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
This multicentre study analysed 12 alumina ceramic-on-ceramic
components retrieved from
We investigated factors that were thought to be associated with an increased incidence of
Objectives. Studies reporting specifically on
Noise generation has been reported with ceramic-on-ceramic
articulations in total hip replacement (THR). This study evaluated
208 consecutive Delta Motion THRs at a mean follow-up of 21 months
(12 to 35). There were 141 women and 67 men with a mean age of 59
years (22 to 84). Patients were reviewed clinically and radiologically,
and the incidence of noise was determined using a newly described
assessment method. Noise production was examined against range of
movement, ligamentous laxity, patient-reported outcome scores, activity
level and orientation of the acetabular component. There were 143
silent hips (69%), 22 (11%) with noises other than
Aims. This study reports the mid-term results of total hip arthroplasty (THA) performed using a monoblock acetabular component with a large-diameter head (LDH) ceramic-on-ceramic (CoC) bearing. Patients and Methods. Of the 276 hips (246 patients) included in this study, 264 (96%) were reviewed at a mean of 67 months (48 to 79) postoperatively. Procedures were performed with a mini posterior approach. Clinical and radiological outcomes were recorded at regular intervals. A noise assessment questionnaire was completed at last follow-up. Results. There were four re-operations (1%) including one early revision for insufficient primary fixation (0.4%). No hip dislocation was reported. The mean University of California, Los Angeles (UCLA) activity score, 12-Item Short-Form Health Survey (SF-12) Mental Component Summary (MCS) score, SF-12 Physical Component Summary (PCS) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and Forgotten Joint Score (FJS) were 6.6 (2 to 10), 52.8 (25.5 to 65.7), 53.0 (27.2 to 66.5), 7.7 (0 to 63), and 88.5 (23 to 100), respectively. No signs of loosening or osteolysis were observed on radiological review. The incidence of
Aims. Long-term clinical outcomes for ceramic-on-ceramic (CoC) bearings
are encouraging. However, there is a risk of
Introduction and Objective. Ceramic on Ceramic bearings in Total Hip Arthroplasty (THA) afford a low friction coefficient, low wear rates and extreme hardness. Significant complications include hip
Explanations for “bearing” noise in ceramic-on-ceramic hips (COC) included stripe-wear formation and loss of lubrication leading to higher friction. However clinical and retrieval studies have clearly documented stripe wear in patients that did not have
Introduction. Acetabular cup orientation has been shown to be a factor in edge-loading of a ceramic-on-ceramic THR bearing. Currently all recommended guidelines for cup orientation are defined from static measurements with the patient positioned supine. The objectives of this study are to investigate functional cup orientation and the incidence of edge-loading in ceramic hips using commercially available, dynamic musculoskeletal modelling software that simulates each patient performing activities associated with edge-loading. Methodology. Eighteen patients with reproducible
The April 2014 Hip & Pelvis Roundup. 360 . looks at: Recent arthroplasty and flight; whether that
Introduction. Squeaking is a potential problem of all hard on hard bearings yet it has been less frequently reported in metal-on-metal hips. We compared a cohort of 11
INTRODUCTION. Squeaking after total hip replacement has been reported in up to 10% of patients. Some authors proposed that sound emissions from
The problem associated with ceramic on ceramic total hip replacement (THR) is audible noise. Squeaking is the most frequently documented sound. The incidence of
The use of hard-on-hard bearings, including ceramics peaked in the mid 2000's and has seen rapid decline since that time. Ceramics are not new to the market place but have had a 40 year history outside the U.S. The basis for renewed enthusiasm for ceramics included improved manufacturing, improved taper tolerances, higher strength, and lower wear. In spite of the major improvements concerns have been expressed with new generation ceramics by the experts and thought leaders in the field. The major concerns included complications related to modularity, continued problems with fracture and consequences of fracture, limited surgical options, and
At the present time, there is no bearing in total hip arthroplasty that a surgeon can present to a younger and/or more active patient as being the bearing that will necessarily last them a lifetime. This is the driver to offering alternative bearings (crosslinked polyethylene with either a CoCr or ceramic head, resurfacings, and ceramic-on-ceramic) to patients. Each of these bearings has pros and cons, and none has emerged as the clear victor in the ongoing debate. Ceramic-on-ceramic (CoC) bearings have been available for decades. Earlier generation CoC bearings did encounter problems with rare fractures, however, with a greater understanding and improvement in the material, the fracture incidence has been significantly reduced. However, what has emerged in the past few years is an increasing reporting of significant
Introduction. One of the most common complications of ceramic on ceramic hip replacement is
Alumina ceramic-ceramic bearings have the benefit of very low wear and studies showing the complete absence of osteolysis during the first decade of close study. However, good results depend on several critical factors including surgical exposure, surgical technique, component placement, and choice of component design. The following abstract discusses our experience with several of these factors. Initially, there were concerns that the use of ceramic-ceramic bearings would lead to a higher incidence of hip dislocation since the bearings have fewer femoral head-length choices and the absence of lipped-liners. In our prospective study of 418 hips the incidence of hip dislocation at 1 to 10 year followup is 0.5% (2/418). This experience suggests that the use of alumina ceramic-ceramic bearings is not associated with an increased incidence of dislocation. More recently, concerns about
Introduction: Squeaking after total hip replacement has been reported in up to 10% of patients. Some authors proposed that sound emissions from
Ceramic-on-ceramic (CoC) total hip arthroplasty (THA) can produce articular noise during the normal activities, generating discomfort to the patient. THA noise has to be investigated also as a potential predictor and a clinical sign of prosthetic failure. An observational study has been carried out to characterize the noise in CoC cementless THA, and to analyze the related factors. A total of 46 patients with noisy hip have been enrolled in 38 months, within the follow-up protocol normally applied for the early diagnosis of ceramic liner fracture [1]. Noise recording was based on a high-quality audible recorder (mod. LS 3, Olympus, Japan) and a portable ultrasonic transducer (mod USB AE 1ch, PAC, USA). The sensors for noise recording were applied to the hip of the patient during a sequence of repeatable motorial activities (forward and backward walking, squat, sit in a chair, flexion and extension of the leg). Sessions were also video-recorded to associate the noise emission to the specific movements. Each noise event was initially identified by the operator and therefore classified by comparison to the spectral characteristics (duration, intensity and frequency) of the main noise types. Number and spectral characteristics of noise events were obtained and correlated to the factors describing the clinical status of the patient, the surgical approach, the prosthetic device implanted. The study investigated also the noise as a sign of implant failure, by comparison with the total number of implants failed in the cohort during the study. We observed three types of noise with the main spectral characteristics in agreement to the literature: clicking,
Ceramic-on-ceramic bearings in hip replacement have low rates of wear and are increasingly being used in young adults. Our aim was to determine the incidence of audible phenomena or other bearing-related complications. We retrospectively analysed 250 ceramic-on-ceramic hip replacements in 224 patients which had been implanted between April 2000 and December 2007. The mean age of the patients at operation was 44 years (14 to 83) and all the operations were performed using the same surgical technique at a single centre. At a mean follow-up of 59 months (24 to 94), the mean Oxford hip score was 40.89 (11 to 48). There were six revisions, three of which were for impingement-related complications. No patient reported
Background: Squeaking in hip arthroplasty is a phenomenon that was described decades ago, but has only been brought back to attention recently. It occurs predominantly in ceramic on ceramic bearings, and has a reported incidence from less than 1% to 21%. The cause and the implication of
Polyimide (MP-1, MMATech, Haifa, Israel), is a high performance aerospace thermoplastic used for its lubricity, stability, inertness and radiation resistance. A wear resistant thin robust bearing is needed for total hip arthroplasty (THR). After independent laboratory testing, in 2006, the author used the material as a bearing in two Reflection (Smith and Nephew, USA) hip surgeries. The first, a revision for polyethylene wear, survives with no evidence of wear, noise, new osteolysis or complications related to the MP-1 bearing after 16 yrs. The second donated his asymptomatic MP-1 hip at 6.5yrs for post-mortem examination. There were no osteoclasts, cellular reaction bland in contrast to that of polyethylene. In 2013 a clinical study with ethical committee approval was started using a Biolox Delta (Ceramtec, Germany) head against a polyimide liner in 97 patients. MMATech sold all liners, irradiated: steam 52:45. Sixteen were re-machined in New Zealand. Acetabular shells were Delta PF (LIMA, Italy). The liner locked by taper. The cohort consisted of 46:51 M:F, and ages 43 to 85, mean 65. Ten received cemented stems. For contralateral surgery, a ceramic or polyethylene liner was used. Initial patients were lower demand, later, more active patients, mountain-biking and running. All patients have on-going follow up, including MP-1 liner revision cases. There has been no measurable wear, or osteolysis around the acetabular components using weight-bearing radiographs. Squeaking within the first 6 weeks was noted in 39 number of cases and subtle increase in palpable friction, (passive rotation at 50 degrees flexion), but then disappeared. There were 6 revisions, four of which were related to cementless Stemsys implants (Evolutis, Italy) fixed distally with proximal linear lucencies in Gruen zones 1 and 7, and 2 and 6. No shells were revised and MP-1 liners were routinely changed to ceramic or polyethylene. The liners showed no head contact at the apex, with highly polished contact areas. There were no deep or superficial infections, but one traumatic anterior dislocation at 7 years associated with 5 mm subsidence of a non-collared stem. The initial
Squeaking in ceramic on ceramic bearing total hip arthroplasty is well documented but its aetiology is poorly understood. In this study we have undertaken an acoustic analysis of the
Squeaking of ceramic-on-ceramic (CoC) hips is a clinical phenomenon that is concerning with regard to the long term performance of these joint devices. Investigations into the cause of the
Introduction. The Delta Motion device (developed by Finsbury Orthopaedics, Leatherhead, United Kingdom, now manufactured by DePuy, Leeds, United Kingdom) is a pre-assembled factory fitted cup. It has been introduced to overcome some of the concerns relating to intra-operative assembly with improper seating of the liner and chipping. This device has a thinner shell and liner in comparison with other cups, allowing the use of larger sized heads which should help reduce the risk of impingement and dislocation. A drawback of the pre-assembled design is the inability to use supplementary screws to achieve stability and the difficulty in obtaining primary stability compared with a thin titanium shell. To date we are not aware of any publications reviewing the outcomes of these devices. Methods. 206 DeltaMotion cups were implanted in 195 patients, between Dec 2008 to Dec 2009 by the three senior authors. All the hips had the same stem (Osteonics) and a ceramic head was used. Data was prospectively collected and we reflect on our two year results. Results. A total of 206 cups (123 F: 83 M) were implanted in 195 patients. The mean age at implantation was 69 years (range 38–93). 11 patients had bilateral hips (6M:5F). Complications were 1 pulmonary embolism, 2 femoral stem subsidence, 1 dislocation, 2 femoral fractures, 13
Squeaking in ceramic total hip joint replacements has become a controversial topic. This study aims to document the incidence of
At the present time, there is no bearing in total hip arthroplasty that a surgeon can present to a younger and/or more active patient as being the bearing that will necessarily last them a lifetime. This is the driver to offering alternative bearings (crosslinked polyethylene with either a CoCr or ceramic head, resurfacings, and ceramic-on-ceramic) to patients. Each of these bearings has pros and cons, and none has emerged as the clear victor in the ongoing debate. Ceramic-on-Ceramic (CoC) bearings have been available for decades. Earlier generation CoC bearings did encounter problems with rare fractures, however, with a greater understanding and improvement in the material, the fracture incidence has been significantly reduced. However, what has emerged in the past few years is an increasing reporting of significant
Hip arthroplasty surgeons have various bearing choices to make on behalf of their patients. We make those choices based on our knowledge of pre-clinical wear testing data and the outcome of clinical and radiological follow-up studies. The initial use of conventional polyethylene revealed limitations in its use in younger patients. Modern highly crosslinked polyethylene is a vastly improved bearing surface that means less wear and its consequences. Despite this, registry data still suggests that loosening, lysis and dislocation are problematic causes of implant failure. The functional success of hip replacement surgery, the ageing population and younger patients requesting arthroplasty means we should predict ongoing issues consequent to wear related events even with the newer polyethylenes. Ceramic-on-ceramic bearings surfaces have a long history of successful clinical use. The benefits of ceramic bearings are its superior wear characteristics, the minimal biological response to the ceramic wear products and the ability of ceramics to be offered in larger head sizes. Its limitations have been reports of fracture and
Previous clinical studies have documented the incidence of
While alumina ceramic-ceramic THA has been performed in the US for more than 12 years, the phenomenon of frequent, clinically reproducible
Audible
Ceramic on ceramic articulations had been used since 1970s but with high failure rate. More recent third generation alumina ceramic had improved results due to better material properties to resist wear and fracture and better methods of fixation with metal back acetabular components. A new clinical problem of
Introduction: The goal of the study was to compare the
This study assesses the incidence of noise in ceramic on ceramic (COC) bearings compared to metal on polyethylene (MOP) bearings. Noise after MOP implants has rarely been studied and they never been linked to
Ceramic-on-ceramic bearings provide a solution to the osteolysis seen with traditional metal-on-polyethylene bearings. Sporadic reports of ceramic breakage and
Squeaking in hip arthroplasty is now well-documented but hitherto poorly understood. In this paper, we report data progressively accumulated from a series of studies undertaken by our group to investigate the mechanisms of noise production associated with ceramic-on-ceramic bearings. We reviewed demographic and radiographic data comparing
Aims. We conducted a prospective study of a delta ceramic total hip
arthroplasty (THA) to determine the rate of ceramic fracture, to
characterise post-operative noise, and to evaluate the mid-term
results and survivorship. Patients and Methods. Between March 2009 and March 2011, 274 patients (310 hips) underwent
cementless THA using a delta ceramic femoral head and liner. At
each follow-up, clinical and radiological outcomes were recorded.
A Kaplan-Meier analysis was undertaken to estimate survival. Results. Four patients (four hips) died and 18 patients (20 hips) were
lost to follow-up within five years. The remaining 252 patients
(286 hips) were followed for a mean of 66.5 months (60 to 84). There
were 144 men (166 hips) and 108 women (120 hips) with a mean age
of 49.7 years (16 to 83) at surgery. The mean pre-operative Harris
Hip Score of 47.1 points improved to 93.8 points at final follow-up.
Six patients reported
The link between
Young patients have been reported to have a higher risk of revision following total hip arthroplasty than older cohorts. This was attributed to the higher activity level which led to increased wear, osteolysis, and component fracture. We prospectively assessed the clinical results, wear and osteolysis, the incidence of
The purpose of this study is to analyze clinical and radiological results of total hip arthroplasty using the 3rd generation ceramic on ceramic articular surface. Between July 1999 and May 2005, 339 hips of 250 patients had primary cementless total hip arthroplasty with the 3rd generation ceramic on ceramic bearing implants. And 325 hips of 236 patients were followed up over 3 years. Male were 168 patients(237 hips) and female were 68 patients(88 hips). The mean age at the time of operation was 47.3(range, 25~76) years old and the mean follow up period was 62.4(range, 36~107.6) months. The preoperative diagnoses were osteonecrosis of the femoral head (ONFH) in 250 hips, secondary osteoarthritis in 55 hips(dysplasia in 35, infection sequalae in 12, LCP in 2, CDH in 2), hemophilic arthropathy in 9 hips, ankylosing spondylitis in 7 hips etc. We used Bicontact system(Aesculap, Germany) in 65 hips, Secur-FitTM(Stryker Howmedica Osteonics, USA) in 206 hips, Trilogy ABTM (Zimmer, USA) in 54 hips. Clinically, Harris Hip Score, thigh pain,
Ceramic-on-ceramic bearings provide a solution to the osteolysis seen with traditional metal-on-polyethylene bearings. Sporadic reports of ceramic breakage and
Squeaking ceramics bearing surfaces have been recently recognised as a problem in total hip arthroplasty. The position of the acetabular cup has been alluded to as a potential cause of the
Acoustic emission is an uncommon but well-recognised phenomenon following total-hip arthroplasty using hard-on-hard bearing surfaces. The incidence of
Background. Theoretically, improved material properties of new alumina matrix composite (AMC) material, Delta ceramics, are expected to decrease concerns associated with pure alumina ceramics and allow manufacturing thinner liners and consequent larger heads. However, limited short-term clinical results are available and mid-term results of these effects are unclear. Questions/Purposes. (1) Does AMC material decrease the rate of ceramic fracture and noise, concerns of previous-generation ceramics, following change of material properties? (2) Does the possible use of larger heads consequent to manufacturing thinner liners decrease dislocation rate and affect inguinal pain? (3) Do any other complications associated with the use of AMC ceramics occur?. Materials and Methods. One-hundred cementless primary total hip arthroplasties (THAs) using AMC ceramic bearings were performed consecutively by single surgeon. The mean follow-up period was 5.4 years (range, 5.0 to 5.7) and average age at the time of arthroplasty was 54.7 years. Prostheses with identical design and Biolox® Delta ceramics were used in all patients. Clinical evaluation included the occurrence of inguinal pain and noise which was classified into
Large diameter metal-on-metal (MOM) bearings are becoming increasingly popular for young, active patients. Clearance is a particularly important consideration for designing MOM implants, considering historical experience of equatorial contact and high frictional torque. Lubrication theory predicts increasing the clearance will result in diminished lubrication, resulting in increased friction and wear. Clinical cases of transient
There are pros and cons of all bearing surface options for our young patients. I pick the bearing surface for my young patients trying to maximise durability and minimise risks. For the ultra-young, ≤30 years of age patient, I use ceramic-on-ceramic. The pros of this are the best wear couple available and a favorable track record (with well designed implants). The risks can be minimised: fracture risk now decreased, runaway wear minimised with good surgical technique, impingement problems minimised with good technique and well designed implants, as well as
The leading cause for total hip arthroplasty (THA) revision remains aseptic loosening due to bearing wear. The younger and more active patients currently undergoing arthroplasty present unprecedented demands on THA-bearings. Ceramic-on-ceramic (CoC) bearings have consistently shown the lowest wear rates. The recent advances, especially in alumina CoC bearings, have solved many past problems and produced preferable results in vitro. Alumina ceramics are extremely hard, scratch resistant, biocompatible, offer a low coefficient of friction, superior lubrication and lower wear rates in comparison to other bearings in THA. The major disadvantage of ceramics used to be fracture. The new generation of alumina ceramics, has reduced the risk of ball fracture to 0.03–0.05%. The risk for liner fracture is even lower. Assuming an impingement-free component implantation, CoC bearings have major advantages over other bearing combinations. Due to the superior hardness, CoC bearings produce less third body wear and are virtually impervious to damage from instruments during the implantation process. A complication specific to CoC bearings is
Squeaking is a rare complication of hard-on-hard hip bearings. Occasionally the noise is troublesome enough to warrant revision surgery. The purpose of this study is to contribute to the understanding of the mechanism(s) underlying
Squeaking has become a more common problem following hard on hard bearings in total hip replacements. Although most
Introduction. Long term results of Total Hip Arthroplasty (THA) are affected by wear of articulation. Ceramic on ceramic articulation have been used especially for young patients because of its low wear and bio-inert property. However, because of its hardness, it is concerned that ceramic fracture, chipping, or
While total hip arthroplasty (THA) has been shown successful at relieving pain and improving function in patients with coxarthrosis, wear and instability remain leading causes for revision surgery. Highly crosslinked polyethylene (HXPE) has significantly reduced wear and osteolysis but volumetric wear associated with the use of larger diameter ball heads may be an issue in the long-term. Finally, concerns with femoral taper corrosion have increased the utilization of ceramic ball heads in recent years. Ceramic on ceramic articulations are optimised for both minimizing implant wear and instability. It is biocompatible, wettable, and possesses the lowest in vitro and in vivo wear rates among all bearing couples. In fact, wear rates are lowest when the ceramic ball head size is maximised. Additionally, modern ceramic on ceramic THA designs have had an excellent clinical track record with low rates of loosening, failure, and no reports of osteolysis in even highly active, young patients. Concerns with ceramics center around issues related to fracture risk,
Total hip arthroplasty (THA) in patients with developmental dysplasia of the hip (DDH) has been associated with increased rates of complications and revision. Hip instability and wear-induced osteolysis are among the more common and serious of these problems. The current investigation prospectively assessed the survivorship and clinical results of patients with DDH treated by alumina ceramic-ceramic THA. We investigated 161 consecutive hips in 145 patients with DDH classified as Crowe type I (131 hips, 81%), II (26 hips, 16%), III (2 hips, 1%), and IV (2 hips, 1%). All patients had an uncemented titanium acetabular component with a flush mounted alumina ceramic-ceramic bearing. The mean age at operation was 48.0 ± 12.2 years (range, 18 – 79 years). The preoperative Merle d'Aubigné score was 11.4 ± 1.7 (6 – 15). 27 hips (17%) had at least one previous surgical procedure. 92 hips (57%) were replaced with the use of surgical navigation for acetabular component positioning. The mean cup diameter was 49.9 ± 3.4 mm (46 – 60 mm). 88 (55%) bearings were 28mm and 73 (45%) bearings were 32mm. At a mean follow-up of 6.1 ± 2.5 years (2 – 11.3 years), the mean Merle d'Aubigné score was 17.4 ± 0.9 (14 – 18). There were no cases of osteolysis or dislocation. There was one reoperation of an early displaced cup. In addition, there was one calcar crack that was cerclaged, one intraoperative trochanteric fracture also repaired at surgery. No patient complained of
Introduction: Squeaking is reported ceramic-on-ceramic hip bearings in association with acetabular component malposition – particularly too much or too little anteversion. Acoustic analysis of
The use of cementless acetabular components is currently the gold standard for treatment in total hip arthroplasty (THA). Porous coated cups have a low modulus of elasticity that enhances press-fit and a surface that promotes osseointegration. Monoblock acetabular cups represent a subtype of uncemented cup with the liner moulded into the metal shell, minimizing potential backside wear and eliminating the chance of mal-seating. The aim of this study was to compare the short-term clinical and radiographic performances of a modular cup with that of a monoblock cup, with particular interest in the advent of lucent lines and their correlation with clinical outcomes. In this multi-surgeon, prospective, randomized, controlled trial, 86 patients undergoing unilateral THA were recruited. Participants were randomized to either a porous-coated, modular metal-on-polyethylene (MoP) acetabular component (n=46) or a hydroxyapatite (HA)- and titanium-coated monoblock shell with ceramic-on-ceramic (CoC) bearing (n=42). The porous-coated cup had an average pore size of 250 microns with an average volume porosity of 45%, whereas the monoblock shell had an average pore size of 300 microns with an average volume porosity of 48% and a HA coating thickness of 80 nm. There were no baseline demographic differences between both groups regarding sex, age, body mass index (BMI), or American Society of Anaesthesia (ASA) class (p>0.05). All of the sockets were under-reamed by 1 mm. Radiographs and patient-reported outcome measures (PROMs), including modified Harris Hip Score (mHHS), Western Ontario and McMaster Universities Arthritis Index (WOMAC) and University of California at Los Angeles (UCLA) Hip Score, were available for evaluation at a minimum of 2 years of follow-up. A radiolucent distance between the cup and acetabulum of ≥0.5 mm was defined as gap if it was diagnosed from outset or as radiolucency if it had sclerotic edges and was found on progressive x-ray analyses. Thirty-two gaps (69%) were found in the modular cup group and 28 (6%) in the monoblock one (p=0.001). Of the former, 17 filled the gaps whereas 15 turned into a radiolucency at final assessment. Of the latter, only 1 of the gaps turned into a radiolucency at final follow-up (p 0.05) in both groups. Only the porous-coated cup was an independent predictor of lucent lines (OR:0.052, p=0.007). No case underwent revision surgery due to acetabular loosening during the study period. Only 2 cases of
Total hip arthroplasty (THA) in patients with developmental dysplasia of the hip (DDH) has been associated with increased rates of complications and revision. Hip instability and wear-induced osteolysis are among the more common and serious of these problems. The current investigation prospectively assessed the clinical results and the survivorship of patients with DDH treated by alumina ceramic-ceramic THA. We investigated 164 consecutive hips in 147 patients with DDH. Twenty-five hips (15%) had prior surgery to improve acetabular coverage, 108 hips (66%) were classified as Crowe type I, 21 (13%) as type II, and 10 (6%) as type III. All patients had an uncemented titanium acetabular component with a flush mounted alumina ceramic-ceramic bearing and were treated between 1997 and 2006. The mean age at operation was 48.5 ± 12.2 years (range, 18–75 years). The preoperative Merle d’Aubigné score was 11.3 ± 1.6 (6–15). Ninety-four hips (57%) were replaced with the use of surgical navigation for acetabular component positioning. The mean cup diameter was 51.2 ± 3.9 mm (46–60 mm). Seventy-seven (47%) bearings were 28mm and 87 (53%) bearings were 32mm. At a mean follow-up of 4.5 ± 2.3 years (2–10 years), the mean Merle d’Aubigné score was 17.5 ± 1.2 (14–18). There were no cases of osteolysis or dislocation. There was one reoperation of an early displaced cup. In addition, there was one calcar crack that was cerclaged, one intraoperative trochanteric fracture also repaired at surgery. No patient complained of
Introduction. Modern ceramic-on-ceramic bearings have become attractive alternatives to conventional polyethylene due to their low wear and minimal particle production. However, ceramic-on-ceramic implants have been associated with ceramic fracture and
Introduction. Dislocation due to suboptimal cup positioning is a devastating complication in the early phase after total hip arthroplasty. Malpositioning can also result in other mechanical complications like subluxation, edge loading, increased debris, surface damage or
Total hip arthroplasty (THA) is one of the most successful and commonly performed surgical interventions worldwide. Based on registry data, at one-year post THA, implant survivorship is nearly 100% and patient satisfaction is 90%. A novel, porous coated acetabular implant was introduced in Europe and Australia in 2007. Several years after its introduction, warnings were issued for the system when used with metal-on-metal bearings due to adverse local tissue reaction, with one study reporting a 24% failure rate (Dramis et al. 2014). A subsequent 2018 study by Teoh et al. showed that the acetabular system had a survival rate of 98.9% at five years when used with conventional polyethylene or ceramic bearing surfaces. The current study was conducted to determine the safety and effectiveness of the acetabular system using standard highly-crosslinked polyethylene (XLPE) and ceramic liners at five-year follow-up. Our hypothesis was that the acetabular system would exhibit survivorship comparable to other acetabular components on the market at five-year follow-up. A prospective, non-randomized study was conducted from February 2009 to June 2017 at eight sites in Canada and the USA. One hundred fifty-five hips were enrolled and 148 hips analyzed after THA indicated for degenerative arthritis. At five-year follow-up, 103 subjects remained for final analysis. All patients received a zero, three, or multi-hole R3 acetabular shell with Stiktite porous coating (Smith & Nephew, Inc., Memphis, TN, USA). Standard THA surgical techniques were employed, with surgical approach and either of a XLPE or ceramic bearing surface chosen at the discretion of the surgeon. The primary outcome was revision at five-years post-op with secondary outcomes including the Harris Hip Score (HHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), radiographic analysis, and post-operative adverse events. Data and outcomes were analyzed using summary statistics with 95% confidence intervals, t-tests, and Wilcoxon Rank tests. At five-year follow-up the overall success rate was 97.14% (95% CI: 91.88–100). When analyzed by liner type, the success rate was 96.81% (95% CI: 90.96–99.34) for polyethylene (n=94) and 100% (95% CI: 71.51–100) for ceramic (n=11), with no significant difference between either liner type (p=1). There were three revisions during the study (1.9%), two for femoral stem revision post fracture, and one for deep infection. The HHS (51.36 pre-op, 94.50 five-year), all 5 HOOS sub-scales, and WOMAC (40.9 pre-op, 89.13 five-year) scores all significantly improved (p < 0 .001) over baseline scores at all follow-up points. One (0.7%) subject met the criteria for radiographic failure at one-year post-op but did not require revision. Six (1.8%) of the reported adverse events were considered related to the study device, including four cases of
Due to issues related to osteolysis which became increasingly evident in the 1990's, approaches to combat wear focused upon either improving ultra-high molecular grade polyethylene or to abandon it and employ alternative bearings: metal upon metal or ceramic upon ceramic (COC). Ceramics have played a role in hip bearings for decades with much of the experience coming from Europe. While there is consistent evidence of low wear rates in this bearing couple due to its surface hardness, wettability and resultant low friction, problems unique to this bearing couple were noted: a small but real incidence of fracture, surface damage due to metal transfer and stripe wear as well as the unique issue of
Since 1999 we have adopted the ceramic on ceramic bearing in total hip arthroplasty. We started with sandwich liners, abandoned afterwards in favor of all ceramic liners. We witnessed the progressive evolution of the diameters of the femoral heads from 28 mm to the actual 40 mm. Out of more than 500 implants, we experienced 1 case of fracture of the ceramics, 5 cases of
Osteolysis is one of a major cause of failure that affect long term survival rate in THA. Hard-on-hard bearing surface were developed to reduce wear and osteolysis, such as ceramic-on-ceramic which is the lowest wear rate was introduced but it still has
The recent introduction of modern ceramic-on-ceramic total hip arthroplasties have demonstrated excellent clinical and radiographic results without catastrophic failure such as implant fracture associated with earlier designs. In laboratory wear testing, ceramicon-ceramic provides the least volumetric wear among all bearing surfaces. In recent years, with modern ceramic-on-ceramic bearing surfaces, clinical results with 5-to 7-year follow up have been good to excellent in 95–97% of cases. In spite of excellent results, certain limitations still exist including occasional fracture, stripe wear,
Introduction. Porous coated cups have a low modulus of elasticity that enhances press-fit and a surface that promotes osseointegration as well as permitting modularity. Monoblock ceramic acetabular cups represent a subtype of uncemented cup permitting the use of large femoral heads. The aim of this study was to compare the short-term clinical and radiographic performances of both cups. Methods. This was a prospective RCT of 86 unilateral THA patients (M: 40, F: 48; mean age: 59.5 ± 10.6) randomized to either a porous-coated, modular metal-on-polyethylene (MoP) acetabular component (pore size 250µm, 45% mean volume porosity)(n=46) or a hydroxyapatite (HA) and titanium-coated monoblock shell with ceramic-on-ceramic(CoC) bearing (pore size 300µm, 48% mean volume porosity & 80nm HA coating thickness)(n=42). All sockets were under-reamed by 1 mm. Two-year radiographs and patient-reported outcomes (PROMs) were available. Results. Thirty-two (69%) and 28 (6%) gaps were found in modular cup and monoblock groups, respectively (p=0.001). For the modular, 17 filled the gaps, whereas 15 turned into radiolucency; for the monoblock, 1 of the gaps turned into radiolucency at final follow-up (p<0.001). Complete shell-to-bone contact without radiolucent lines was seen in 30 (65%) porous-coated cups and in 41 (98%) HA shells (p<0.001). There were no associations between presence of lucent lines and PROMs (mHHS, WOMAC and UCLA) (p>0.05) in both groups. Modular cup group was an independent predictor of developing lucent lines (OR: 19.1, p= 0.007). No case underwent revision surgery due to acetabular loosening. There were 2 cases of
Aluminia ceramic on ceramic (COC) bearing surfaces have been used for 35 years in total hip arthroplasty (THA). Studies report 85% survival at a minimum follow-up of 18.5 years. Nonetheless, an audible noise is a finding associated with COC bearings with incidence rates of 2–10%. This study aims to determine the prevalence of noise and evaluate its effect on patients. All patients who had a COC THA from August 2003 to December 2010 were contacted and asked to complete a standardised questionnaire. This asked about the presence and characteristics of a noise and if associated with activities, pain and whether this phenomenon should be mentioned preoperatively. Four consultant surgeons performed 282 consecutive primary COC THAs in 258 patients. (Male=122, Female=136 mean age 68.5; age range 28–88). In all cases, the same brand of ceramic acetabular component and stems were implanted. 11.0% had a noise, of which 5.5% had a
INTRODUCTION. Young patients (< 50 years old) have been reported to have a higher risk of revision following total hip arthroplasty (THA) than older patient cohorts, possibly to due higher activity, a higher incidence of deformity and greater probability of prior surgery. Ceramic-on-ceramic bearing surfaces have been proposed for use in young and active individuals due to their low wear, low risk of adverse biologic reaction, and long-term survivorship. We assessed the clinical results and long-term survivorship of uncemented ceramic-on-ceramic THA in a young patient population. METHODS. Between August 1999 and December 2007, 220 total hip arthroplasties in 191 patients under 50 years of age at the time of surgery were performed using alumina ceramic-ceramic bearings as part of a prospective, non-randomized study. All patients received uncemented acetabular components with flush-mounted acetabular liners using an 18 degree taper, and uncemented femoral components. The average patient age at the time of surgery was 42.1 ±7.2 years (range: 17.4 years to 49.9 years), and the average time to follow-up was 10.1 ±2.4 years (range: 4.2 years to 15.2 years). We evaluated implant-related complications and performed Kaplan-Meier analyses to determine survivorship of the THA components with revision for any reason as the endpoint. RESULTS. There were no dislocations or failures due to osteolysis or aseptic loosening. There was one patient death not related to the THA procedure. Through 15-years, the Kaplan-Meier survivorship of all components was 94.9% (CI: ±8.0) with 8 revisions (3.6%) of either the cup, the stem, or both. For the acetabular component, the 15-year survivorship was 97.0% (CI: ±6.1) and included 4 revisions (1.8%), and 98.1% (CI: ±1.9) for the femoral component including 4 revisions (1.8%). One patient had both the femoral and acetabular components revised. There were two liner fractures (0.59%) and one head fracture (0.3%), two of which were sustained as a result of a fall from significant height. There were three failures of osseointegration (1.3%), and one acetabular component dislodged (0.4%) immediately following surgery. Two patients reported non-reproducible
INTRODUCTION. Ceramic-on-ceramic hip resurfacing offers a bone conserving treatment for more active patients without the potential metal ion risks associated with resurfacing devices. The Biolox Delta ceramic material has over 15 years of clinical history with low wear and good biocompatibility but has been limited previously in total hip replacement to 48mm diameter bearings [1]. Further increasing the diameter for resurfacing bearings and removing the metal shell to allow for direct fixation of the ceramic cup may increase the wear of this material and increase the risk of fracture. METHODS. Eighteen implants (ReCerf™, MatOrtho, UK; Figure1) were wear tested; six were ⊘40mm (small) and twelve ⊘64mm (large). All small and six large implants were tested under ISO 14242 standard conditions for 5 million cycles (mc) at 30° inclination (45° clinically). The six remaining large implants were tested under microseparation conditions in which rim contact was initiated during heel strike of the gait cycle for 5mc. Cups were orientated at 45° inclination (60° clinically) to allow for separation of the head and cup with a reduced 50N swing phase load and a spring load applied to induce a 0.5mm medial-superior translation of the cup. Wear was determined gravimetrically at 0.5mc, 1mc and every mc after. RESULTS. Wear was low in both standard and microseparation tests, less than 1mm. 3. cumulatively over 5mc (Figure 2). Standard conditions showed a run-in wear phase over the first mc followed by negligible wear in both diameters. The run-in wear significantly increased from 0.2mm. 3. /mc in the 40mm diameter bearings to 0.5mm. 3. /mc with the larger diameter implants. Under microseparation conditions, there was low wear over the first mc, increasing to 0.28mm. 3. /mc between 1–3mc. The wear rate reduced to 0.11mm. 3. /mc from 3=5mc. Stripe wear was evidenced on the microseparated components. There were no incidences of fracture or
Introduction. The purpose of this study was to compare pre-operative acetabular cup parameters using this novel dynamic imaging sequence to the Lewinnek safe zone. Methods. We retrospectively reviewed 350 consecutive primary THAs that underwent dynamic pre-operative acetabular cup planning utilizing a pre-operative CT scan to capture the individual's hip anatomy, followed by standing (posterior pelvic tilt), sitting (anterior pelvic tilt), and supine X-rays. Using these inputs, we modeled an optimal cup position for each patient. Radiographic parameters including inclination, anteversion, pelvic tilt, pelvic incidence, and lumbar flexion were analyzed. Results. Mean age of patients was 63 years (range, 18 to 95). Mean supine pelvic tilt was 4.7o (range, −31o to 21o), standing pelvic tilt was −0.3o (range, −33o to 23o), and flex-seated pelvic tilt was −0.7o (range, −42o to 32o). Mean pelvic incidence was 54o (range, 24o to 88o) and mean lumbar flexion was 43o (range, 0o to 78o). Mean inclination was 40° (range, 34 to 49) and mean anteversion was 24° (range, 3.5 to 39). Only 56% of the dynamically planned cups were within the Lewinnek safe zone (p<0.05, Figure 1). Mean inclination and anteversion difference between dynamic and Lewinnek safe zone was 1.3o (range, 0o to 12o) and 8.9o (range, 0o to 25o), respectively. Conclusion. Our study demonstrates that historical target parameters for cup inclination and anteversion significantly differ to target values obtained with the use of functional imaging. Understanding the individual spinopelvic motion for each patient allows for more accurate placement of the acetabular component, which may help to reduce the risk of dislocation, premature wear and
Introduction. Wear performances and fracture toughness of the alumina-matrix composite (AMC) Biolox-delta(r) are pointed out in the literature. This study is a prospective monocentric evaluation of 32 and 36 mm AMC/AMC bearing surfaces. Material and methods. 141 THA were included prospectively since 2006 in 127 patients. (62 females, 65 males, mean age 62, 2 years, mean BMI 25, 5). 134 cases were primary implantations. Mean follow-up is 40.9 months (29.8-53.4). In all patients we used the same cementless stem and cup. Clinical and radiological data were evaluated with a special attention for ceramic fracture and
Introduction: Wear performances and fracture toughness of the alumina-matrix composite (AMC) Biolox-delta. ®. are pointed out in the literature. Clinical and radiological studies are needed to assess the potential benefits of AMC/AMC bearing surfaces. The aim of this study is the prospective evaluation of complications and risk factors in patients implanted with AMC liners and 32–36 mm AMC femoral heads. Methods: 323 consecutive patients were included prospectively since 2006. 243 were implanted for primary surgery with 32 or 36 mm ball heads for a 10–12, 6° tapers. In 80 cases, we used 32 and 36 mm Delta. ®. sleeved heads (M,L,XL) for the adaptation on 12–14,5°43 tapers or 10–12, 6° tapers (acetabular revisions in absence of stem exchange, or to increase the lenght of the femoral neck and the offset) All the clinical and radiological files were evaluated at a minimum 2 years follow-up with a special attention for the fracture risk and
Introduction:. Young patients have been reported to have a higher risk of revision following total hip arthroplasty (THA) than older cohorts, possibly to due higher activity and a higher incidence of deformity and prior surgery. Ceramic-on-ceramic bearing surfaces have been proposed for use in young and active individuals due to their low wear, low risk of adverse biologic reaction, and long-term survivorship. We assessed the clinical results and long-term survivorship of uncemented ceramic-on-ceramic THA in a young patient population. Methods:. 341 total hip arthroplasties in 218 patients under 50 years of age at the time of surgery were performed were performed using alumina ceramic-on-ceramic bearings from August 1999 to April 2009 as part of a prospective nonrandomized study. All patients received uncemented acetabular components with flush-mounted acetabular liners using an 18 degree taper and uncemented femoral components. The average patient age at the time of surgery was 41.7 years (range 17.8–49.9 years). The minimum follow-up time was 2 years, (mean 9.1, range 2–13.9). We evaluated implant-related complications and performed Kaplan-Meier analyses to determine survivorship of the femoral and acetabular components with revision for any reason as the endpoint. Results:. There were no dislocations or failures due to osteolysis or aseptic loosening. The 13-year survivorship of all components was 95.9% (CI 91.0–98.2). The 13-year survivorship was 97.4% (CI 92.3–99.1) for the acetabular component and 98.5% (CI 95.3–99.5) for the femoral component. There were two liner fractures (0.59%) and one head fracture (0.3%), two of which were sustained as a result of a fall from significant height. There were three failures of osseointegration (0.88%), and one acetabular component dislodged (0.3%) immediately following surgery. Two patients reported nonreproducible
Introduction:. Dislocation is still one of the major complications in total hip arthroplasty. Among other factors, it is important to maximize the intended range of movement (iROM) in order to reduce the risk for prosthetic impingement and to prevent edge loading in order to avoid surface damage and
The need for a more durable, metal free, non-osteolytic particle generating material in Total Hip Replacement (THR) is urgently required to reduce revision surgeries. Current used materials; ceramic, metal and UHMWPE remain discrepant for long-term use. Polyimide (MP-1™) is a high performance biopolymer, originating from aerospace industry. MP-1™ is heat resistant, highly cross-linked and exhibits a self-lubrication property required for bearings and articulating joints. Being resistant to fatigue, creep and chemicals and serializable by autoclave or irradiation, MP-1™ is ideal for medical devices. Finalizing pre-clinical testing, two patients were implanted 13 years ago after informed consent. A PM (Post Mortem) retrieval at 6.5 years, showed no measureable wear, a bland synovium, and no osteoclastic or bone marrow reaction. The 13Y patients' hip, a revision from Polyethylene wear to MP-1™, has an unchanged radiograph and is fully active (Fig. 1). The Ethical Committee approved 100 patients with a single surgeon (PJB) post-marketing trial running Delta ceramic femoral ball against MP-1™ liner. Age range is from 81 to 33 years. The younger patients now being offered MP-1™, in view of the retrieval data. The MP-1™ acetabular liner is 4mm thick, as currently used in a LIMA PF shell, which replaces polyethylene, ceramic or dual mobility options. Out of the 78 enrolled patients, 52 patients have the implant for more than 5 years. The only “Complications” in a few patients was an initial
This was a retrospective study of registry data from a National Orthopaedic Hospital for all THRs with 10-year follow-up data. Inclusion criteria were all THRs with a minimum of 10-year follow-up data. All metal-on-metal (MoM) THRs and MoM resurfacings were excluded from the analysis due to the high rate of revision associated with these bearings. Univariate and multivariate analyses controlling for confounding variables were performed to compare outcomes. A total of 1,697 THRs were performed in 1,553 patients. The four significant predictors for revision were fixation type (p<0.01), surface bearing type (p<0.01), age (P<0.05) and head size (p<0.05). Gender, BMI and approach had no effect on revision rates. The lowest 10-year all-cause revision rates were seen in cemented THRs at 1.7%. Ceramic-on-poly bearings had the lowest revision rate at only 1.2%. Metal-on-poly bearings had a 1.7% revision rate. Ceramic on ceramic bearings had a 7.1% revision rate with 1 revision for
Total hip arthroplasty (THA) is effective, reproducible, and durable in the treatment of hip joint arthritis. While improvements in polyethylene materials have significantly reduced wear rates and osteolysis, aseptic loosening of implants remains one of the leading causes of revision THA. Additionally, fears of dislocation and instability have driven the increase in the utilization of larger diameter femoral heads in primary THA which can lead to increased wear when coupled with a polyethylene articulation. Finally, the increasing number of younger and active patients undergoing THA raises questions with regards to the ability of modern conventional bearings to provide durability and longevity beyond second and third decades following joint implantation. Ceramic-on-ceramic articulations are ideally suited for today's young and high demand patients undergoing primary THA. It has the lowest in-vitro wear properties of any bearing couple and the wear characteristics are further improved by its wettability and lubrication particularly when larger heads are utilised. Additionally, improvements in material properties and prosthesis design have significantly decreased fracture rates and increased the reliability of these implants. Furthermore, reported outcomes and longevity of modern ceramic-on-ceramic THAs in younger patients have all shown excellent survivorship despite patients achieving and maintaining a very high level of activity and function. In short, it is the bearing couple most in tune with current market demands and utilization trends. While registry data and meta-analyses of published literature have failed to show the superiority of ceramic-on-ceramic articulations compared to conventional bearings at 10 years, there is evidence that even highly crosslinked polyethylene (HXPE) is not immune to wear. Selvarajah et al. reported steady, in-vivo wear rates of HXPE exceeding 0.1mm/year threshold in young THA patients with 36mm ceramic ball heads. Additionally, small osteolytic lesions have been observed in hips with HXPE bearings at 12–14 years follow up. Finally, analysis of all controlled randomised studies have shown less osteolysis of ceramic-on-ceramic hips compared to polyethylene articulations. The significance of these lesions are unclear but the question remains: Can HXPE as a bearing be able to provide over 30 years of service needed to outlast patients younger than 60 years?. Concerns with cost,
Introduction: The use of hard-on-hard hip prostheses has highlighted specific problems like the “stripe-wear” and the
Purpose: The ideal bearing surface for total hip arthroplasty is still an area of debate. Increasing numbers of total hip replacements are being done in the younger patient population. Ceramic-on-ceramic bearings have gained popularity due to their low wear rate; however, ceramic fractures with subsequent catastrophic failures have been reported and
The use of hard-on-hard hip prostheses has highlighted specific problems like the “stripe-wear” and the
The selection of an acetabular component for primary hip arthroplasty has narrowed significantly over the past 10 years. Although monoblock components demonstrated excellent long-term success the difficulty with insertion and failure to fully appreciate full coaptation of contact with the acetabular floor has led to almost complete elimination of its utilization. Modular acetabular components usually with titanium shells and highly crosslinked polyethylene are by far the most utilised today. This is particularly true with mid-term results demonstrating excellent wear rates and extremely low failure rates and the concern of possible mechanical failure of highly crosslinked polyethylene not being a clinical problem. Ceramic liners are also used but problems with
Introduction:. Femoral head surface roughness has been recognized as an important determinant of linear and volumetric polyethylene (UHMWPE) wear in total hip replacement (THR), particularly for metal heads. Fisher et al. 1. found that a 2- μm scratch with a 1- μm buildup of metal debris produced a 70-fold increase in the wear rate. Ceramic materials and hard-on-hard bearing couples have been introduced to provide more scratch resistance. However, THR bearing surfaces of all materials can become damaged during in vivo function, potentially impacting wettability. The purpose of this study is to quantify surface roughness as related to distinct damage types on retrieved femoral heads and to assess wettability of common bearing materials. Materials and Methods:. An IRB-approved archive of retrieved THR bearing components was queried, identifying 29 metal (CoCr) and ceramic (alumina, zirconia) femoral heads that had articulated with UHMWPE and ceramic acetabular liners, respectively. Mean in vivo functional duration was 5.5 ± 4.5 years (range, 1 month to 27 yrs), and patient age and weight averaged 68 ± 12 years (range, 36–81) and 72 ± 21 kilograms (range, 52–123), respectively. Retrieval reasons were dislocation (18), loosening (4), polyethylene wear (2), infection (1),
A common feature of retrieved ceramic-on-ceramic (CoC) hips is the presence of metal transfer on the femoral head. This metal transfer represents an important change in the articulating surface and can have consequences in terms of lubrication, friction, wear, and
Ceramic-on-ceramic was shown to have advantageous tribologic properties (low wear and friction). For medical applications two ceramics, alumina and zircona, are available. This case study shows that the combination of different ceramics for hard-hard pairings can be critical. A 57 year old patient received a total hip prosthesis (cementless stem with a ceramic head and a monolithic ceramic cup). Thirty-five months postoperatively the patient complained about
The new technology using femoral heads with sleeves allows conservative procedures for revision hip arthroplasty. The implantation of classical ceramic heads on a previously used femoral taper is not recommanded. When there is no loosening of the femoral implant, the use of sleeves is a good solution for using an alumine on alumine couple, specially in young and active patients. Material and methods: 25 hips in 25 patients were included. In 12 cases the cause of revision was an acetabular osteolysis with or without loosening in metal on metal cimented THR. In 13 patients the revision was performed for a loosening and a wear of the PHE cup with osteolysis (4 zyrcon and 9 chrome-cobalt heads). The mean age was 49 years for the metal on metal revisions (36 to 75) and 54 years for the prosthesis using a polyethylen socket. Cementless cups were implanted using XLW delta alumina inserts. The 32 mm delta alumina sleeved heads were adjusted on the existing femoral 12–14 tapers. Patients were evaluated preoperatively and followed-up with clinical and radiological examinations. Results: At 2 years mean follow-up, average Harris Hip Score was significantly improved (97 vs 54, p<
0.05). We did not observe ceramic fracture or
Introduction. Increasing numbers and incidence rates of noisy (squeaking, scratching or clicking) ceramic-on-ceramic (CoC) total hip arthroplasties (THA) are being reported. The etiology seems to always involve stripe wear producing a stick-slip effect in the bearing which excites vibrations. As stripe wear is also found in silent CoC bearings, a theory has been developed that the vibrations become audible only via amplification through the vibrating stem. This was supported by showing that the excitation frequency and the resonance frequency of the plain stem are similar [1]. However, stem resonance in-vivo would be influenced by the periprosthetic bone damping and transmitting stem vibrations. Thus, if stem resonance is conditional for noisy COC hips, these should show periprosthetic bone different to silent hips. This study compares stem fit&fill and periprosthetic bone between noisy and silent CoC hips. Methods. In a consecutive series of 186 primary CoC hips with identical stems, cups (Stryker ABG-II) and femoral heads (Alumina V40, 28mm) a dedicated patient questionnaire [2] identified 38 noisy hips (incidence rate: 20.4%,
Introduction: Increasing numbers and incidence rates of noisy (squeaking, scratching, clicking) ceramic-on-ceramic (CoC) total hip arthroplasties (THA) are being reported. The etiology seems to always involve stripe wear producing a stick-slip effect in the bearing which excites vibrations. As stripe wear is also found in silent CoC bearings, a theory has been developed that the vibrations become audible only via amplification through the vibrating stem (bell-clapper theory). This was supported by showing that the excitation frequency and the resonance frequency of the plain stem are similar. However, stem resonance in-vivo would be influenced by the periprosthetic bone damping and transmitting stem vibrations. Thus, if the bell-clapper theory were true, noisy CoC hips should show periprosthetic bone different to silent hips. This study compares stem fit&
fill and periprosthetic bone between noisy and silent CoC hips. Methods: In a consecutive series of 186 primary CoC hips with identical stems, cups (Stryker ABG-II) and femoral heads (Alumina V40, 28mm) a survey identified 38 noisy hips (incidence rate: 20.4%,
The benefit of a dual-mobility acetabular component (DMC) for primary total hip arthroplasties (THAs) is controversial. This study aimed to compare the dislocation and complication rates when using a DMC compared to single-mobility (SM) acetabular component in primary elective THA using data collected at a single centre, and compare the revision rates and survival outcomes in these two groups. Between 2010 and 2019, 2,075 primary THAs using either a cementless DM or SM acetabular component were included. Indications for DMC were patients aged older than 70 years or with high risk of dislocation. All other patients received a SM acetabular component. Exclusion criteria were cemented implants, patients treated for femoral neck fracture, and follow-up of less than one year. In total, 1,940 THAs were analyzed: 1,149 DMC (59.2%) and 791 SM (40.8%). The mean age was 73 years (SD 9.2) in the DMC group and 57 years (SD 12) in the SM group. Complications and revisions have been analyzed retrospectively.Aims
Methods
While
A ceramic is currently considered as the most ideal articulation in primary THA. The authors evaluated clinicoradiographic results and complications of cementless THA with 3rd generation of ceramic bearing. From April 2001 to January 2008, 310 primary THAs were performed in 300 patients using 3rd generation of ceramic bearing. In results, Harris hip score at last follow up was improved to an average of 95.4 points from 51.6 points preoperatively. In all cases, fixations around implants were stable and there was no osteolysis. Complications were dislocations,
Purpose. 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. Materials and methods. 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). Results. Kaplan-Meier survival analysis with an end point of revision for any reason was 100% at 6.8 years. All acetabular and femoral components showed bony ingrowth. No radiographic evidence of osteolysis was identified. No ceramic fracture occurred. There were 4 (2.6%) noisy hips (1
Total hip arthroplasty (THA) is a very successful and cost-effective operation, yet debate continues about the optimum fixation philosophy in different age groups. The concept of the 'cementless paradox' and the UK 'Getting it Right First Time' initiative encourage increased use of cemented fixation due to purported lower revision rates, especially in elderly patients, and decreased cost. In a high-volume, tertiary referral centre, we identified 10,112 THAs from a prospectively collected database, including 1,699 cemented THAs, 5,782 hybrid THAs, and 2,631 cementless THAs. The endpoint was revision for any reason. Secondary analysis included examination of implant survivorship in patients aged over 70 years, over 75 years, and over 80 years at primary THA.Aims
Methods
Purpose. The results of ceramic-on-ceramic (CoC) bearing surfaces in primary total hip arthroplasty (THA) were well known. However, it was not known in revision THA. The purpose of this study is to report the results of revision THA with ceramic articulation. Materials and Methods. 112 revision THAs with ceramic articulation were evaluated. The mean age at the time of surgery was 58.3 years (28 to 97). The mean duration of the follow-up periods was 6.4 years (2 to 11.8 years). Results. The Harris hip scores improved from an average of 79.0 at the index surgery to an average of 91.1 at the last follow-up. (P<0.001) None of hips showed osteolysis or ceramic head fracture. One hip shows aseptic loosening in the acetabular components with
Introduction. Proximal short stems have gained in popularity for perceived bone preservation but more recently, physiological loading. We report the medium term success of a calcar loading, short stem in a large cohort from a single unit with multiple surgeons. Patients/Materials & Methods. Prospectively collected sequential data, with no loss to follow-up, was retrospectively analysed from our own local database. Demographic data was assimilated to collect age, sex, BMI smoking history. Revision cases were analysed for cause and a PTIR and Kaplan Meier Curve constructed to quantify survival. Radiographs reviewed in 100 of the oldest (2009 to 2011) cases to look specifically for calcar resorption and stem sink. Imatri software was used for calculations: sink was categorised into greater or less than 0.5cm; calcar resorption was estimated using maximal osteotomy surface change of slope. Patient pre-operative and post-operative outcome scores (using Harris Hip, Charnley and Oxford scales) were extracted from the database. Results. 752 cases (in 685 patients) were identified: 313 male, 372 females with a combined average age of 61 (19 to 84); and, an average BMI of 29 kg/m. 2. ; (18–49); and, 4% were noted to be smoking on their last assessment with a maximum implantation of 9 (average 4.2) years. 74% (556) of cases utilised a 36mm Solid Ceramic head but 28, 32, 40 and 44mm heads in CrCo and TiN were also used. The majority (84%) of cases were performed for Osteoarthritis (Inflammatory arthropathy was a relative contraindication); but, 22 cases were performed for revision from a resurfacing arthroplasty. 17 patients were noted to have died (all more than 90 days post-operatively). 14 cases were revised for any cause (1.8%): 5 for cup related reasons (including dislocation); 4 deep infection, 2 for failure of fixation; 3 for periprosthetic fracture. All failures occurred within the first 4.5 years and all within the first 100 cases for each surgeon. The KM survival curve gave a 5 year survival (185 at risk) of 96.1% all causes and 99.1% for femur only. The PTIR (non-competing) was 6.5 (per 1000 years exposed) and 6.3 (competing). No reported cases of thigh pain were observed; one ceramic on ceramic bearing reported transient but recurrent
Expectations for ceramic-on-metal (COM) bearings included (i) optimal lubrication due to smoother ceramic heads (ii), reduction of metal ions due to elimination of CoCr heads, and (iii) ‘differential hardness’ reducing adhesive wear and
Ceramic-on-ceramic bearings are considered in several European and Asian countries a reliable alternative to metal-on-polyethylene, ceramic-on-polyethylene, or metal-on-metal (with small diameter heads) for total hip arthroplasty (THA) management. Reduced joint wear and limited peri-prosthetic osteolytic changes are the main reasons supporting the use of ceramic. So far, the available observational data show a low rate of revision following the use of Ceramic-on-Ceramic bearings, but concern remains regarding the risk of fracture and the prevalence of
This study reports the ten-year wear rates, incidence of osteolysis, clinical outcomes, and complications of a multicentre randomized controlled trial comparing oxidized zirconium (OxZr) versus cobalt-chrome (CoCr) femoral heads with ultra-high molecular weight polyethylene (UHMWPE) and highly cross-linked polyethylene (XLPE) liners in total hip arthroplasty (THA). Patients undergoing primary THA were recruited from four institutions and prospectively allocated to the following treatment groups: Group A, CoCr femoral head with XLPE liner; Group B, OxZr femoral head with XLPE liner; and Group C, OxZr femoral head with UHMWPE liner. All study patients and assessors recording outcomes were blinded to the treatment groups. The outcomes of 262 study patients were analyzed at ten years’ follow-up.Aims
Methods
Introduction. Malpositioning of the acetabular cup during total hip arthroplasty increases the risk of dislocation, edge loading,
Total hip arthroplasty (THA) is effective, reproducible, and durable in the treatment of hip joint arthritis. While improvements in polyethylene materials have significantly reduced wear rates and osteolysis, aseptic loosening of implants remains one of the leading causes of revision THA. Additionally, fears of dislocation and instability have driven the increase in the utilization of larger diameter femoral heads in primary THA which can lead to increased wear when coupled with a polyethylene articulation. Finally, the increasing number of younger and active patients undergoing THA raises questions with regards to the ability of modern conventional bearings to provide durability and longevity beyond second and third decades following joint implantation. Ceramic-on-ceramic articulations are ideally suited for today's young and high demand patients undergoing primary THA. It has the lowest in-vitro wear properties of any bearing couple and the wear characteristics further improved by its wettability and lubrication particularly when larger heads are utilised. Additionally, improvements in material properties and prosthesis design have significantly decreased fracture rates and increased the reliability of these implants. Furthermore, reported outcomes and longevity of modern ceramic-on-ceramic THAs in younger patients have all shown excellent survivorship despite patients achieving and maintaining a very high level of activity and function. In short, it is the bearing couple most in tune with current market demands and utilization trends. While registry data and meta-analyses of published literature have failed to show the superiority of ceramic-on-ceramic articulations compared to conventional bearings at 10 years, there is evidence that even highly crosslinked polyethylene (HXPE) is not immune to wear. Selvarajah et al. reported steady, in-vivo wear rates of HXPE exceeding 0.1 mm/year threshold in young THA patients with 36 mm ceramic ball heads. Additionally, small osteolytic lesions have been observed in hips with HXPE bearings at 12–14 years follow up. Finally, analysis of all controlled randomised studies have shown less osteolysis of ceramic-on-ceramic hips compared to polyethylene articulations. The significance of these lesions are unclear but the question remains: Can HXPE as a bearing be able to provide over 30 years of service needed to outlast patients younger than 60 years?. Concerns with cost,
Introduction. Accurate acetabular position is an important goal during THA. It is also well known that accurate acetabular positioning is very frequently not achieved, even by experienced, high volume surgeons. Problems associated with cup malposition are: dislocation, accelerated poly wear, impingement, ceramic
Background/Purpose. Total hip arthroplasties (THAs) with ceramic bearings are widely performed in young, active patients and thus, long-term outcome in these population is important. Moreover, clinical implication of noise, in which most studies focused on ‘squeaking’, remains controversial and one of concerns unsolved associated with the use of ceramic bearings. However, there is little literature regarding the long-term outcomes after THAs using these contemporary ceramic bearings in young patients. Therefore, we performed a long-term study with a minimum follow-up of . 1. 5 years after THAs using contemporary ceramic bearings in young patients with osteonecrosis of the femoral head (ONFH) less than fifty. Materials and Methods. Among sixty patients (71 hips) with a mean age of 39.1 years, 7 patients (7 hips) died and 4 patients (4 hips) were lost before 15-year follow-up. The remaining 60 hips were included in this study with an average follow-up period of 16.3 years (range, 15 to 18). All patients underwent cementless THA using a prosthesis of identical design and a 28-mm third-generation alumina head by single surgeon. The clinical evaluations included the modified Harris hip score (HHS), history of dislocation and noise around the hip joint: Noise was classified into
Different bearing surfaces, including alumina-on-alumina have been used to avoid osteolysis. We ask if the use of modern ceramics matched with metal-backed sockets improves clinical results avoiding aseptic loosening, osteolysis and late dislocations. We prospectively analysed 315 Cerafit cups in two different generations: First generation implanted between 1999 and 2005 (124 cups) and second generation (191 cups) all implanted with a 5-year minimum follow-up, and associated with a Multicone-HAP stem using alumina-on-alumina bearings. Patients' mean age was 48.7+13.6 years. There were three dislocations within the first postoperative month and one early recurrent dislocation requiring reoperation using a double mobility cup. There were four intraoperative fractures, two in rheumatoid juvenile arthritis cases solved with a cerclage, and one postoperative fracture solved using a femoral long-stem. No fractures were seen in the alumina components in this series. Also, there have been no infections. There were 4 patients reporting non-reproducible