Introduction. Previous registry studies of ceramic-on-polyethylene (C-PE) and ceramic-on-ceramic (COC) have focused on revision outcomes following primary surgery. Less is known about the effect of
Introduction. Previous studies of ceramic-on-polyethylene (C-PE) and ceramic-on-ceramic (COC) hip bearings have focused on outcomes following primary surgery. Less is known about the utilization or outcomes of
Aims: Todayñs major challenge for total hip arthroplasty is to minimize wear and osteolysis in our younger and more active patients. Alumina
Today’s major challenge for total hip arthroplasty is to minimise wear and osteolysis in our younger and more active patients. Alumina
Aims Osteolysis from polythene debris contributes to loosening of total hip components. Will
Hydroxyapatite Ceramic Coated Hips (HAC) were first used in Sunderland, U.K. in May 1988. More than 1725 HAC hips have been inserted. There are 264 hips in 237 patients with ceramic/
Prosthetic joint infections (PJI) are a devastating consequence in total hip arthroplasties (THA) with both significant morbidity and sometimes mortality, posing a significant health economic burden. Studies, both clinical and in-vitro have suggested possible reduction in PJI with the use of
Aims. Will Hydroxyapatite hip (HA) arthroplasty associated with
Aim: Alumina ceramic on
Aim. Alumina ceramic on
Introduction. The success of total hip arthroplasty has meant its indications have been extended to the younger more active patient. Due to the higher activity levels and increased demands of these patients, revision rates have been traditionally higher than when compared to older patients [1]. Ceramic on
Large bearing surfaces are appealing in total hip arthroplasty (THA) as they may help create a greater range of impingement free motion and reduce the risk of dislocation. However, attempts to achieve this with a metal bearing surface have been blighted by adverse reactions to metal debris.
The CoCrMo large bearings had shown a high failure rate, because of metal ion and particle release. Alumina matrix composite (AMC) ball heads have shown to mitigate such phenomena. The aim of this study was to investigate the leaching properties of AMC clinically as well as experimentally. Two patient groups were compared: a control group (n=15) without any implant (Controls) and 15 Patients with unilateral treatment with Biolox delta ceramic-on-ceramic (CoC). Whole-blood samples of Controls and Patients (after 3 and 12 months from treatment with CoC) were measured by means of trace element analysis using a HR-ICPMS. The leaching behaviour of BIOLOX delta was also analysed in-vitro: five Biolox delta heads and five CoCrMo heads were immersed in serum for seven days at 37°C. Aluminium, cobalt, chromium and strontium were detected based on HR-ICPMS.Background
Methods
The objective of this study was to determine whether the bearing surface is a risk factor for revision after late dislocation in total hip arthroplasty (THA). Data from primary THAs were extracted from the New Zealand Joint Registry over a 13-year period. The mean age of patients was 68.9 years; 53.2% were female. The surgical approach used was posterior in 66% of THAs, lateral in 29% and anterior in 5%. There were 53,331 (65.1%) metal-on-polyethylene THAs, 14,093 (17.2%) ceramic-on-polyethylene, 8,177 (10.0%) ceramic-on-ceramic, 461 (0.5%) ceramic-on-metal, 5910, and (7.2%) metal-on-metal. The primary endpoint was late revision for dislocation, with ‘late’ defined as greater than one year post-operatively. 73,386 hips were available for analysis. The overall revision rate was 4.3% (3,130 THAs), 1.1% (836) were revised for dislocation. Only 0.65% (470) hips were revised for dislocation after the first post-operative year. The unadjusted hazard ratios (HR) showed significantly higher rates of revision for dislocation in ceramic-on-polyethylene (HR 2.48; p=0.001) and metal-on-polyethylene (HR 2.00; 95% p =0.007) compared to ceramic-on-ceramic. However, when adjusted for head size, age and surgical approach, only ceramic-on-polyethylene (HR 2.10; p=0.021) maintained a significantly higher rate of revision, whereas metal-on-polyethylene approached significance (HR 1.76; 95% p = 0.075). In New Zealand, dislocation is the most common reason for revision, ahead of aseptic loosening of the acetabular component. The relationships between bearing materials and risk of revision for late dislocation is controversial. However, in this study ceramic-on-ceramic shows lower risk rates for revision than other bearing surface combinations. Low wear and less debris, limited peri-articular inflammatory reaction and an healthy fibrotic pseudo-capsule are potential factors determining long-term stability of the hip joint.
Ceramic-ceramic articulations have been in used in total hip arthroplasty (THA) since 1970. Although the problems of wear were well recognised in the early days of hip replacement, early ceramic-ceramic implants were plagued by poor design, fixation problems and component fractures. Early designs were often uncemented with no biological coating to augment fixation. Loosening of one side of the joint or the other was common-place. Improvements in ceramic manufacturing were made and included improved purity, hot isostatic pressing and proof testing. The grain size, an indicator of toughness had dropped from 4.5 um in the 1970’s to 1.8 um in the 1990’s. Ceramic ball heads were approved in both alumina and zirconia in the late 1980’s for use on polyethylene. The hardness and toughness of ceramic pieces had now reached a new level of reliability, worthy of routine use in total hip replacements. Taper technology was also enhanced, resulting in proper load transfer to the ceramic parts. Fracture rates are estimated at 4/100 000. Stem fractures occur at a rate of 35 times higher. Wear studies label ceramic-ceramic bearings among the lowest in debris generation, up to 200 times less than metal on conventional polyethylene. Modern alumina-alumina ceramic THAs were developed and clinical trials began under the auspices of several FDA Investigational Device Exemptions (IDE). Two have been completed and await full approval from the FDA. With a much better understanding of the aspects of design coupled with successful fixation, both cemented and uncemented, ceramic components can be coupled with these implants with the potential for optimal survivorship. America, brace yourself for the next generation of THA that is truly new and improved.
The fourth generation ceramic, in which zirconia is incorporated into the alumina matrix, was developed to reduce the risk of ceramic fractures. The purpose of this study was to evaluate the survivorship, clinical and radiographic results, and bearing-related failures associated with total hip arthroplasty using zirconia-toughened alumina ceramic-on-ceramic bearings over a minimum follow-up of 5 years. We retrospectively analysed 135 patients (151 hips) who underwent cementless total hip arthroplasty using zirconia-toughened alumina ceramic-on-ceramic bearings. There were 58 men and 77 women with mean age of 55.9 years (range, 20 to 82 years) at index surgery. Acetabular and femoral components were cementless in all hips. A 36 mm head was used in 81 of 151 hips and a 32 mm head was used in 70 hips with smaller acetabular shells. The mean duration of follow-up was 6.1 years (range, 5 to 6.8 years).Purpose
Materials and methods
Patients with femoral heads of 32 mm and 36 mm diameter had excellent clinical results after 2 years follow-up for flexion angle, range of motion and Harris Hip Score. The Harris Hip Score increased from a pre-operative mean of 48.7 points to 93.5 points. Hip flex-ion increased from 91° to 113°. The Visual Analogue Scale for pain decreased from 6.7 to 0.9 and VAS for satisfaction increased from 3.2 to 9.3.
The choice to use alumina in the manufacture of a low-wear THR bearing made by Boutin and its co-workers has proven its effectiveness in almost 35 years of clinical use. A continuous development process aimed to improve mechanical properties led to today’s materials that exhibit extreme high reliability. The recent introduction in clinical use of alumina matrix composites represents the latest evolution of alumina that thanks to high hardness, toughness, and bending strength allow to manufacture new design of ceramic components. Composites obtained introducing zirconia in the alumina matrix, known as Zirconia Toughened Alumina (ZTA) are candidate for use in THA bearings from a long time. A real breakthrough was represented by alumina ceramics toughened both by zirconia both by platelets nucleated in-situ during sintering (Zirconia-Platelet Toughened Alumina - ZPTA). The chemical composition and the microstructure of ZPTA were optimised to achieve a ceramic material joining strength of more than 1200MPa, Vickers hardness 1975, fracture toughness of 6,5 MPa m-1/2, andextremely low wear also in the most severe simulator tests performed in microseparation mode The paper reviews the improvements introduced in the technology of ceramic for arthoplasty, and their effects on the microstructural properties and on the performances of the past and actual generation of ceramic for THR bearings, and summarise the results obtained in the development of alumina matrix composites.
The choice to use alumina in the manufacture of a low-wear THR bearing made by Boutin and its co-workers has proven its effectiveness in almost 35 years of clinical use. A continuous development process aimed to improve mechanical properties led to today’s materials that exhibit extreme high reliability. The recent introduction in clinical use of an alumina matrix composite developed by CeramTec and available under the trade name Biolox®Delta represents the latest evolution of alumina. This material allow new design in ceramic components thanks to its equilibrium among high hardness, high toughness, and high bending strength. Composites obtained introducing zirconia in the alumina matrix, known as Zirconia Toughened Alumina (ZTA) are candidate for use in THA bearings from a long time. A real breakthrough was represented by alumina ceramics toughened both by phase transformation both by platelets nucleated in-situ during sintering. Optimised processing and quality control led to optimised material behaviour. The chemical composition and the microstructure of Biolox®Delta were optimised to achieve a ceramic material joining strength of more than 1200 MPa, Vickers hardness 1975, fracture toughness of 6,5 MPam-1/2, and extremely low wear also in the most severe simulator tests performed in microseparation mode. The paper reviews the improvements introduced in the technology of ceramic for arthoplasty, and their effects on the microstructural properties and on the performances of the past and actual generation of ceramic for THR bearings, and summarise the results obtained in the development of alumina matrix composite Biolox® Delta.