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Portet A, Besnard M, Ratsimbazafy C, Berhouet J, Samargandi R, Le Nail LR. The RM Press fit cup™: an investigation in 182 hips at ten-year follow-up. Orthop Traumatol Surg Res 2024:103988. [PMID: 39245266 DOI: 10.1016/j.otsr.2024.103988] [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: 02/05/2024] [Revised: 08/04/2024] [Accepted: 09/05/2024] [Indexed: 09/10/2024]
Abstract
INTRODUCTION For over 10 years, the RM Pressfit cup™ has been used in our department. This is a one-piece, elastic, cementless implant designed with standard polyethylene (PE), covered with a thin coating of titanium particles. To date, there is no French study evaluating this cup after more than 10 years. Therefore, we conducted a retrospective study in order to: (1) evaluate the survival of the implant with a minimum follow-up of 10 years, (2) evaluate the functional scores at the last follow-up, (3) measure the wear of the PE, (4) identify radiological loosening, (5) search for risk factors for cup removal, (6) identify complications that required management in the operating theatre. HYPOTHESIS The working hypothesis was that the survival of this implant was greater than 95% at 10 years' follow-up, in accordance with the criteria of the National Institute for Health and Care Excellence (NICE). MATERIALS AND METHODS This was a retrospective monocentric study, including adult patients who underwent total hip arthroplasty (THA) with an RM Pressfit cup™ (28 mm friction size) for coxarthrosis (primary or secondary) or femoral head osteonecrosis. Exclusion criteria were a follow-up period of less than 10 years, the placement of an RM Pressfit cup™ as a secondary intention for a THA (n = 5) or following a trochanteric fracture (n = 1). In total, 163 patients (182 hips) with a median age (Q1-Q3) of 63 (56-68) years, and a sex ratio (M/F) of 1.7 were included. Functional scores were evaluated using the Harris and Oxford scores. Radiographs were analyzed in the immediate postoperative period and at the last follow-up. RESULTS The median follow-up was 10.5 (10-11.5) years. Of the 182 included hips, 7 cups were removed, corresponding to a 10-year survival rate of 96.1% (95% CI [93.3; 96.9]). The median Harris and Oxford scores at 10.5 years were 95 (90-98) and 19 (17-23) points, respectively. The median PE wear rate was 0.058 (0.039-0.087) mm/year. Univariate analysis showed that male gender was associated with PE wear (OR = 3.6; 95% CI [1.3; 12.9] [p = 0.012]). Ten cups (6%) showed radiological instability with migration greater than 3 mm and/or variation in inclination greater than 8 °, and only 9 hips (6%) showed bone resorption. No preoperative or perioperative factors analyzed were associated with cup removal. Dislocation accounted for 71% (n = 5) of the causes of cup removal. Additionally, 6 hips experienced at least one dislocation episode requiring reduction by external maneuvers in the operating room, bringing the overall dislocation rate in the series to 6% (n = 11). Increased cup inclination was the only risk factor for prosthetic dislocation (OR = 1.2; 95% CI [1.09; 1.4] [p = 0.0003]). Overall complications requiring surgical intervention included 15 (8.3%) implanted cups (7 removed cups, 6 dislocation episodes requiring reduction by external maneuvers in the operating room, and 2 hips reoperated for washing and changing of mobile components due to early infection). CONCLUSION The RM Pressfit cup™ gives good long-term clinical and radiological results with an overall survival of 96.1% and a low complication rate over 10 years. Over the last 2 years the RM Vitamys™ cup has been introduced allowing the use of 32 mm femoral head diameter for size 48 cups, to reduce the risk of dislocation. LEVEL OF EVIDENCE IV; retrospective cohort.
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Affiliation(s)
- Adrien Portet
- Service de Chirurgie Orthopédique, Hôpital Trousseau, CHRU de Tours, Avenue de la République, Chambray-lès-Tours, Tours Cedex 9, 37044, France.
| | - Marion Besnard
- Centre Hospitalier Intercommunal Amboise-Château-Renault, Hôpital Robert-Debré, rue des Ursulines, BP 329, 37403 Amboise Cedex, France
| | - Carole Ratsimbazafy
- Hôpital Saint-Antoine, Pharmacie, GHU AP-HP Sorbonne Université 184 rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Julien Berhouet
- Service de Chirurgie Orthopédique, Hôpital Trousseau, CHRU de Tours, Avenue de la République, Chambray-lès-Tours, Tours Cedex 9, 37044, France
| | - Ramy Samargandi
- Service de Chirurgie Orthopédique, Hôpital Trousseau, CHRU de Tours, Avenue de la République, Chambray-lès-Tours, Tours Cedex 9, 37044, France; Department of Orthopedic Surgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Louis-Romée Le Nail
- Service de Chirurgie Orthopédique, Hôpital Trousseau, CHRU de Tours, Avenue de la République, Chambray-lès-Tours, Tours Cedex 9, 37044, France
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Li Z, Niu EL, Fu J, Zhou YG, Chai W, Hao LB, Chen JY, Xu C. A Nomogram That Characterizes a Patient's Odds of Developing Squeaking After Fourth-generation Ceramic-on-ceramic THA. Clin Orthop Relat Res 2023; 481:1322-1336. [PMID: 36749832 PMCID: PMC10263255 DOI: 10.1097/corr.0000000000002573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/05/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND Although ceramic-on-ceramic (CoC) bearings result in the lowest wear rate of any bearing combination, postoperative squeaking remains worrisome. However, data concerning squeaking in long-term follow-up studies are still lacking, especially for fourth-generation CoC THA. QUESTIONS/PURPOSES (1) After keeping the prosthesis in place for 10 years, what percentage of patients treated with fourth-generation CoC THA implants report squeaking, and are there points in time when squeaking occurs more frequently? (2) What are the characteristics, association with hip function, and factors associated with squeaking? (3) Can we create a nomogram that characterizes a patient's odds of experiencing squeaking based on the factors associated with it? METHODS Between January 2009 and December 2011, 1050 patients received primary THAs at our institution, 97% (1017) of whom received fourth-generation CoC THAs because this was the preferred bearing during this period. Of the 1017 eligible patients, 5% (54) underwent THAs performed by low-volume surgeons, 3% (30) were implanted with cemented prostheses, 2% (22) died, 1% (10) were immobile, 1% (six) underwent revision surgery, and 17% (169) were lost to follow-up before 10 years, leaving 726 patients for analysis here at a mean of 11 ± 1 years. In the study cohort, 64% (464) were male and 36% (262) were female, with a mean age of 44 ± 13 years at primary THA. We extracted data about articular noise from follow-up records in our institutional database and used a newly developed questionnaire to ascertain the percentage of patients who reported squeaking at the latest follow-up interval. Although not validated, the questionnaire was modeled on previous studies on this topic. The longitudinal pattern for squeaking was explored to find timepoints when squeaking occurs more frequently. Based on the questionnaire data, we calculated the percentages of frequent, reproducible, and avoidable squeaking. Hip function was evaluated with the Harris Hip Score and WOMAC score and compared between the squeaking and nonsqueaking groups. Factors associated with squeaking, which were examined in a multivariate analysis, were used to develop a nomogram. RESULTS At 10 years, 16% (116 of 726) of patients reported squeaking. Two squeaking peaks were determined, at 0 to 1 year and 8 to 10 years. Frequent, reproducible, and avoidable squeaking accounted for 42% (36 of 86), 20% (17 of 86), and 41% (35 of 86), respectively. The mean Harris Hip Score (93 ± 4 versus 94 ± 5; p = 0.81) and WOMAC score (16 ± 13 versus 15 ± 13; p = 0.23) did not differ between patients with squeaking and those without. After controlling for potential confounding variables such as etiology and head offset, we found that patients younger than 46 years (odds ratio 2.5 [95% confidence interval 1.5 to 5.0]; p < 0. 001), those who were male (OR 2.0 [95% CI 1.1 to 3.5]; p = 0.04), those having a total flexion and extension arc of less than 50° (OR 2.0 [95% CI 1.2 to 3.3]; p = 0.02), and those with the Corail hip implant (OR 4.1 [95% CI 2.1 to 7.7]; p < 0. 001) were more likely to report squeaking. We created a nomogram that can be used at the point of care that can help clinicians identify patients at a higher risk of experiencing squeaking; this nomogram had good performance (area under the receiver operating characteristic curve of 77%). CONCLUSION As a potential late complication, squeaking after fourth-generation CoC THA is of concern and may be related to increased stripe wear. We recommend that surgeons use this nomogram to assess the odds of squeaking before selecting a bearing, especially in patients at high risk, to facilitate shared decision-making and improve patient satisfaction. Future external validation of the model is still needed to enhance its applicability.Level of Evidence Level III, therapeutic study.
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Affiliation(s)
- Zhuo Li
- School of Medicine, Nankai University, Tianjin, PR China
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, PR China
| | - Er-Long Niu
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, PR China
- 305 Hospital of PLA, Beijing, PR China
| | - Jun Fu
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, PR China
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, PR China
| | - Yong-Gang Zhou
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, PR China
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, PR China
| | - Wei Chai
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, PR China
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, PR China
| | - Li-Bo Hao
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, PR China
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, PR China
| | - Ji-Ying Chen
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, PR China
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, PR China
| | - Chi Xu
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, PR China
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, PR China
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Xu J, Oni T, Shen D, Chai Y, Walter WK, Walter WL. Long-Term Results of Alumina Ceramic-On-Ceramic Bearings in Cementless Total Hip Arthroplasty: A 20-Year Minimum Follow-Up. J Arthroplasty 2022; 37:549-553. [PMID: 34843912 DOI: 10.1016/j.arth.2021.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/10/2021] [Accepted: 11/22/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Alumina ceramic-on-ceramic bearings are used in total hip arthroplasty (THA) because of their wear-resistant and inert properties. In this study, we assessed the clinical and radiographic outcomes of patients undergoing primary cementless ceramic-on-ceramic THA at a minimum follow-up of 20 years. METHODS A series of 301 consecutive primary THAs in 283 patients were assessed. Clinically, patients were assessed with the modified Harris Hip Score (HHS) and pain questionnaires. Anteroposterior radiographs of the pelvis and lateral radiographs of the hip were used to radiologically assess the implant. Patients were classified as lost to follow-up if they could not be contacted on multiple occasions or did not wish to participate further in this study. RESULTS At twenty years after operation, 60 patients had died of a cause unrelated to surgery, 16 had experienced complications requiring reoperation, and 100 hips had both clinical assessments and radiographs at a minimum of 20 years of follow-up. The average HHS improved from 56.1 (range: 17-89) before THA to 92.5 (range: 63-100) at the latest follow-up. The classification of the HHS was good or excellent in 96.4% of patients. Only 1.8% of patients still had moderate residual pain at the thigh or groin. Radiographically, all patients demonstrated bony ingrowth but no clinical symptoms of loosening. The overall survival rate of the implants was 94.2% at 20 years with revision for any reason as the end point. CONCLUSION Long-Term follow-up in our series showed excellent implant survival, excellent functional outcomes, and minimal late complications. There was no significant radiographic evidence of failure at a minimum of 20 years after THA. LEVEL OF EVIDENCE Therapeutic Level IV.
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Affiliation(s)
- Joshua Xu
- Department of Orthopaedics and Traumatic Surgery, Royal North Shore Hospital, Sydney, Australia; Institute of Bone and Joint Research, Kolling Institute, The University of Sydney, Sydney, Australia
| | - Tofunmi Oni
- Department of Orthopaedics and Traumatic Surgery, Royal North Shore Hospital, Sydney, Australia
| | - David Shen
- Department of Orthopaedics and Traumatic Surgery, Royal North Shore Hospital, Sydney, Australia
| | - Yuan Chai
- Institute of Bone and Joint Research, Kolling Institute, The University of Sydney, Sydney, Australia
| | - William K Walter
- Department of Orthopaedic Surgery, Mater Hospital, Sydney, Australia
| | - William L Walter
- Department of Orthopaedics and Traumatic Surgery, Royal North Shore Hospital, Sydney, Australia; Institute of Bone and Joint Research, Kolling Institute, The University of Sydney, Sydney, Australia
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Chung KY, Cheung KW, Fan CH, Poon WC, Chiu KH, Ho KKW. Long-Term Outcome on the Mal-Seating of Ceramic-on-Ceramic Articulation in Total Hip Arthroplasty. J Arthroplasty 2021; 36:2100-2104. [PMID: 33573813 DOI: 10.1016/j.arth.2021.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/04/2021] [Accepted: 01/11/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total hip arthroplasty with ceramic-on-ceramic articulation aims to decrease wear, osteolysis, and aseptic loosening. A metal-backed ceramic liner was developed to reduce the risk of liner fracture. However, a significant number of cases of mal-seating of the metal-backed ceramic liner were observed in the 2000s, and there were concerns about their outcome. This review aims to investigate the long-term performance of the mal-seated ceramic liner. METHODS From July 2003 to March 2007, 35 ceramic-on-ceramic total hip arthroplasties were performed with the Trident acetabular system. Clinical assessment, radiological analysis, and outcome assessment were performed. The prevalence of liner mal-seating and its long-term outcomes were investigated. RESULTS There was liner mal-seating in 8 hips (22.9%). One liner was exchanged in the early postoperative period. No revision surgery was required for the remaining 7 hips at a mean follow-up of 14 years. All patients were free of hip pain with a mean Harris Hip Score of 94.7 at the most recent follow-up. No adverse event was observed. CONCLUSION The long-term outcomes of the mal-seated liner were favorable. However, surgeons should exercise meticulous surgical technique to achieve a properly aligned liner within the acetabular shell to minimize this potentially correctable error.
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Affiliation(s)
| | | | - Chi-Ho Fan
- Department of Orthopaedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong
| | - Wai-Chin Poon
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kwok-Hing Chiu
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, Hong Kong
| | - Kevin Ki-Wai Ho
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, Hong Kong
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Atrey A, Khoshbin A, Rolfson O, Campbell D, Wood G, Bohm E, Jones C, Kandel C, Davis J, Atri N, Abdelbary H, Moojen DJ, Dunbar M, Manning L, Paxton EW, Yates P, Waddell JP, Ravi B, Reed M. Infection: The Final Frontier of Arthroplasty Management: A Proposal for a Global Periprosthetic Joint Infection Registry from a Multinational Collaborative Group, the GAIA (Global Arthroplasty Infection Association). J Bone Joint Surg Am 2021; 103:e22. [PMID: 33433125 DOI: 10.2106/jbjs.20.01517] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Amit Atrey
- University of Toronto, Toronto, Ontario, Canada
| | | | - Ola Rolfson
- University of Gothenburg, Gothenburg, Sweden
| | - David Campbell
- Wakefield Hospital, Adelaide, South Australia, Australia
| | - Gavin Wood
- University of Queens, Kingston, Ontario, Canada
| | - Eric Bohm
- University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | - Joshua Davis
- Menzies University, Darwin, Northern Territory, Australia
| | - Nipun Atri
- Rush University Medical Centre, Chicago, Illinois
| | | | - Dirk Jan Moojen
- Department of Orthopaedic Surgery, Joint Research OLVG, Amsterdam, the Netherlands
| | | | - Laurens Manning
- University of Western Australia, Perth, Western Australia, Australia
| | | | - Piers Yates
- University of Western Australia, Perth, Western Australia, Australia
| | | | | | - Mike Reed
- Bone and Joint Infection Registry (BAJIR), Northumbria, United Kingdom
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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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Yoon BH, Park JW, Cha YH, Won SH, Lee YK, Ha YC, Koo KH. Incidence of Ceramic Fracture in Contemporary Ceramic-on-Ceramic Total Hip Arthroplasty: A Meta-analysis of Proportions. J Arthroplasty 2020; 35:1437-1443.e3. [PMID: 31902618 DOI: 10.1016/j.arth.2019.12.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 12/02/2019] [Accepted: 12/09/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We performed a proportion meta-analysis of currently available data to determine the prevalence of ceramic fracture for each generation. METHODS A total of 10,571 total hip arthroplasties from 45 studies were included. Proportion meta-analysis with a random-effects model was performed to estimate the prevalence of ceramic fracture. To determine whether the ceramic fractures have a fatigue nature and a risk or latent period for the development, postoperative time lapse, patient age, and body mass index were related with ceramic fracture by metaregression analysis. RESULTS As of postoperative 2.0 to 18.8 years, the rate of ceramic fracture was 0.5% (95% CI, 0.3%-0.8%) in the forte group and 0.2% (95% CI, 0.1%-0.4%) in the delta group (P = .059). The ceramic fracture rate for each component was 0.2% (95% CI, 0.1%-0.3%) for the forte head, 0.1% (95% CI, 0.0%-0.2%) for the delta head (P = .210), 0.2% (95% CI, 0.1%-0.3%) for the forte liner, and 0.2% (95% CI, 0.1%-0.4%) for the delta liner (P = .305). The rate of ceramic fracture per 1000 patient-years was 0.9 (95% CI, 0.5-0.13) in the forte group and 0.5 (95% CI, 0.2-0.8) in the delta group (P = .072). In metaregression analysis, no significant associations were found between prevalence of ceramic fracture and postoperative time lapse, patient age, or body mass index. CONCLUSIONS The rate of ceramic fracture was 0.9/1000 patient-year in the forte group and 0.5/1000 patient-year in the delta group. The results of this study provide baseline data for further studies validating ceramic bearings. LEVEL OF EVIDENCE Level I, meta-analysis.
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Affiliation(s)
- Byung-Ho Yoon
- Department of Orthopaedic Surgery, Inje University College of Medicine, Seoul Paik Hospital, Seoul, South Korea
| | - Jung-Wee Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yong-Han Cha
- Department of Orthopaedic Surgery, Eulji University College of Medicine, Seoul, South Korea
| | - Suk-Hyung Won
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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Sobti AS, Busch CA, Afolayan JO, Michael D, Chana R. Early to mid-term outcome of Oxinium on Verilast highly cross-linked polyethylene bearing surface in uncemented total hip arthroplasty. Hip Int 2019; 29:660-664. [PMID: 30630363 DOI: 10.1177/1120700018813316] [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: 02/04/2023]
Abstract
INTRODUCTION We report 5- to 10-year clinical and radiological outcomes of a series of uncemented Oxinium on Verilast (highly cross-linked polyethylene liners) total hip replacements (THAs) using the Anthology stem and R3/Reflection cup system. METHODS 116 THAs were performed by 2 senior authors in 104 patients from 2005 to 2009. The mean age at time of operation was 63.8 (45-80) years. The average length of follow-up was 8.8 years. At final data collection 12 patients had died (13 THAs) and 3 patients (3 THAs) were lost to follow-up. RESULTS In the remaining 100 THAs, the preoperative Harris Hip Score of 39 improved to 91 and Oxford Hip Score improved from 16 to 44 (mean at 5 to 10 years). 100 THAs were available for radiographic analysis: all had stable bony ingrowth of both the stem and cup. Dorr's methods for wear in the 100 THAs showed an average wear <0.01 mm/year and no osteolysis; only 1 case showed 0.22 mm/year with some proximal femoral osteolysis but no cup lesions. There were no dislocations or revisions, survivorship in this series for both components for any cause as an endpoint was 100%. 1 intraoperative calcar fracture was sustained and treated with a cerclage wires, 2 peri-prosthetic fractures occurred and were treated with open reduction and fixation, both healed well with excellent outcomes. DISCUSSION The study has shown good clinical and radiological outcomes at 5-10 years and supports existing data on the potential benefits of this bearing performance in literature.
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Affiliation(s)
- Anshul S Sobti
- Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK
| | - Constant A Busch
- Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK
| | - John O Afolayan
- Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK
| | - Dean Michael
- Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK
| | - Rishi Chana
- Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK
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Konan S, Alazzawi S, Yoon BH, Cha YH, Koo KH. A focused update on preventing ceramic fractures in hip arthroplasty. Bone Joint J 2019; 101-B:897-901. [DOI: 10.1302/0301-620x.101b8.bjj-2019-0309.r1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Ceramic bearings have several desirable properties, such as resistance to wear, hardness, and biocompatibility, that favour it as an articulating surface in hip arthroplasty. However, ceramic fracture remains a concern. We have reviewed the contemporary literature, addressing the factors that can influence the incidence of ceramic bearing surface fracture. Cite this article: Bone Joint J 2019;101-B:897–901.
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Affiliation(s)
- S. Konan
- Princess Grace Hospital, London, UK
| | - S. Alazzawi
- Orthopaedic Department, University of British Columbia Hospital and Vancouver General Hospital, Vancouver, Canada
| | - B-H. Yoon
- Inje University Seoul Paik Hospital, Seoul, South Korea
| | - Y-H. Cha
- Orthopedic Surgery, Eulji University Hospital, Daejeon, South Korea
| | - K-H. Koo
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
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Solarino G, Piazzolla A, Moretti L, Vicenti G, Moretti B. A minimum 20-year outcome of 100 consecutive alumina-on-alumina arthroplasties performed by a single surgeon. Hip Int 2018; 28:10-14. [PMID: 30755120 DOI: 10.1177/1120700018813218] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND: Ceramic-on-ceramic (CoC) is currently a viable bearing combination in primary total hip arthroplasty (THA) and, due to its mechanical properties, it can be used in young patients requiring a long-lasting implant. The aim of this study is to report the results of a series of CoC THAs at a minimum 20 years follow-up. METHODS: A retrospective study was conducted on the 1st 100 consecutive alumina-on-alumina arthroplasties performed by a single surgeon on 51 females and 40 males with an average age of 60.7 years. The mean preoperative Harris Hip Score was 35. The press-fit cup consisted of a pure titanium core with a titanium alloy mesh. Both the inlay and the head were made of dense polycrystalline surgical-grade alumina. The 32-mm femoral head was anchored on 3 different femoral components. RESULTS: 19 patients with 22 THAs were died or lost, 2 anatomic cementless stems were revised due to sinking, 1 THA was revised for periprosthetic infection. 2 patients sustained a Vancouver B1 periprosthetic femoral fracture. None of the 78 THAs eligible for this study were revised for wear, breakage, noise of the ceramic components. None of the cups, none of the cemented stems, none of the cementless straight stems failed. HHS raised up to a mean value of 95. CONCLUSIONS: The present report demonstrates that CoC coupling offers minimal wear at a long-term follow-up. Further studies are needed to evaluate whether the modern ceramic composites will confirm such excellent results in total hip replacement.
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Affiliation(s)
- Giuseppe Solarino
- Department of Neuroscience and Organs of Sense, Orthopaedic Unit, Faculty of Medicine and Surgery, University of Bari, Italy
| | - Andrea Piazzolla
- Department of Neuroscience and Organs of Sense, Orthopaedic Unit, Faculty of Medicine and Surgery, University of Bari, Italy
| | - Lorenzo Moretti
- Department of Neuroscience and Organs of Sense, Orthopaedic Unit, Faculty of Medicine and Surgery, University of Bari, Italy
| | - Giovanni Vicenti
- Department of Neuroscience and Organs of Sense, Orthopaedic Unit, Faculty of Medicine and Surgery, University of Bari, Italy
| | - Biagio Moretti
- Department of Neuroscience and Organs of Sense, Orthopaedic Unit, Faculty of Medicine and Surgery, University of Bari, Italy
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Lau YJ, Sarmah S, Witt JD. 3 rd generation ceramic-on-ceramic cementless total hip arthroplasty: a minimum 10-year follow-up study. Hip Int 2018; 28:133-138. [PMID: 29890910 DOI: 10.1177/1120700018768617] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION 3rd generation ceramic bearings were introduced in total hip arthroplasty (THA) with the potential to have better mechanical strength and wear properties than their predecessors. At present, there are few studies looking at the long-term results of this latest generation of ceramic bearings. The purpose of our study was to investigate the long-term clinical and radiographic results of 3rd generation ceramic-on-ceramic THA and the incidence of ceramic specific complications such as squeaking and bearing surface fracture. METHODS The database of the senior author (J.D.W.) was reviewed. A total of 126 hip replacements performed in 108 patients (average age 39.6 years) with an average follow-up of 12.1 years (10-16 years) was identified. Clinical notes and plain radiographs were reviewed. To measure function, patients were contacted and an Oxford Hip Questionnaire was completed. Patients were also directly questioned about the presence of squeaking or any other sounds from the hip. Radiographs were evaluated for signs of wear, osteolysis, loosening and heterotopic ossification. The abduction angle of the acetabular component was measured. RESULTS The average Oxford Hip Score was 39.8 out of 48. Survivorship at 10 years was 94.6% (95% CI) with revision for any cause as the endpoint. There was 1 femoral head fracture, no osteolysis, no squeaking and no detectable wear. CONCLUSIONS The good clinical and radiographic results for this series of patients are similar to other recent long-term studies looking at 3rd generation ceramic-on-ceramic THA. The results compare favourably with other bearing surfaces. The lack of osteolysis associated with this articulation is encouraging and may also make it a good choice for younger patients requiring total hip replacement.
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Becker LC, Boyer I, Bergfeld WF, Belsito DV, Hill RA, Klaassen CD, Liebler DC, Marks JG, Shank RC, Slaga TJ, Snyder PW, Andersen FA. Safety Assessment of Alumina and Aluminum Hydroxide as Used in Cosmetics. Int J Toxicol 2018; 35:16S-33S. [PMID: 27913785 DOI: 10.1177/1091581816677948] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This is a safety assessment of alumina and aluminum hydroxide as used in cosmetics. Alumina functions as an abrasive, absorbent, anticaking agent, bulking agent, and opacifying agent. Aluminum hydroxide functions as a buffering agent, corrosion inhibitor, and pH adjuster. The Food and Drug Administration (FDA) evaluated the safe use of alumina in several medical devices and aluminum hydroxide in over-the-counter drugs, which included a review of human and animal safety data. The Cosmetic Ingredient Review (CIR) Expert Panel considered the FDA evaluations as part of the basis for determining the safety of these ingredients as used in cosmetics. Alumina used in cosmetics is essentially the same as that used in medical devices. This safety assessment does not include metallic or elemental aluminum as a cosmetic ingredient. The CIR Expert Panel concluded that alumina and aluminum hydroxide are safe in the present practices of use and concentration described in this safety assessment.
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Affiliation(s)
- Lillian C Becker
- Cosmetic Ingredient Review Scientific Analyst/Writer, Washington, DC, USA
| | - Ivan Boyer
- Cosmetic Ingredient Review Toxicologist, Washington, DC, USA
| | - Wilma F Bergfeld
- Cosmetic Ingredient Review Expert Panel Member, Washington, DC, USA
| | - Donald V Belsito
- Cosmetic Ingredient Review Expert Panel Member, Washington, DC, USA
| | - Ronald A Hill
- Cosmetic Ingredient Review Expert Panel Member, Washington, DC, USA
| | | | - Daniel C Liebler
- Cosmetic Ingredient Review Expert Panel Member, Washington, DC, USA
| | - James G Marks
- Cosmetic Ingredient Review Expert Panel Member, Washington, DC, USA
| | - Ronald C Shank
- Cosmetic Ingredient Review Expert Panel Member, Washington, DC, USA
| | - Thomas J Slaga
- Cosmetic Ingredient Review Expert Panel Member, Washington, DC, USA
| | - Paul W Snyder
- Cosmetic Ingredient Review Expert Panel Member, Washington, DC, USA
| | - F Alan Andersen
- Former Director, Cosmetic Ingredient Review, Washington, DC, USA
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Abstract
Metal-on-highly cross-linked polyethylene is considered the preferred bearing surface for conventional total hip arthroplasty because of its safety profile and excellent results in the first 10 to 15 years of use. However, with younger patient age, activity expectations increase, and the life expectancy of patients with total hip arthroplasty also has increased, so interest remains in other bearing couples. These other options include the use of various ceramic composites for the femoral head on highly cross-linked polyethylene, the so-called second-generation antioxidant polyethylenes, and ceramic acetabular liners. Several of these bearing couples have shown excellent wear rates in vitro, and short-term clinical studies have demonstrated favorable wear and safety results. It is uncertain whether any of these bearing couples should be adopted at present. Understanding the unique properties and possible complications of these bearing couples is critical for appropriate implant selection.
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Lau YJ, Sarmah S, Witt JD. 3rd generation ceramic-on-ceramic cementless total hip arthroplasty: a minimum 10-year follow-up study. Hip Int 2017:0. [PMID: 28777383 DOI: 10.5301/hipint.5000541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION 3rd generation ceramic bearings were introduced in total hip arthroplasty (THA) with the potential to have better mechanical strength and wear properties than their predecessors. At present, there are few studies looking at the long-term results of this latest generation of ceramic bearings.The purpose of our study was to investigate the long-term clinical and radiographic results of 3rd generation ceramic-on-ceramic THA and the incidence of ceramic specific complications such as squeaking and bearing surface fracture. METHODS The database of the senior author (J.D.W.) was reviewed. A total of 126 hip replacements performed in 108 patients (average age 39.6 years) with an average follow-up of 12.1 years (10-16 years) was identified. Clinical notes and plain radiographs were reviewed. To measure function, patients were contacted and an Oxford Hip Questionnaire was completed. Patients were also directly questioned about the presence of squeaking or any other sounds from the hip. Radiographs were evaluated for signs of wear, osteolysis, loosening and heterotopic ossification. The abduction angle of the acetabular component was measured. RESULTS The average Oxford Hip Score was 39.8 out of 48. Survivorship at 10 years was 94.6% (95% CI) with revision for any cause as the endpoint. There was 1 femoral head fracture, no osteolysis, no squeaking and no detectable wear. CONCLUSIONS The good clinical and radiographic results for this series of patients are similar to other recent long-term studies looking at 3rd generation ceramic-on-ceramic THA. The results compare favourably with other bearing surfaces. The lack of osteolysis associated with this articulation is encouraging and may also make it a good choice for younger patients requiring total hip replacement.
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Grammatopoulos G, Kendrick B, McNally M, Athanasou NA, Atkins B, McLardy-Smith P, Taylor A, Gundle R. Outcome Following Debridement, Antibiotics, and Implant Retention in Hip Periprosthetic Joint Infection-An 18-Year Experience. J Arthroplasty 2017; 32:2248-2255. [PMID: 28385345 DOI: 10.1016/j.arth.2017.02.066] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/27/2017] [Accepted: 02/18/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Debridement-antibiotics-and-implant-retention (DAIR) may be considered a suitable surgical option in periprosthetic joint infections (PJIs) with soundly fixed prostheses, despite chronicity. This study aims to define the long-term outcome following DAIR in hip PJI. METHODS We reviewed all hip DAIRs performed between 1997 and 2013 (n = 122) to define long-term outcome and identify factors influencing it. Data recorded included patient demographics, medical history, type of DAIR performed (+/- exchange of modular components), and organisms identified. Outcome measures included complications and/or mortality rate, implant survivorship, and functional outcome (Oxford Hip Score). RESULTS Most DAIRs (67%) were of primary arthroplasties and 60% were performed within 6 weeks from the index arthroplasty. Infection eradication was achieved in 68% of the first DAIR procedure. In 32 cases, more than one DAIR was required. Infection eradication was achieved in 85% of the cases (104/122) with the (single or multiple) DAIR approach. The most common complication was PJI-persistence (15%), followed by dislocation (14%). Very good functional outcomes were obtained, especially in primary arthroplasties. All streptococcus infections were resolved with DAIR and had better outcome. Twenty-one hips have been revised (17%) to-date, 16 were for persistence of PJI. The 10-y implant survivorship was 77%. Early PJI and exchanging modular components at DAIR were independent factors for a 4-fold increased infection eradication and improved long-term implant survival. CONCLUSION DAIR is, therefore, a valuable option in the treatment of hip PJI, especially in the early postoperative period (≤6 weeks), with good outcomes. However, DAIR is associated with increased morbidity; further surgery may be necessary and instability may occur. Where possible, exchange of modular implants should be undertaken.
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Affiliation(s)
| | | | - Martin McNally
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford, UK
| | | | - Bridget Atkins
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford, UK
| | | | - Adrian Taylor
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford, UK
| | - Roger Gundle
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford, UK
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3rd generation alumina-on-alumina in modular hip prosthesis: 13 to 18 years follow-up results. Hip Int 2017; 27:8-13. [PMID: 27791244 DOI: 10.5301/hipint.5000429] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2016] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Ceramic-on-ceramic (CoC) couplings are alternative bearings surfaces that have been reported to reduce osteolysis, wear debris and aseptic loosening compared to the use of polyethylene. Early experiences with ceramics had poor results, but they have led to many improvements in the manufacture and design of subsequent implants. METHODS We analysed medical files of 300 CoC total hip arthroplasty (THA) with a modular neck performed during period 1995-2000 by a single surgeon for a minimum follow-up of 13 years, evaluating clinical and radiological outcome. RESULTS The mean clinical Merle d'Aubigne and Postel hip score at the final follow-up is 17.4, against a preoperative value of 11.4. Overall survivorship with an endpoint of revision is 93.2% (95% CI, 89.0%-97.3%) at 15 years, while considering only prosthesis failures related to aseptic loosening and ceramic breakage, survival rate at 15 years is 97.2% (95% CI, 94.8%-100%). We observed complications that led to revision surgery in 11 patients (4%) (periprosthetic fractures, liner ruptures, septic loosening of the implant, aseptic loosening of the cup, aseptic loosening of the stem). The occurrence of squeaking is low (1.6%, 4 cases) and we analysed the characteristics of these patients. DISCUSSION Our study shows an excellent long term survivorship of third generation alumina CoC THA. We reiterate the importance to have a stable implant to maximise the advantage of ceramic and to avoid complications.
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Abstract
BACKGROUND Sickle cell disease (SCD) affects around 80,000 people in the USA and 12,000 in the UK. Up to 40% of patients will get osteonecrosis of the femoral head. Cemented acetabular components yield poor results with the rate of osteolysis ranging from 13.5 to 46%. We report on a consecutive cohort of patients with SCD who underwent uncemented THA with ceramic-on-ceramic (CoC) bearings. METHODS Since 2002 52 primary THAs were carried out in 40 patients. The average age was 36.1 years (17-54). 48 cases had exchange blood transfusion preoperatively and 3 had top-up transfusions.An S-ROM was used in 47 hips a Solutions stem in 4 hips and an AML in 1. It was necessary to drill the femur during 12 hips. There were 5 intra-operative peri-prosthetic fractures. 2 dislocations were observed. 2 superficial infections were detected. RESULTS All components have in-grown. There have been no cases of radiographic osteolysis, migration or loosening of the hip with average 5-year (2-10.1) follow-up. CONCLUSIONS The combination of a multidisciplinary team approach and uncemented implants, with ceramic-on-ceramic bearings used, has made THA in patients with SCD a safe and reliable procedure in our hospital.
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Burgo FJ, Mengelle DE, Ozols A, Fernandez C, Autorino CM. The damping effect of cement as a potential mitigation factor of squeaking in ceramic-on-ceramic total hip arthroplasty. Bone Joint Res 2016; 5:531-537. [PMID: 27811144 PMCID: PMC5131093 DOI: 10.1302/2046-3758.511.bjr-2016-0058.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objectives Studies reporting specifically on squeaking in total hip arthroplasty have focused on cementless, and not on hybrid, fixation. We hypothesised that the cement mantle of the femur might have a damping effect on the sound transmitted through the metal stem. The objective of this study was to test the effect of cement on sound propagation along different stem designs and under different fixation conditions. Methods An in vitro model for sound detection, composed of a mechanical suspension structure and a sound-registering electronic assembly, was designed. A pulse of sound in the audible range was propagated along bare stems and stems implanted in cadaveric bone femurs with and without cement. Two stems of different alloy and geometry were compared. Results The magnitudes of the maximum amplitudes of the bare stem were in the range of 10.8 V to 11.8 V, whereas the amplitudes for the same stems with a cement mantle in a cadaveric bone decreased to 0.3 V to 0.7 V, implying a pulse-attenuation efficiency of greater than 97%. The same magnitude is close to 40% when the comparison is made against stems implanted in cadaveric bone femurs without cement. Conclusion The in vitro model presented here has shown that the cement had a remarkable effect on sound attenuation and a strong energy absorption in cement mantle and bone. The visco-elastic properties of cement can contribute to the dissipation of vibro-acoustic energy, thus preventing hip prostheses from squeaking. This could explain, at least in part, the lack of reports of squeaking when hybrid fixation is used. Cite this article: F. J. Burgo, D. E. Mengelle, A. Ozols, C. Fernandez, C. M. Autorino. The damping effect of cement as a potential mitigation factor of squeaking in ceramic-on-ceramic total hip arthroplasty. Bone Joint Res 2016;5:531–537. DOI: 10.1302/2046-3758.511.BJR-2016-0058.R1.
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Affiliation(s)
- F J Burgo
- Department of Orthopaedics and Traumatology, Unit of Hip and Knee Reconstructive Surgery, Hospital Universitario Austral, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - D E Mengelle
- Department of Orthopaedics and Traumatology, Unit of Hip and Knee Reconstructive Surgery, Hospital Universitario Austral, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - A Ozols
- Buenos Aires University, Av. Paseo Colón 850, C1063ACV Ciudad Autónoma de Buenos Aires, Argentina
| | - C Fernandez
- Buenos Aires University, Av. Paseo Colón 850, C1063ACV Ciudad Autónoma de Buenos Aires, Argentina
| | - C M Autorino
- Department of Orthopaedics and Traumatology, Unit of Hip and Knee Reconstructive Surgery, Hospital Universitario Austral, Universidad de Buenos Aires, Buenos Aires, Argentina
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Patient satisfaction after total hip arthroplasty in an Egyptian population as an example of a developing country. CURRENT ORTHOPAEDIC PRACTICE 2016. [DOI: 10.1097/bco.0000000000000436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Do the Reasons for Ceramic-on-ceramic Revisions Differ From Other Bearings in Total Hip Arthroplasty? Clin Orthop Relat Res 2016; 474:2190-9. [PMID: 27255729 PMCID: PMC5014815 DOI: 10.1007/s11999-016-4917-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Despite widespread use of ceramic-on-ceramic (CoC) in total hip arthroplasty (THA) during the past 10 years, little is known about why revisions are performed in hips with this bearing or the time elapsed before revision. QUESTIONS/PURPOSES The purposes of this study were: (1) Do the reasons for first revision differ between CoC bearings and other bearing couples? (2) Does the time to revision differ between CoC and other bearing couples? (3) Are there unique reasons for revisions of CoC bearings? METHODS All members of the Société Française de Chirurgie Orthopédique et Traumatologique (SoFCOT) who performed ≥ 30 revisions per year were invited to participate in this multicenter, prospective, observational study. Our data represent 12% of the revision procedures performed in France. A total of 2107 first revisions of THA (from January 2010 to December 2011) were done in 2107 patients (1201 females [57%] and 906 males [43%]; median age, 73 years; age range, 17-104 years) at the time of surgery after a median of 11 years (range, 0 day-42 years) after the primary THA. There were 238 of 2107 (11%) CoC, 148 of 2107 (7%) metal-on-metal (MoM), and 1721 of 2017 (82%) metal-on-polyethylene (MoP) bearings. RESULTS The reasons for reoperation differed according to the bearing component: (1) for the MoP reference bearing (odds ratio [OR]; 95% confidence interval), cup loosening occurred in 698 of 1721 hips (41%), periprosthetic fracture in 220 of 1721 hips (13%), and osteolysis in 213 of 1721 hips (12%); (2) for CoC, cup loosening occurred in 41 of 238 hips (17%) (OR, 0.31 [0.22-0.43; p < 0.001), infection in 39 of 238 hips (16%) (OR, 1.63 [1.12-2.37]; p = 0.01), and dislocation in 23 of 238 hips (10%) (OR, 0.9 [0.57-1.42]; p = 0.9); (3) for MoM, cup loosening occurred in 28 of 148 hips (19%) (OR, 0.34 [0.22-0.52]; p < 0.001), adverse reaction to metallic debris in 26 of 148 hips (18%) (OR, 18.12 [9.84-33.4]; p < 0.001), and infection in 16 of 148 hips (11%) (OR, 1 [0.59-1.73]; p = 0.9). In comparison with MoP, osteolysis was rarely the reason for revision in CoC (four of 238 hips [2%]; OR, 0.12 [0.05-0.33]; p < 0.001), but this bearing was frequently revised because of iliopsoas irritation (18 of 238 hips [8%]; OR, 4.9 [2.7-9]; p < 0.001). The time elapsed before revision differed between bearings: median of 3 years (range, 3 days to 28 years) for CoC and 4 years (range, 14 days to 37 years) for MoM versus a median 13 years (range, 0 day to 42 years) for MoP (p < 0.001). Thirty-seven of the 238 revisions (16%) were directly related to ceramic use (ceramic breakage [n = 23], squeaking [n = 6], impingement [n = 7], incorrect ceramic insert insertion [n = 1]). No factors were identified that contributed to breakage of the 12 bulk ceramic components (eight heads, four inserts, four of 12 Delta ceramic). No factors were associated with squeaking, iliopsoas irritation, or impingement, but component orientation was not assessed. CONCLUSIONS The reasons and time to first revision differed between CoC and other bearings. CoC THAs are revised earlier and are sensitive to mechanical problems such as impingement, squeaking, and ceramic rupture that did not disappear with introduction of Delta ceramics and large-diameter (≥ 36 mm) bearings. CoC was rarely revised for osteolysis, but a high rate of iliopsoas irritation requires further investigation. LEVEL OF EVIDENCE Level III, therapeutic study.
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Ferreira A, Aslanian T, Dalin T, Picaud J. Ceramic bearings with bilayer coating in cementless total hip arthroplasty. A safe solution. A retrospective study of one hundred and twenty six cases with more than ten years’ follow-up. INTERNATIONAL ORTHOPAEDICS 2016; 41:893-899. [DOI: 10.1007/s00264-016-3271-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 08/01/2016] [Indexed: 10/21/2022]
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Piriou P, Ouenzerfi G, Migaud H, Renault E, Massi F, Serrault M. A numerical model to reproduce squeaking of ceramic-on-ceramic total hip arthroplasty. Influence of design and material. Orthop Traumatol Surg Res 2016; 102:S229-34. [PMID: 27033843 DOI: 10.1016/j.otsr.2016.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 02/24/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Modern ceramic (CoC) bearings for hip arthroplasty (THA) have been used in younger patients who expect improved survivorship. However, audible squeaking produced by the implant is an annoying complication. Previous numerical simulations were not able to accurately reproduce in vitro and in vivo observations. Therefore, we developed a finite element model to: (1) reproduce in vitro squeaking and validate the model by comparing it with in vivo recordings, (2) determine why there are differences between in vivo and in vitro squeaking frequencies, (3) identify the stem's role in this squeaking, (4) predict which designs and materials are more likely to produce squeaking. HYPOTHESIS A CoC THA numerical model can be developed that reproduces the squeaking frequencies observed in vivo. MATERIAL AND METHODS Numerical methods (finite element analysis [ANSYS]) and experimental methods (using a non-lubricated simulated hip with a cementless 32mm CoC THA) were developed to reproduce squeaking. Numerical analysis was performed to identify the frequencies that cause vibrations perceived as an acoustic emission. The finite element analysis (FEA) model was enhanced by adjusting periprosthetic bone and soft tissue elements in order to reproduce the squeaking frequencies recorded in vivo. A numerical method (complex eigenvalue analysis) was used to find the acoustic frequencies of the squeaking noise. The frequencies obtained from the model and the hip simulator were compared to those recorded in vivo. RESULTS The numerical results were validated by experiments with the laboratory hip simulator. The frequencies obtained (mean 2790Hz with FEA, 2755Hz with simulator, decreasing to 1759Hz when bone and soft tissue were included in the FEA) were consistent with those of squeaking hips recorded in vivo (1521Hz). The cup and ceramic insert were the source of the vibration, but had little influence on the diffusion of the noise required to make the squeaking audible to the human ear. The FEA showed that diffusion of squeaking was due to an unstable vibration of the stem during frictional contact. The FEA predicted a higher rate of squeaking (at a lower coefficient of friction) when TZMF™ alloy is used instead of Ti6Al4V and when an anatomic press-fit stem is used instead of straight self-locking designs. DISCUSSION The current FEA model is reliable; it can be used to assess various stem designs and alloys to predict the different rates of squeaking that certain stems will likely produce. LEVEL OF EVIDENCE Level IV in vitro study.
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Affiliation(s)
- P Piriou
- Clinique du parc, 6, avenue du Morvan, 71400 Autun, France
| | - G Ouenzerfi
- Institut National des Sciences Appliquées de Lyon (INSA), Laboratoire de Mécanique des Contacts et des Structures, bâtiment Jean-d'Alembert, 18-20, rue des Sciences, 69621 Villeurbanne cedex, France
| | - H Migaud
- Université de Lille, Département Universitaire de Chirurgie Orthopédique et de Traumatologie, place de Verdun, 59000 Lille, France.
| | - E Renault
- Tornier, 161, rue Lavoisier, 38334 Montbonnot, France
| | - F Massi
- Institut National des Sciences Appliquées de Lyon (INSA), Laboratoire de Mécanique des Contacts et des Structures, bâtiment Jean-d'Alembert, 18-20, rue des Sciences, 69621 Villeurbanne cedex, France
| | - M Serrault
- Clinique Saint-Dominique, 99, rue de Messei, 61100 Flers, France
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Dilogo IH, Chandra W. Short-term outcome of ceramic-on-ceramic total hip replacement in young adult patients. MEDICAL JOURNAL OF INDONESIA 2015. [DOI: 10.13181/mji.v24i3.1184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Background: Ceramic-on-ceramic (CoC) total hip replacement (THR) was developed to minimize debris and osteolytic reaction. The major concern is its brittleness. The aim of this study was to evaluate the short-term outcome of CoC THR in young adult patients. Methods: 11 patients, 13 THR procedures, were followed up until six months after surgery in Cipto Mangunkusumo Hospital. Evaluation included Harris hip score (HHS), visual analog scale (VAS), patients’ complaint, short form-36 (SF-36), and acetabular and femoral component angles. Data were analyzed using Wilcoxon signed rank test, paired t-test, and Spearman test. Results: The average age of the patients was 33.6 years old and 55% of them were female. Systemic lupus erythematosus was the main causative disease for THR. The VAS average decreased before surgery and after six months of surgery (5 to 1). Pre- and post-operative HHS and SF-36 increased significantly by (25 to 92) and (21 to 54) respectively. Squeaking sound was reported by two patients. No correlation was found between acetabular and femoral component and squeaking incidence.Conclusion: CoC THR showed excellent short term outcome for young adult patients. With proper indications, CoC THR ensures excellent clinical outcomes and promising survivorship.
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Pomeroy E, Rowan F, Masterson E. Atraumatic Fracture of a BIOLOX Delta Ceramic Femoral Head Articulating with a Polyethylene Liner: A Case Report. JBJS Case Connect 2015; 5:e112. [PMID: 29252818 DOI: 10.2106/jbjs.cc.o.00146] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
CASE We describe the case of a forty-one-year-old man who underwent total hip arthroplasty with a 32-mm BIOLOX delta ceramic head articulating with a polyethylene liner. The patient did not suffer any trauma postoperatively, and his only symptom was of a "clicking" noise from the operatively treated hip. At his six-week postoperative review, fracture of the femoral head was diagnosed. CONCLUSION Fracture of a ceramic femoral head is a rare but catastrophic complication. This case report highlights the importance of vigilance on the part of the surgeon when reviewing patients after hip arthroplasty with ceramic-on-polyethylene bearing couples, even with limited symptoms associated with the hip and no reported trauma.
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Affiliation(s)
- Eoghan Pomeroy
- Department of Trauma and Orthopaedics, Croom Orthopaedic Hospital, County Limerick, Ireland
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Zhao X, Hu D, Qin J, Mohanan R, Chen L. Effect of bisphosphonates in preventing femoral periprosthetic bone resorption after primary cementless total hip arthroplasty: a meta-analysis. J Orthop Surg Res 2015; 10:65. [PMID: 25962791 PMCID: PMC4437696 DOI: 10.1186/s13018-015-0206-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 04/15/2015] [Indexed: 01/27/2023] Open
Abstract
Background Bone loss leading to aseptic loosening of the prosthesis and periprosthetic fracture is a mode of failure in cementless total hip arthroplasty (THA). The aim of this meta-analysis was to evaluate the effect of bisphosphonates in preventing femoral periprosthetic bone resorption following primary cementless THA zone by zone. Method Clinical randomized controlled trials concerning bisphosphonates application after primary cementless THA published up to October 2014 were retrieved from PubMed, Cochrane library, and Embase databases. The methodological quality of the included studies was assessed by the Physiotherapy Evidence Database (PEDro) scale. Data analysis was performed using StataSE12.0. Results Ten randomized controlled trials involving a total of 502 patients were assessed; the bisphosphonates group included 256 patients and the control group included 246 patients. The meta-analysis showed that the bone mineral density (BMD) of most femoral periprosthetic zones in bisphosphonates group was significantly higher than that in the control group at 3 months postoperatively except zone 5 with no significant difference. At 6 and 12 months, the BMD of bisphosphonates group was much higher than that in control group except zone 5, which showed no statistical difference. The BMD of bisphosphonates group was persistently higher than control group in zone 6 and 7 at 5 years postoperatively, while the other zones had no significant difference. Both serum bone alkaline phosphatase and urinary type I collagen N-telopeptide were significantly suppressed by bisphosphonates at 3, 6, and 12 months. Conclusion Bisphosphonates seem to decrease early femoral periprosthetic bone resorption after primary cementless THA. Drug efficacy was found to be long-standing in the main load-bearing zones.
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Affiliation(s)
- Xinyu Zhao
- Department of Orthopaedics, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei Province, 430071, China.
| | - Dongcai Hu
- Department of Orthopaedics, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei Province, 430071, China.
| | - Jun Qin
- Department of Orthopaedics, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei Province, 430071, China.
| | - Rahul Mohanan
- Department of Orthopaedics, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei Province, 430071, China.
| | - Liaobin Chen
- Department of Orthopaedics, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei Province, 430071, China.
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Kang BJ, Ha YC, Ham DW, Hwang SC, Lee YK, Koo KH. Third-generation alumina-on-alumina total hip arthroplasty: 14 to 16-year follow-up study. J Arthroplasty 2015; 30:411-5. [PMID: 25449586 DOI: 10.1016/j.arth.2014.09.020] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/16/2014] [Accepted: 09/23/2014] [Indexed: 02/01/2023] Open
Abstract
Ceramic-on-ceramic articulation has the lowest wear with little osteolysis. However, the wear and osteolysis in long-term follow-up are not known. Another concern is ceramic fracture, which might occur after repeated stress during a long period. Ninety hips (76 patients with a mean age of 47 years) that underwent cementless total hip arthroplasty using third-generation ceramic-on-ceramic articulation were followed for 14-16 years. At final follow-up, there was no measurable ceramic wear and no periprosthetic osteolysis was identified. No ceramic fracture occurred during the follow-up. One hip was revised because of late infection. All prostheses were bone-ingrown. Two patients experienced a grinding sensation. However, no patient had squeak. The mean Harris hip score at the final evaluation was 89 points and the survival rate was 98.9%.
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Affiliation(s)
- Bun-Jung Kang
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine, Jinju, South Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Dae-Woong Ham
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Sun-Chul Hwang
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine, Jinju, South Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
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Varnum C, Pedersen AB, Kjærsgaard-Andersen P, Overgaard S. Comparison of the risk of revision in cementless total hip arthroplasty with ceramic-on-ceramic and metal-on-polyethylene bearings. Acta Orthop 2015; 86:477-84. [PMID: 25637339 PMCID: PMC4513604 DOI: 10.3109/17453674.2015.1012975] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 12/30/2014] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Ceramic-on-ceramic (CoC) bearings were introduced in total hip arthroplasty (THA) to reduce problems related to polyethylene wear. We compared the 9-year revision risk for cementless CoC THA and for cementless metal-on-polyethylene (MoP) THA. PATIENTS AND METHODS In this prospective, population-based study from the Danish Hip Arthroplasty Registry, we identified all the primary cementless THAs that had been performed from 2002 through 2009 (n = 25,656). Of these, 1,773 THAs with CoC bearings and 9,323 THAs with MoP bearings were included in the study. To estimate the relative risk (RR) of revision, we used regression with the pseudo-value approach and treated death as a competing risk. RESULTS 444 revisions were identified: 4.0% for CoC THA (71 of 1,773) and 4.0% for MoP THA (373 of 9,323). No statistically significant difference in the risk of revision for any reason was found for CoC and MoP bearings after 9 years of follow-up (adjusted RR = 1.3, 95% CI: 0.72-2.4). Revision rates due to component failure were 0.5% (n = 8) for CoC bearings and 0.1% (n = 6) for MoP bearings (p < 0.001). 6 patients with CoC bearings (0.34%) underwent revision due to ceramic fracture. INTERPRETATION When compared to the "standard" MoP bearings, CoC THA had a 33% higher (though not statistically significantly higher) risk of revision for any reason at 9 years.
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Affiliation(s)
- Claus Varnum
- Department of Orthopedic Surgery and Traumatology , Odense University Hospital , Odense
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28
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Mihalko WM, Wimmer MA, Pacione CA, Laurent MP, Murphy RF, Rider C. How have alternative bearings and modularity affected revision rates in total hip arthroplasty? Clin Orthop Relat Res 2014; 472:3747-58. [PMID: 25070918 PMCID: PMC4397767 DOI: 10.1007/s11999-014-3816-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Total hip arthroplasty (THA) continues to be one of the most successful surgical procedures in the medical field. However, over the last two decades, the use of modularity and alternative bearings in THA has become routine. Given the known problems associated with hard-on-hard bearing couples, including taper failures with more modular stem designs, local and systemic effects from metal-on-metal bearings, and fractures with ceramic-on-ceramic bearings, it is not known whether in aggregate the survivorship of these implants is better or worse than the metal-on-polyethylene bearings that they sought to replace. QUESTIONS/PURPOSES Have alternative bearings (metal-on-metal and ceramic-on-ceramic) and implant modularity decreased revision rates of primary THAs? METHODS In this systematic review of MEDLINE and EMBASE, we used several Boolean search strings for each topic and surveyed national registry data from English-speaking countries. Clinical research (Level IV or higher) with ≥ 5 years of followup was included; retrieval studies and case reports were excluded. We included registry data at ≥ 7 years followup. A total of 32 studies (and five registry reports) on metal-on-metal, 19 studies (and five registry reports) on ceramic-on-ceramic, and 20 studies (and one registry report) on modular stem designs met inclusion criteria and were evaluated in detail. Insufficient data were available on metal-on-ceramic and ceramic-on-metal implants, and monoblock acetabular designs were evaluated in another recent systematic review so these were not evaluated here. RESULTS There was no evidence in the literature that alternative bearings (either metal-on-metal or ceramic-on-ceramic) in THA have decreased revision rates. Registry data, however, showed that large head metal-on-metal implants have lower 7- to 10-year survivorship than do standard bearings. In THA, modular exchangeable femoral neck implants had a lower 10-year survival rate in both literature reviews and in registry data compared with combined registry primary THA implant survivorship. CONCLUSIONS Despite improvements in implant technology, there is no evidence that alternative bearings or modularity have resulted in decreased THA revision rates after 5 years. In fact, both large head metal-on-metal THA and added modularity may well lower survivorship and should only be used in select cases in which the mission cannot be achieved without it. Based on this experience, followup and/or postmarket surveillance studies should have a duration of at least 5 years before introducing new alternative bearings or modularity on a widespread scale.
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Affiliation(s)
- William M Mihalko
- Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee, 956 Court Avenue, Suite E226, Memphis, TN, 38163, USA,
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29
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Owen DH, Russell NC, Smith PN, Walter WL. An estimation of the incidence of squeaking and revision surgery for squeaking in ceramic-on-ceramic total hip replacement: a meta-analysis and report from the Australian Orthopaedic Association National Joint Registry. Bone Joint J 2014; 96-B:181-7. [PMID: 24493182 DOI: 10.1302/0301-620x.96b2.32784] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Squeaking arising from a ceramic-on-ceramic (CoC) total hip replacement (THR) may cause patient concern and in some cases causes patients to seek revision surgery. We performed a meta-analysis to determine the incidence of squeaking and the incidence of revision surgery for squeaking. A total of 43 studies including 16,828 CoC THR that reported squeaking, or revision for squeaking, were entered into the analysis. The incidence of squeaking was 4.2% and the incidence of revision for squeaking was 0.2%. The incidence of squeaking in patients receiving the Accolade femoral stem was 8.3%, and the incidence of revision for squeaking in these patients was 1.3%.
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Affiliation(s)
- D H Owen
- Trauma and Orthopaedic Research Unit, Building 6 Level 1, The Canberra Hospital, PO Box 11, Woden ACT, 2606, and Australian National University Medical School, Level 2, Peter Baume Building 42, Linnaeus Way, Canberra, ACT, 0200, Australia
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D’Antonio JA, Capello WN, Naughton M. High survivorship with a titanium-encased alumina ceramic bearing for total hip arthroplasty. Clin Orthop Relat Res 2014; 472:611-6. [PMID: 23543419 PMCID: PMC3890188 DOI: 10.1007/s11999-013-2943-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although ceramic-on-ceramic bearings for total hip arthroplasty (THA) show promising results in terms of bearing-surface wear, fracture of the bearing, insertional chips, and squeaking remain a concern. QUESTIONS/PURPOSES Our primary objective of this report was to determine overall survivorship of a titanium-encased ceramic-on-ceramic bearing couple. Our secondary objectives were to evaluate for ceramic fracture, insertional chips, osteolysis, and device squeaking. METHODS Six surgeons at six institutions implanted 194 patients (209 hips) with an average age of 52 years with cementless hips and alumina ceramic bearings. One hundred thirty-seven patients (146 hips) have 10-year followup (70%). We determined Kaplan-Meier survivorship of the bearing surface and implant system and collected radiographic and clinical data to evaluate for osteolysis and squeaking. RESULTS Survivorship using revision for any reason as the end point was 97% at 10 years and survivorship end point bearing surface failure or aseptic loosening of 99%. There was one ceramic insert fracture (0.5%), there were no insertional chips, there was no visible osteolysis on AP and lateral radiographs, and there was a 1% patient-self-reported incidence of squeaking at the last clinical followup. Six hips underwent revision (3.7%). CONCLUSIONS Ceramic bearings for THA with a titanium-encased insert have high survivorship at 10 years followup and a fracture risk of 0.5%. We found at last followup on routine radiographs no evidence of osteolysis, and no patient has been revised for squeaking or has reported dissatisfaction with the clinical result because of noise. IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- James A. D’Antonio
- Greater Pittsburgh Orthopaedics Association, 725 Cherrington Parkway, Suite 200, Moon Township, PA 15108 USA
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31
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Abstract
We reviewed the literature on the currently available choices of bearing surface in total hip replacement (THR). We present a detailed description of the properties of articulating surfaces review the understanding of the advantages and disadvantages of existing bearing couples. Recent technological developments in the field of polyethylene and ceramics have altered the risk of fracture and the rate of wear, although the use of metal-on-metal bearings has largely fallen out of favour, owing to concerns about reactions to metal debris. As expected, all bearing surface combinations have advantages and disadvantages. A patient-based approach is recommended, balancing the risks of different options against an individual’s functional demands. Cite this article: Bone Joint J 2014;96-B:147–56.
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Affiliation(s)
- A. Rajpura
- Wrightington Hospital, The Centre
for Hip Surgery, Appley Bridge, Wigan
WN6 9EP, UK
| | - D. Kendoff
- Helios ENDO Klinik, Holstenstr. 2, 22767
Hamburg, Germany
| | - T. N. Board
- Wrightington Hospital, The Centre
for Hip Surgery, Appley Bridge, Wigan
WN6 9EP, UK
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Topolovec M, Milošev I. A comparative study of four bearing couples of the same acetabular and femoral component: a mean follow-up of 11.5 years. J Arthroplasty 2014; 29:176-80. [PMID: 23639386 DOI: 10.1016/j.arth.2013.03.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 02/27/2013] [Accepted: 03/29/2013] [Indexed: 02/01/2023] Open
Abstract
We present a retrospective evaluation of 1369 hip arthroplasties performed using the Bicon-Plus cups and SL-Plus stems, differing only in the bearing combination. Four bearing combination groups were used: metal-on-polyethylene (MoP) group with 587 hips, ceramic-on-polyethylene (CoP) group with 161 hips, metal-on-metal (MoM) group with 322 hips and ceramic-on-ceramic (CoC) group with 299 hips. The mean follow-up was 11.5 years (4.1 to 15.0). Radiological evaluation was performed on implants failed due to aseptic loosening. The survival for prosthesis with revision for any reason at ten years was 96.1% (95% confidence interval (CI) 94.3 to 97.9) for MoP, 98.1% (CI 95.9 to 100) for CoP, 90.2% (CI 86.8 to 93.6) for MoM, and 95.6% (CI 93.0 to 98.2) for CoC. Survival for aseptic loosening was also determined.
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Affiliation(s)
- Matevž Topolovec
- Valdoltra Orthopedic Hospital, Jadranska c. 31, SI-6280, Ankaran, Slovenia
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33
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No difference in gait recovery after THA with different head diameters: a prospective randomized study. Clin Orthop Relat Res 2013; 471:3830-7. [PMID: 23640204 PMCID: PMC3825870 DOI: 10.1007/s11999-013-2926-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Larger femoral heads are commonly presumed to improve joint stability and hip biomechanics; some studies have suggested they may hasten recovery of a normal gait. To our knowledge, no gait analysis studies have compared different size head diameters in THA. QUESTIONS/PURPOSES We compared (1) spatiotemporal gait parameters, (2) kinematic and kinetic gait parameters, and (3) Harris hip scores in patients undergoing THA randomized to receive a 28-, 36-, or ≥ 42-mm bearing couple. We hypothesized a larger femoral head would restore an earlier, more physiologic gait pattern. METHODS This randomized, blinded study involved 60 patients who received the same cementless THA except for the size of the bearing. Inclusion criteria were primary hip arthritis, female sex, and age between 55 and 70 years. Exclusion criteria were other problems influencing walking ability. The patients were randomized into three groups of 20 each (28- and 36-mm ceramic-on-crosslinked polyethylene, ≥ 42-mm metal-on-metal). All patients underwent the same postoperative rehabilitation protocol. Gait evaluation using an optoelectronic system was performed preoperatively and at 2 and 4 months postoperatively. RESULTS With the numbers available, no differences in spatiotemporal gait parameters, kinematic or kinetic gait parameters, or Harris hip scores emerged among the three groups. All variables assessed at 4 months postoperatively showed improvements across all groups, but the differences among them were not significant. CONCLUSIONS The hypothesis that a larger femoral head results in improved early gait performance was not supported by this study.
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34
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Chana R, Facek M, Tilley S, Walter WK, Zicat B, Walter WL. Ceramic-on-ceramic bearings in young patients. Bone Joint J 2013; 95-B:1603-9. [DOI: 10.1302/0301-620x.95b12.30917] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report the clinical and radiological outcomes of a series of contemporary cementless ceramic-on-ceramic total hip replacements (THRs) at ten years in patients aged ≤ 55 years of age. Pre- and post-operative activity levels are described. A total of 120 consecutive ceramic cementless THRs were performed at a single centre in 110 patients from 1997 to 1999. The mean age of the patients at operation was 45 years (20 to 55). At ten years, four patients had died and six were lost to follow-up, comprising ten hips. The mean post-operative Harris hip score was 94.7 (55 to 100). Radiological analysis was undertaken in 90 available THRs of the surviving 106 hips at final review: all had evidence of stable bony ingrowth, with no cases of osteolysis. Wear was undetectable. There were four revisions. The survival for both components with revision for any cause as an endpoint was 96.5% (95% confidence interval 94.5 to 98.7). The mean modified University of California, Los Angeles activity level rose from a mean of 6.4 (4 to 10) pre-operatively to 9.0 (6 to 10) at the ten-year post-operative period. Alumina ceramic-on-ceramic bearings in cementless primary THR in this series have resulted in good clinical and radiological outcomes with undetectable rates of wear and excellent function in the demanding younger patient group at ten years. Cite this article: Bone Joint J 2013;95-B:1603–9.
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Affiliation(s)
- R. Chana
- Specialist Orthopaedic Group, Mater
Hospital, Suite 1.08, 3-9
Gillies Street, Sydney, New
South Wales 2065, Australia
| | - M. Facek
- Specialist Orthopaedic Group, Mater
Hospital, Suite 1.08, 3-9
Gillies Street, Sydney, New
South Wales 2065, Australia
| | - S. Tilley
- University Hospital Southampton NHS Foundation
Trust, Tremona Road, Southampton, Hampshire
SO16 6YD, UK
| | - W. K. Walter
- Specialist Orthopaedic Group, Mater
Hospital, Suite 1.08, 3-9
Gillies Street, Sydney, New
South Wales 2065, Australia
| | - B. Zicat
- Specialist Orthopaedic Group, Mater
Hospital, Suite 1.08, 3-9
Gillies Street, Sydney, New
South Wales 2065, Australia
| | - W. L. Walter
- Specialist Orthopaedic Group, Mater
Hospital, Suite 1.08, 3-9
Gillies Street, Sydney, New
South Wales 2065, Australia
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35
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Bouras T, Repantis T, Fennema P, Korovessis P. Low aseptic loosening and revision rate in Zweymüller-Plus total hip arthroplasty with ceramic-on-ceramic bearings. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 24:1439-45. [DOI: 10.1007/s00590-013-1314-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 09/03/2013] [Indexed: 10/26/2022]
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Brandt JM, Gascoyne TC, Guenther LE, Allen A, Hedden DR, Turgeon TR, Bohm ER. Clinical failure analysis of contemporary ceramic-on-ceramic total hip replacements. Proc Inst Mech Eng H 2013; 227:833-46. [DOI: 10.1177/0954411913489803] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The present study investigates the performance of ceramic-on-ceramic total hip replacements by combining a retrieval analysis with a survivorship analysis to elucidate mechanisms that led to clinical failure. Semiquantitative surface damage assessment, contact profilometry, contour measurements, and scanning electron microscopy were performed to characterize the types and quantify the extent of surface damage on the retrieved ceramic components. The implantation period was positively correlated with both damage scores of the femoral heads (R = 0.573, p < 0.001) and the acetabular cups (R = 0.592, p < 0.001). Increased maximal out-of-roundness values of the femoral heads correlated with both increased metal transfer damage score (R = 0.384, p = 0.023) and increased stripe damage score (R = 0.729, p ≤ 0.001) of the acetabular liners. The damage rate (damage score/year) for both the retrieved heads and acetabular liners was at least 2.2-fold greater at inclination angles of >45° than the damage rate at inclination angles of ≤45°. For the retrieved femoral heads only, the linear wear rate of 25.5 ± 21.3 µm/year at inclination angles of >45° was 6-fold greater than the linear wear rate of 4.2 ± 2.3 µm/year at inclination angles of ≤45°. Metal transfer on the ceramic bearing surface could possibly contribute to fluid-film starvation and, in combination with an increased inclination angle, may facilitate an adhesive wear mechanism associated with stripe surface damage. At our institution, the clinical survivorship of ceramic-on-ceramic total hip replacements was 98.9% (a total of 9 out of 815 patients were revised within 10 years after total hip arthroplasty) with revision as the end point, suggesting their safe use in younger patients.
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Affiliation(s)
- Jan-M Brandt
- Concordia Joint Replacement Group, Winnipeg, MB, Canada
| | | | | | - Andrew Allen
- School of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada
| | | | - Thomas R Turgeon
- Concordia Joint Replacement Group, Winnipeg, MB, Canada
- Orthopaedic Innovation Centre, Inc., Winnipeg, MB, Canada
| | - Eric R Bohm
- Concordia Joint Replacement Group, Winnipeg, MB, Canada
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Tsukada S, Wakui M, Matsueda M. Uncemented third-generation ceramic-on-ceramic total hip arthroplasty using metal acetabular shell with direct taper locking liner. Arch Orthop Trauma Surg 2013; 133:861-8. [PMID: 23508514 DOI: 10.1007/s00402-013-1724-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND The ceramic-on-ceramic (CoC)-bearing couple in total hip arthroplasty (THA) was developed to reduce the wear debris and osteolysis. Although the mechanical strength of third-generation ceramic has improved over previous generations, the risk of osteolysis and ceramic fracture is still an important concern. METHODS We studied 124 uncemented THAs with third-generation CoC-bearing couple implanted between 2000 and 2004. The ceramic liner and head were secured with the direct taper locking mechanism. One hundred and eleven hips were followed-up for minimum of 8 years, with an average follow-up period of 10.1 years (range 8.0-12.8 years). Patients were evaluated with a particular emphasis on the prevalence of the osteolysis and the ceramic fracture. RESULTS The survivorship with the end point as implant revision for any reason was 94.9 % (95 % confidence intervals 90.0-99.3 %) at 12.8 years. Revisions were performed because of one ceramic liner fracture, three dislocations, and two deep infections. No radiographic evidence of wear or osteolysis was observed. The preoperative Merle d'Aubigne and Postel hip score increased from 11.6 to 17.1. CONCLUSIONS Patients, who received third-generation CoC THA had no detectable wear and osteolysis. One ceramic fracture occurred, and the main reason for revision was dislocation.
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Affiliation(s)
- Sachiyuki Tsukada
- Department of Orthopaedic Surgery, Nekoyama Miyao Hospital, 14-7 Konan, Chuo-ku, Niigata, Niigata, 950-1151, Japan.
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Esposito C, Maclean F, Campbell P, Walter WL, Walter WK, Bonar SF. Periprosthetic tissues from third generation alumina-on-alumina total hip arthroplasties. J Arthroplasty 2013; 28:860-6. [PMID: 23489720 DOI: 10.1016/j.arth.2012.10.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 10/22/2012] [Accepted: 10/23/2012] [Indexed: 02/01/2023] Open
Abstract
The histological features of periprosthetic tissues are related to the bioreactivity of particles generated by the prosthesis. This study analyzed synovial-like pseudocapsules collected from 21 patients with alumina ceramic-on-ceramic hip arthroplasties and correlated histological features with wear of the ceramic bearings, duration of implantation and clinical factors such as neck-to-rim impingement. A histopathological classification system was developed for this purpose. The pseudocapsules were viable, with few foreign body type giant cells and occasional lymphocytes. This differs from tissues in polyethylene containing hip arthroplasties which often have extensive foreign body type inflammatory changes or from metal-on-metal hip arthroplasties in which extensive necrosis is common. Soft-tissue inflammation was not associated with failure of the hip arthroplasties, and may be clinically insignificant in alumina-on-alumina total hip arthroplasties.
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Molloy D, Jack C, Esposito C, Walter WL. A mid-term analysis suggests ceramic on ceramic hip arthroplasty is durable with minimal wear and low risk of squeak. HSS J 2012; 8:291-4. [PMID: 24082875 PMCID: PMC3470676 DOI: 10.1007/s11420-012-9291-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 06/22/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND The incidence of hip replacements in the younger patient is ever increasing. With this in mind, improving the longevity of hip arthroplasties is paramount. Alumina ceramic is a promising bearing surface due to its low wear rate and biological inertness. PURPOSE This study aims to review our experience with ceramic-on-ceramic total hip arthroplasty, reporting on the need for revision as well as the cause of failure. Our secondary purpose is to review our experience with the phenomenon of squeaking analysing and its effect on clinical outcome with specific emphasis on component positioning. Also reported are the results of our retrieval analysis of explanted components documenting the wear rate and our analysis of strip wear. METHODS A consecutive series of 301 primary cementless alumina-on-alumina total hip arthroplasties at a minimum of 10 years follow-up was reviewed. These arthroplasties all had third-generation ceramic-on-ceramic bearings performed through a posterior approach with repair of capsule and external rotators to bone. We analysed hips both clinically and radiographically. Analysis of wear in 62 ceramic bearings was performed using a Roundtest RA300 machine (Mitutoyo; Andover, UK), which has an accuracy of 0.01 μm. RESULTS Overall, the survival rate of the implants was 98% at 10 years. No ceramic fractures were encountered in this study. Seventy-four patients reported squeaking hips, and two cases were revised due to squeaking (0.6%). No failures were related to bearing wear. CONCLUSIONS We believe that ceramic-on-ceramic is a safe bearing coupling with excellent survivorship at 10 years.
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Affiliation(s)
- Dennis Molloy
- Sydney Hip and Knee Surgeons, North Sydney, New South Wales Australia
| | - Chris Jack
- Sydney Hip and Knee Surgeons, North Sydney, New South Wales Australia
| | | | - William L. Walter
- Sydney Hip and Knee Surgeons, North Sydney, New South Wales Australia
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40
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Long-term results of cementless hip arthroplasty with ceramic-on-ceramic articulation. INTERNATIONAL ORTHOPAEDICS 2012; 36:2225-9. [PMID: 22903410 PMCID: PMC3479287 DOI: 10.1007/s00264-012-1639-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Accepted: 07/28/2012] [Indexed: 12/19/2022]
Abstract
PURPOSE The goal of the study was to evaluate long-term results of hip arthroplasty in patients with ceramic-on-ceramic articulation. METHODS The follow-up involved 220 primary total hip arthroplasty procedures (188 patients, 101 women and 87 men) after implantation of the Mittelmeier cementless hip endoprosthesis. The mean age of patients at surgery was 44.5 years and the mean follow-up was 19.6 years, with a minimum of 12.3 years. Dysplastic, idiopathic and post-traumatic coxarthrosis were the most frequent forms of degenerative hip changes. The Merle d'Aubigné and Postel classification, as modified by Charnley, was used for clinical evaluation. RESULTS Very good results were obtained in 39.5 % of the patients, good results in 43.6 %, satisfactory results in 9.1 % and poor results in 7.8 %. Twelve-year survival for the whole prosthesis was 86.36 %, for the acetabulum 89.99 % and for the stem 91.36 %. CONCLUSIONS Long-term results of hip arthroplasty using the Mittelmeier prosthesis are fairly encouraging with their low incidence of loosened prosthesis components after surgery.
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