risk of revision in the first decade. However, there is a small risk of stem fracture as a late complication and some patients experience significant noise.
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Affiliation(s)
- Stephen K McHale
- Exeter Hip Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon University Hospital NHS Foundation Trust, Exeter, UK
| | - Sarah L Whitehouse
- Exeter Hip Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon University Hospital NHS Foundation Trust, Exeter, UK
- Orthopaedic Research Unit, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jonathan R Howell
- Exeter Hip Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon University Hospital NHS Foundation Trust, Exeter, UK
| | - Matthew Jw Hubble
- Exeter Hip Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon University Hospital NHS Foundation Trust, Exeter, UK
| | - A John Timperley
- Exeter Hip Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon University Hospital NHS Foundation Trust, Exeter, UK
- University of Exeter, UK
| | - Matthew J Wilson
- Exeter Hip Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon University Hospital NHS Foundation Trust, Exeter, UK
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Solís Pinargote NW, Yanushevich O, Krikheli N, Smirnov A, Savilkin S, Grigoriev SN, Peretyagin P. Materials and Methods for All-Ceramic Dental Restorations Using Computer-Aided Design (CAD) and Computer-Aided Manufacturing (CAM) Technologies-A Brief Review. Dent J (Basel) 2024; 12:47. [PMID: 38534271 DOI: 10.3390/dj12030047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/21/2023] [Accepted: 01/03/2024] [Indexed: 03/28/2024] Open
Abstract
The materials used in dentistry for the fabrication of all-ceramic restorations have undergone great and rapid developments over the last two decades. Among the most common ceramic materials in dentistry are those based on zirconium and lithium disilicate. Due to the properties of these materials, they are in great demand in the field of dental restoration production. Thus, dental restorations that will use those materials are commonly machined in CAD/CAM systems, which offer the possibility of manufacturing all-ceramic dental restorations in a very short period of time. This article reviews the modern materials in the field of all-ceramic dental restorations, their manufacturing processes, as well as what determines which ceramic materials are used for the production of CAD/CAM blanks and their production technology.
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Affiliation(s)
- Nestor Washington Solís Pinargote
- Federal State Budgetary Educational Institution of the Higher Education Moscow State University of Technology "STANKIN", 127055 Moscow, Russia
| | - Oleg Yanushevich
- Federal State Budgetary Educational Institution of the Higher Education "A.I. Yevdokimov Moscow State University of Medicine and Dentistry" of the Ministry of Healthcare of the Russian Federation, 127473 Moscow, Russia
| | - Natella Krikheli
- Federal State Budgetary Educational Institution of the Higher Education "A.I. Yevdokimov Moscow State University of Medicine and Dentistry" of the Ministry of Healthcare of the Russian Federation, 127473 Moscow, Russia
| | - Anton Smirnov
- Federal State Budgetary Educational Institution of the Higher Education Moscow State University of Technology "STANKIN", 127055 Moscow, Russia
| | - Sergey Savilkin
- Federal State Budgetary Educational Institution of the Higher Education Moscow State University of Technology "STANKIN", 127055 Moscow, Russia
| | - Sergey N Grigoriev
- Federal State Budgetary Educational Institution of the Higher Education Moscow State University of Technology "STANKIN", 127055 Moscow, Russia
| | - Pavel Peretyagin
- Federal State Budgetary Educational Institution of the Higher Education Moscow State University of Technology "STANKIN", 127055 Moscow, Russia
- Federal State Budgetary Educational Institution of the Higher Education "A.I. Yevdokimov Moscow State University of Medicine and Dentistry" of the Ministry of Healthcare of the Russian Federation, 127473 Moscow, Russia
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Savin L, Pinteala T, Mihai DN, Mihailescu D, Miu SS, Sirbu MT, Veliceasa B, Popescu DC, Sirbu PD, Forna N. Updates on Biomaterials Used in Total Hip Arthroplasty (THA). Polymers (Basel) 2023; 15:3278. [PMID: 37571172 PMCID: PMC10422432 DOI: 10.3390/polym15153278] [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: 07/05/2023] [Revised: 07/30/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
One of the most popular and effective orthopedic surgical interventions for treating a variety of hip diseases is total hip arthroplasty. Despite being a radical procedure that involves replacing bone and cartilaginous surfaces with biomaterials, it produces excellent outcomes that significantly increase the patient's quality of life. Patient factors and surgical technique, as well as biomaterials, play a role in prosthetic survival, with aseptic loosening (one of the most common causes of total hip arthroplasty failure) being linked to the quality of biomaterials utilized. Over the years, various biomaterials have been developed to limit the amount of wear particles generated over time by friction between the prosthetic head (metal alloys or ceramic) and the insert fixed in the acetabular component (polyethylene or ceramic). An ideal biomaterial must be biocompatible, have a low coefficient of friction, be corrosion resistant, and have great mechanical power. Comprehensive knowledge regarding what causes hip arthroplasty failure, as well as improvements in biomaterial quality and surgical technique, will influence the survivability of the prosthetic implant. The purpose of this article was to assess the benefits and drawbacks of various biomaterial and friction couples used in total hip arthroplasties by reviewing the scientific literature published over the last 10 years.
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Affiliation(s)
- Liliana Savin
- Department of Orthopedics and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.S.); (D.M.); (M.T.S.); (B.V.); (D.C.P.); (P.D.S.); (N.F.)
- Department of Orthopedics, Clinical Rehabilitation Hospital, 700661 Iasi, Romania;
| | - Tudor Pinteala
- Department of Orthopedics and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.S.); (D.M.); (M.T.S.); (B.V.); (D.C.P.); (P.D.S.); (N.F.)
- Department of Orthopedics, Clinical Rehabilitation Hospital, 700661 Iasi, Romania;
| | - Dana Nicoleta Mihai
- Department of Orthopedics, Clinical Rehabilitation Hospital, 700661 Iasi, Romania;
- Department of Protheses Technology, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Dan Mihailescu
- Department of Orthopedics and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.S.); (D.M.); (M.T.S.); (B.V.); (D.C.P.); (P.D.S.); (N.F.)
- Department of Orthopedics, Clinical Rehabilitation Hospital, 700661 Iasi, Romania;
| | - Smaranda Stefana Miu
- Department of Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania;
| | - Mihnea Theodor Sirbu
- Department of Orthopedics and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.S.); (D.M.); (M.T.S.); (B.V.); (D.C.P.); (P.D.S.); (N.F.)
| | - Bogdan Veliceasa
- Department of Orthopedics and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.S.); (D.M.); (M.T.S.); (B.V.); (D.C.P.); (P.D.S.); (N.F.)
| | - Dragos Cristian Popescu
- Department of Orthopedics and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.S.); (D.M.); (M.T.S.); (B.V.); (D.C.P.); (P.D.S.); (N.F.)
| | - Paul Dan Sirbu
- Department of Orthopedics and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.S.); (D.M.); (M.T.S.); (B.V.); (D.C.P.); (P.D.S.); (N.F.)
- Department of Orthopedics, Clinical Rehabilitation Hospital, 700661 Iasi, Romania;
| | - Norin Forna
- Department of Orthopedics and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.S.); (D.M.); (M.T.S.); (B.V.); (D.C.P.); (P.D.S.); (N.F.)
- Department of Orthopedics, Clinical Rehabilitation Hospital, 700661 Iasi, Romania;
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Inserra B, Coppola B, Montanaro L, Tulliani JM, Palmero P. Preparation and characterization of Ce-ZrO2/Al2O3 composites by DLP-based stereolithography. Ann Ital Chir 2022. [DOI: 10.1016/j.jeurceramsoc.2022.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Tsukada S, Wakui M, Kizaki K, Iseki T, Miyao M, Tasaki A. Uncemented total hip arthroplasty using alumina ceramic bearings at a minimum of 14 years of follow-up. Arch Orthop Trauma Surg 2022; 142:1689-1695. [PMID: 34269893 DOI: 10.1007/s00402-021-04055-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/02/2021] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The effectiveness of modern ceramic bearings has been well established in reducing the osteolysis associated with wear of the bearing surfaces in total hip arthroplasty (THA). However, there are limited mid- to long-term follow-up data for complications associated with ceramic bearings. MATERIALS AND METHODS This case series analyzed 124 consecutive primary uncemented THAs in 108 patients with a mean age of 61 years using alumina ceramic-on-alumina ceramic bearing couples. Seventy THAs (56%) were evaluated at a minimum 14 years of follow-up; the mean follow-up period was 16 ± 1 years (14-20 years). Kaplan-Meier survivorship was determined with revision surgery for any reason as the end point. Complications were recorded focusing on osteolysis, ceramic fracture, and abnormal sounds until the final follow-up. Clinical data were scored according to the Merle d'Aubigne and Postel hip score at 14 years after THA. RESULTS The survivorship was 93.5% (95% CI 86.7-97.0%) at 14-years postoperatively. Five patients (4.0%) underwent revision surgery due to instability or infection before 1-year postoperatively. Two patients (1.6%) underwent revision surgery due to ceramic liner fracture at 9- and 12-years postoperatively, respectively. There was no radiographic evidence of osteolysis. A total of 27 complications occurred: dislocations (n = 7/124), squeaking sounds (n = 3/124), clicking sounds (n = 6/124), ceramic liner fractures (n = 2/124), periprosthetic fractures (n = 4/124), deep infections (n = 2/124), transient sciatic nerve palsy (n = 2/124), and femoral stem breakage (n = 1/124). The Merle d'Aubigne and Postel hip score was 16.8 ± 1.4 points. CONCLUSIONS The survivorship analysis demonstrates the uncemented THA using alumina ceramic bearings may provide favorable clinical outcome and can offer minimal wear at a minimum 14-year follow-up. Revision surgery was mostly required due to instability and infection in the short-term, and implant breakage in the mid- to long-term.
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Affiliation(s)
- Sachiyuki Tsukada
- Department of Orthopaedic Surgery, Nekoyama Miyao Hospital, 14-7 Konan, Chuo City, Niigata, 950-1151, Japan. .,Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, 3-2-1 Higashihara, Mito, Ibaraki, 310-0035, Japan.
| | - Motohiro Wakui
- Department of Orthopaedic Surgery, Nekoyama Miyao Hospital, 14-7 Konan, Chuo City, Niigata, 950-1151, Japan
| | - Kazuha Kizaki
- Department of Orthopaedic Surgery, Nekoyama Miyao Hospital, 14-7 Konan, Chuo City, Niigata, 950-1151, Japan
| | - Takuya Iseki
- Department of Orthopaedic Surgery, Nekoyama Miyao Hospital, 14-7 Konan, Chuo City, Niigata, 950-1151, Japan
| | - Masunao Miyao
- Department of Orthopaedic Surgery, Nekoyama Miyao Hospital, 14-7 Konan, Chuo City, Niigata, 950-1151, Japan
| | - Atsushi Tasaki
- Department of Orthopaedic Surgery, St. Luke's International Hospital, 9-1 Akashi Cho, Chuo City, Tokyo, 104-8560, Japan
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Outcomes of Ceramic Composite in Total Hip Replacement Bearings: A Single-Center Series. JOURNAL OF COMPOSITES SCIENCE 2021. [DOI: 10.3390/jcs5120320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Despite the fact that total hip replacement is one of the most successful surgical procedures for treatment of a variety of end-stage hip diseases, the process of osteolysis and implant loosening remains a significant problem, especially in young and high-demand patients. More than 40 years ago, ceramic bearings were introduced due to their mechanical advantage in order to obtain a reduction in wear debris, and due to the conviction that it was possible to minimize friction and wear owing to their mechanical hardness, high chemical stability, surface lubrication by fluids and low friction coefficient. Together with excellent mechanical properties, ceramics have a biological inertness: eventual ceramic debris will lead to a reactive response with a high predominance of fibrocystic cells, rather than macrophagic cells, and absence of giant cells, which is ideal from a biological perspective. As a consequence, they will not trigger the granulomatous reaction necessary to induce periprosthetic osteolysis, and this clearly appears to be of great clinical relevance. In recent years, tribology in manufacturing ceramic components has progressed with significant improvements, owing to the development of the latest generation of ceramic composites that allow for an increased material density and reduced grain size. Currently, ceramic-on-ceramic bearings are considered the attractive counterparts of ceramic- or metal-on-polyethylene ones for patients with a long life expectancy. The aim of this paper is to report the results of total hip replacements performed with a ceramic-on-ceramic articulation made from a ceramic composite in a single center, focusing on its usefulness in specific preoperative diagnosis.
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Salmons HI, Ryan SP, Trousdale RT. Intraoperative Fracture of a Dual Modular Delta Ceramic Femoral Head During Total Hip Arthroplasty: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00082. [PMID: 34398843 DOI: 10.2106/jbjs.cc.21.00215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 39-year-old man with cerebral palsy and hip dysplasia status post right Chiari osteotomy presented with right hip osteoarthritis in consultation for total hip arthroplasty (THA). During THA, a Delta ceramic head was misaligned on the taper, but this was obscured by an overlying dual modular polyethylene shell. When we attempted to tap the head onto the taper, fracture occurred requiring revision to a cobalt-chromium head due to slight taper damage. CONCLUSION To our knowledge, this is the first reported case of intraoperative fracture of a BIOLOX Delta dual modular head.
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Affiliation(s)
- Harold I Salmons
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Metasul vs Cerasul bearings: a prospective, randomized study at a mean eighteen years. INTERNATIONAL ORTHOPAEDICS 2020; 44:2545-2551. [PMID: 33083903 DOI: 10.1007/s00264-020-04855-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The aims of our study were to compare the clinical, radiographic outcomes and survivals between second-generation metal-on-metal (Metasul) and ceramic-on-ceramic (Cerasul) bearings at a very long-term follow-up. METHODS A prospective, randomized study was originally performed on a consecutive series of 250 cementless, 28-mm head and primary total hip arthroplasties between 1999 and 2002. For each bearing (Metasul or Cerasul), 125 THAs were initially included. All cases were evaluated both clinically and radiographically, and survival was assessed, considering revisions for aseptic loosening or for any reason as the end points for failure. RESULTS At a mean 18-year follow-up, clinical and radiographic outcomes were similar. Harris Hip Score increased 30% in the Metasul group and 32% in the Cerasul group (p = 0.6). Survival free of aseptic loosening was higher for Cerasul (100%), than for Metasul (94% [CI 88-99.9]) (p = 0.04). Survival free of any revision was 91% ([CI 84-98%]) for Cerasul and 91% ([CI 84-98%]) for Metasul. Fractures of Cerasul insert occurred in four cases (3%) at a mean 12.5 ± 3.3 years (range, 6 to 17 years). CONCLUSION At 18 years, Cerasul demonstrated higher survivorship than Metasul considering aseptic loosening as an end point. However, Cerasul liners had high rate of fracture because of its sandwich design (thin ceramic liner into polyethylene). These implants are no more available on the market.
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Abstract
Choice of articulating materials, head size and the design of the articulation will become decisive for the long-term performance of a total hip arthroplasty (THA) and especially in terms of risk for dislocation and wear-related problems. Here we account for common alternatives based on available studies and the evidence that can be derived from them.Metal or ceramic femoral heads articulating against a liner or cup made of highly cross-linked polyethylene and ceramic-on-ceramic articulations have about similar risk for complications leading to revision, whereas the performance of metal-on-metal articulations, especially with use of big heads, is inferior. The clinical significance of problems related to ceramic-on-ceramic articulations such as squeaking remains unclear. With use of current technology ceramic fractures are rare.Large femoral heads have the potential to increase the range of hip movement before impingement occurs and are therefore expected to reduce dislocation rates. On the other hand, issues related to bearing wear, corrosion at the taper-trunnion junction and groin pain may arise with larger heads and jeopardize the longevity of THA. Based on current knowledge, 32-mm heads seem to be optimal for metal-on-polyethylene bearings. Patients with ceramic-on-ceramic bearings may benefit from even larger heads such as 36 or 40 mm, but so far there are no long-term reports that confirm the safety of bearings larger than 36 mm.Assessment of lipped liners is difficult because randomized studies are lacking, but retrospective clinical studies and registry data seem to indicate that this liner modification will reduce the rate of dislocation or revision due to dislocation without clear evidence of clinically obvious problems due to neck-liner impingement.The majority of studies support the view that constrained liners and dual mobility cups (DMC) will reduce the risk of revision due to dislocation both in primary and revision THA, the latter gaining increasing popularity in some countries. Both these devices suffer from implant-specific problems, which seem to be more common for the constrained liner designs. The majority of studies of these implants suffer from various methodological problems, not least selection bias, which calls for randomized studies preferably in a multi-centre setting to obtain sufficient power. In the 2020s, the orthopaedic profession should place more effort on such studies, as has already been achieved within other medical specialties, to improve the level of evidence in the choice of articulation when performing one of the most common in-hospital surgical procedures in Europe. Cite this article: EFORT Open Rev 2020;5:763-775. DOI: 10.1302/2058-5241.5.200002.
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Affiliation(s)
- Georgios Tsikandylakis
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Orthopaedics, Gothenburg, Sweden
| | - Soren Overgaard
- The Danish Hip Arthroplasty Register, Aarhus, Denmark
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Luigi Zagra
- Hip Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Johan Kärrholm
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Orthopaedics, Gothenburg, Sweden
- The Swedish Hip Arthroplasty Register, Gothenburg, Sweden
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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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Letter to the Editor on "Eighteen-Year Follow-Up Study of 2 Alternative Bearing Surfaces Used in Total Hip Arthroplasty in the Same Young Patients". J Arthroplasty 2020; 35:1956-1957. [PMID: 32279945 DOI: 10.1016/j.arth.2020.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/11/2020] [Indexed: 02/01/2023] Open
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Hallan G, Fenstad AM, Furnes O. What Is the Frequency of Fracture of Ceramic Components in THA? Results from the Norwegian Arthroplasty Register from 1997 to 2017. Clin Orthop Relat Res 2020; 478:1254-1261. [PMID: 32348085 PMCID: PMC7319382 DOI: 10.1097/corr.0000000000001272] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 03/31/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Ceramic bearings in THA have been used to reduce wear and, more recently, to avoid metals in the bearing because of the risk of metal ions adverse effects. Potential disadvantages to ceramic bearings are their brittleness and the ceramic fracture risk, which may lead to revision surgery. The frequency of revision for a fracture ceramic bearing, however, has not been thoroughly studied. QUESTIONS/PURPOSES (1) What is the frequency of revision for a fractured ceramic bearing in ceramic-on-polyethylene (CoP) and ceramic-on-ceramic (CoC) THAs, and is there any difference between alumina ceramics and alumina matrix composites (AMC)? (2) What are the factors associated with this complication? (3) To what extent did the patients who underwent revision for a fractured ceramic bearing undergo subsequent revisions, and for what reason? METHODS The Norwegian Arthroplasty Register has collected data on hip arthroplasty since 1987 and has a completeness of reporting of 97.3% for primary THAs and 93.3% for revision. From 1997 to 2017, 146,171 primary THAs were registered in the Norwegian Arthroplasty Register. Of these, 31,479 had a CoP articulation and 5790 had a CoC articulation. Two manufacturers produced ceramic heads; one produced 25,678 alumina heads and the other made 2465 alumina heads. All 7901 AMC heads were made by the same manufacturer. Patients who underwent CoP THA were a median (range) of 63 years old (11 to 98) and CoC THA were a median (range) 61 years old (17 to 95); 38% (11,833 of 31,479) of the patients who underwent CoP THA and 41% (2379 of 5790) of the patients who underwent CoC THA were males. Femoral heads made of alumina (n = 28,143), zirconia (n = 1225), and AMC (n = 7901) ceramics were used. To assess revision frequency, we identified patients who underwent revision because of fracture of a ceramic head and/or liner, and calculated the Kaplan-Meier survivorship free of revision for fracture in CoC and CoP articulations. Alumina ceramics and AMC were compared. In terms of factors potentially associated with revision, patient factors (age, sex, and diagnosis), type of articulation (CoP or CoC), femoral head size, and femoral head/neck length were evaluated with Cox regression models to evaluate any association with ceramic fracture and a Poisson regression to compare alumina and AMC head fractures. To evaluate subsequent revisions, hips that were revised for ceramic fracture were evaluated for any further revisions; Kaplan-Meier survivorship free of further revisions was calculated, and revision causes were identified. RESULTS Survivorship free from revision for ceramic fracture was 99.9% (95% CI 99.9 to 99.9) for CoP bearings, and 99.8% (95% CI 99.6 to 100) for CoC bearings at 10 years, with 7467 and 1884 hips at risk in the two groups, respectively. The hazard ratio for ceramic head fracture was 3.6 (95% CI 1.7 to 7.6) for CoC compared with CoP. The risk of fracture was greater for alumina ceramics than for AMC heads (adjusted HR 14.1 [95% CI 4.2 to 47.0]; p < 0.001). Factors that were associated with revision for fracture of a ceramic head were male sex (HR 5.2 [95% CI 2.6 to 10.4]; p < 0.001), a CoC articulation compared with CoP (HR 3.6 [95% CI 1.7 to 7.6]; p = 0.001), a 28-mm femoral head compared with a 32-mm head (HR 2.7 [95% CI 1.1 to 6.4]; p = 0.02), and short head/neck length compared with a medium head/neck length (HR 2.5 [95% CI 1.1 to 5.3]; p = 0.03). Five of 50 patients undergoing revision for ceramic fracture underwent further revisions, resulting in a 5-year survivorship free from re-revision of 86% (95% CI 74.4 to 98.0). The reasons for re-revision were infection (n = 2), another ceramic head fracture (n = 2), and cup loosening (n = 1). CONCLUSIONS Fracture of a ceramic THA bearing is rare and seems to affect about one in 1000 patients who receive such a bearing. To minimize the risk of this complication, surgeons should avoid small femoral heads (< 32 mm) and the shortest head/neck lengths. Surgeons should also know that the risk is increased in CoC articulations and in males. Bearings made of AMC appear to be at lower risk than those made from alumina ceramics. However, the long-term clinical wear performance of AMC bearings has not been extensively studied and should be studied further. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Geir Hallan
- G. Hallan, A. M. Fenstad, O. Furnes, The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
- G. Hallan, O. Furnes, Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Anne Marie Fenstad
- G. Hallan, A. M. Fenstad, O. Furnes, The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Ove Furnes
- G. Hallan, A. M. Fenstad, O. Furnes, The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
- G. Hallan, O. Furnes, Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
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Solarino G, Zagra L, Piazzolla A, Morizio A, Vicenti G, Moretti B. Results of 200 Consecutive Ceramic-on-Ceramic Cementless Hip Arthroplasties in Patients Up To 50 Years of Age: A 5-24 Years of Follow-Up Study. J Arthroplasty 2019; 34:S232-S237. [PMID: 30777621 DOI: 10.1016/j.arth.2019.01.057] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/02/2019] [Accepted: 01/24/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Ceramic-on-ceramic (CoC) bearings due to their mechanical properties can be used in primary total hip arthroplasty (THA) especially in young patients requiring a long-lasting implant. The goal of this study is to analyze the results of a series of 200 consecutive CoC THAs in patients aged 50 years or less at the time of surgery. METHODS A retrospective study was conducted on the first 200 consecutive CoC arthroplasties performed using the direct lateral approach on 105 females and 81 males (14 bilateral cases) with an average age of 44.2 (16-50) years. The diagnosis was primary or post-traumatic osteoarthritis in 94 cases, avascular necrosis of the femoral head in 47, displaced intracapsular femoral neck fracture in 29, osteoarthritis secondary to developmental dysplasia of the hip/Legg-Calvè-Perthes disease/slipped capital femoral epiphysis in 20, and rheumatic diseases in 10 cases. The preoperative Harris Hip Score was 32.5 on average (range 15-55). All the implants were cementless. In 177 THAs the coupling was alumina-on-alumina, and in 23 cases the coupling was AMC-on-AMC (alumina matrix composite). RESULTS Twenty-five patients with 28 THAs were lost at the final follow-up, 2 stems were revised due to subsidence, 1 cup was revised due to malposition, 1 femoral head was changed because of impingement, and 1 THA was revised for periprosthetic infection. Three patients sustained a Vancouver B1 periprosthetic femoral fracture. At the final follow-up (mean 14.9 years; minimum 5 years to maximum 24 years), 172 THAs were eligible for clinical and radiographic evaluation: none was revised for wear and/or breakage of the ceramic components. Harris Hip Score rose up to a mean value of 90.1 (52-100). CONCLUSION The present report demonstrates that CoC coupling offers excellent long-term results in THA performed in young patients with very low wear and no adverse effects caused by the material.
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Affiliation(s)
- Giuseppe Solarino
- Department of Basic Medical Sciences, Neuroscience and Organs of Sense, School of Medicine, AOU Policlinico Consorziale, Università di Bari "Aldo Moro", Bari, Italy
| | - Luigi Zagra
- Hip Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Andrea Piazzolla
- Department of Basic Medical Sciences, Neuroscience and Organs of Sense, School of Medicine, AOU Policlinico Consorziale, Università di Bari "Aldo Moro", Bari, Italy
| | - Arcangelo Morizio
- Department of Basic Medical Sciences, Neuroscience and Organs of Sense, School of Medicine, AOU Policlinico Consorziale, Università di Bari "Aldo Moro", Bari, Italy
| | - Giovanni Vicenti
- Department of Basic Medical Sciences, Neuroscience and Organs of Sense, School of Medicine, AOU Policlinico Consorziale, Università di Bari "Aldo Moro", Bari, Italy
| | - Biagio Moretti
- Department of Basic Medical Sciences, Neuroscience and Organs of Sense, School of Medicine, AOU Policlinico Consorziale, Università di Bari "Aldo Moro", Bari, Italy
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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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Zhang X, Shi G, Sun X, Zheng W, Lin X, Chen G. Factors Influencing the Outcomes of Artificial Hip Replacements. Cells Tissues Organs 2019; 206:254-262. [DOI: 10.1159/000500518] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 04/16/2019] [Indexed: 11/19/2022] Open
Abstract
Hip replacement is one of the most successful surgeries in the clinic for the removal of painful joints. Hip osteoarthritis and femoral head necrosis are the 2 main reasons for hip replacement. Several factors are associated with the outcomes of surgery. Nonsurgical factors include gender, age, body mass index, prosthetic material, and risk factors. Surgical factors are anesthesia, postoperative complications, and rehabilitation. Considering the increasing demand for hip arthroplasty and the rise in the number of revision operations, it is imperative to understand factor-related progress and how modifications of these factors promotes recovery following hip replacement. In this review, we first summarize recent findings regarding crucial factors that influence the outcomes of artificial hip replacement surgery. These findings not only show the time-specific effect for the treatment and recovery from hip arthroplasty in the clinic, but also provide suitable choices for different individuals for clinicians to consider. This, in turn, will help to develop the best possible postoperative program for specific patients.
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