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. This study reports on early results of ceramic-on-ceramic total hip replacements. This is a study analyzing a prospectively collected data for seventy-five ceramic-on-ceramic total hip replacements with minimum follow up of eighteen months. Average age at time of surgery was forty-seven years. This study focused on the complications of this ceramic population. Complications included: One posterior dislocation, two intra-operative calcar fractures that needed wiring, one intra-operative fracture of the acetabular liner, two cases of impingement (one which resulted in a revision), and one periprosthetic fracture. The two patients that required further surgery were the periprosthetic fracture after a fall and one for component impingement. No revisions were performed for loosening or catastrophic failures. No wear, loosening, or osteolysis was seen on radiographs. The SF-12, WOMAC, and Harris Hip scores were not significantly different from other reported hip series. Ceramic-on-ceramic bearing surfaces in total hip arthroplasty are a safe option with outcome equivalent to standard THR in the short term. Ceramic Hips may provide a more durable prosthesis, especially in young and active patients. Intra-operative technical guidelines that may enhance the quality of the results will be presented and fully disclosed.
The efficacy of intra-articular corticosteroids has led to their frequent use in the treatment of osteoarthritis (OA) of the knee. It is commonly believed that less soluble preparations given at higher doses provide longer lasting and more significant symptomatic relief. We performed a randomized controlled trial with corticosteroid preparations of different solubilities and dosages to test this longstanding but unproven belief. The pain subscale of the WOMAC was our primary outcome measurement. This study found no statistically significant difference between preparations or dosages. Regression analysis identified early onset of osteoarthritis as predictive of a positive treatment response. To determine if the solubility or dosage of an intra-articular corticosteroid preparation effects treatment outcome when used for the treatment of symptomatic osteoarthritis of the knee. One hundred and seventeen patients, thirty-nine in each treatment arm, were enrolled in the study. Patients were randomly assigned to one of three treatment arms: 40mg of methylprednisolone acetate, 80mg of methyl-prednisolone acetate or 40mg Triamcinolone acetanide. Patients were unaware of the preparation given. The IA injection was given at the commencement of the study period. Patients underwent clinical evaluation at baseline and at two weeks, four weeks and twelve weeks post injection. Patient’s symptoms were evaluated using the Western Ontario and McMaster Universities OA Index (WOMAC). Patient age, sex, age of onset of OA, history of trauma to the knee and BMI were also recorded and used to identify patient variables predictive of a positive treatment response. No statistically significant difference between the three treatment arms was identified. Early onset of OA was identified as predictive of a positive treatment response. It has been taught that physicians should use the least soluble preparation at higher doses (within suggested guidelines) to maximize patient treatment response when using intra-articular corticosteroids. This has always been based on theory and not fact. Our study is the first to scientifically disprove this claim. Solubility and dosage do not effect treatment outcomes. Patients with an early onset of OA seem to have a positive treatment response. Ours is the first study to demonstrate these findings.
