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Tashtanov BR, Kirilova IA, Pavlova DV, Pavlov VV. Ceramic-related noise as an adverse outcome in total hip arthroplasty. GENIJ ORTOPEDII 2023; 29:565-573. [DOI: 10.18019/1028-4427-2023-29-5-565-573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Abstract
Introduction Ceramic hip replacement bearings have shown to be low wearing and biocompatible. The last two generations of Biolox Forte and Biolox Delta ceramics have have established themselves as durable bearings. However, squeaking and noise from ceramic bearing THRs is well recognised in the 21st century.The objective was to explore the problem of noise in the ceramic bearing of THA based on the analysis of the foreign and Russian literature.Material and methods In presented the analysis of Foreign and Russian literature searches for the review were produced according to PRISMA recommendations using PubMed, Scopus, Google Scholar, eLibrary. MINOR was used to assess the methodological quality of articles.Results and Discussion Noise in ceramics is observed in 37.7 %. There are many theories on the origin and mechanism of noise including liner impingement and loading, film disruption, third body, microseparation and resonance. However, there is still no consensus on what is noise in the ceramic bearing and how to solve this problem.Conclusion Literature review of ceramic bearing indicated enough unanswered questions. The noise may play a role as a predictor of improper use of endoprosthesis with accumulated database resulting in better understanding of the phenomenon, methods of the correction and timely prevention of ceramic breakage.
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Affiliation(s)
- B. R. Tashtanov
- Novosibirsk Research Institute of Traumatology and Orthopedics n.a. Ya.L. Tsivyan
| | - I. A. Kirilova
- Novosibirsk Research Institute of Traumatology and Orthopedics n.a. Ya.L. Tsivyan
| | | | - V. V. Pavlov
- Novosibirsk Research Institute of Traumatology and Orthopedics n.a. Ya.L. Tsivyan
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Sharma AR, Lee YH, Gankhuyag B, Chakraborty C, Lee SS. Effect of Alumina Particles on the Osteogenic Ability of Osteoblasts. J Funct Biomater 2022; 13:jfb13030105. [PMID: 35997443 PMCID: PMC9397023 DOI: 10.3390/jfb13030105] [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: 07/06/2022] [Revised: 07/26/2022] [Accepted: 07/26/2022] [Indexed: 02/01/2023] Open
Abstract
Biomaterials are used as implants for bone and dental disabilities. However, wear particles from the implants cause osteolysis following total joint arthroplasty (TJA). Ceramic implants are considered safe and elicit a minimal response to cause periprosthetic osteolysis. However, few reports have highlighted the adverse effect of ceramic particles such as alumina (Al2O3) on various cell types. Hence, we aimed to investigate the effect of Al2O3 particles on osteoprogenitors. A comparative treatment of Al2O3, Ti, and UHMWPE particles to osteoprogenitors at a similar concentration of 200 μg/mL showed that only Al2O3 particles were able to suppress the early and late differentiation markers of osteoprogenitors, including collagen synthesis, alkaline phosphatase (ALP) activity and mRNA expression of Runx2, OSX, Col1α, and OCN. Al2O3 particles even induced inflammation and activated the NFkB signaling pathway in osteoprogenitors. Moreover, bone-forming signals such as the WNT/β-catenin signaling pathway were inhibited by the Al2O3 particles. Al2O3 particles were found to induce the mRNA expression of WNT/β-catenin signaling antagonists such as DKK2, WIF, and sFRP1 several times in osteoprogenitors. Taken together, this study highlights a mechanistic view of the effect of Al2O3 particles on osteoprogenitors and suggests therapeutic targets such as NFĸB and WNT signaling pathways for ceramic particle-induced osteolysis.
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Affiliation(s)
- Ashish Ranjan Sharma
- Institute for Skeletal Aging & Orthopedic Surgery, Hallym University-Chuncheon Sacred Heart Hospital, Chuncheon 24252, Korea; (A.R.S.); (Y.-H.L.); (B.G.)
| | - Yeon-Hee Lee
- Institute for Skeletal Aging & Orthopedic Surgery, Hallym University-Chuncheon Sacred Heart Hospital, Chuncheon 24252, Korea; (A.R.S.); (Y.-H.L.); (B.G.)
| | - Buyankhishig Gankhuyag
- Institute for Skeletal Aging & Orthopedic Surgery, Hallym University-Chuncheon Sacred Heart Hospital, Chuncheon 24252, Korea; (A.R.S.); (Y.-H.L.); (B.G.)
| | - Chiranjib Chakraborty
- Department of Biotechnology, School of Life Science and Biotechnology, Adamas University, Barasat-Barrackpore Rd, Kolkata 700126, India;
| | - Sang-Soo Lee
- Institute for Skeletal Aging & Orthopedic Surgery, Hallym University-Chuncheon Sacred Heart Hospital, Chuncheon 24252, Korea; (A.R.S.); (Y.-H.L.); (B.G.)
- Correspondence:
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Topolovec M, Milošev I, Cör A. Outcome after Two Sequential Revision Hip Arthroplasties for CoC Bearing Fracture with 10 Years Follow-up: A Case Report. J Orthop Case Rep 2021; 11:45-48. [PMID: 34790602 PMCID: PMC8576786 DOI: 10.13107/jocr.2021.v11.i07.2310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 06/20/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Revisions due to the fracture of ceramic-on-ceramic (CoC) bearing are rare, however when they occur, they represent a major challenge to an orthopedic surgeon for ensuring safe and long-term survival of the replaced bearing. Case Report We present a case of fractured ceramic liner of total hip prosthesis that underwent revision to a metal-on-polyethylene (MoP) bearing couple, with consequent huge periprosthetic metallosis. Shortly after, the second revision operation followed using the third bearing couple of ceramic-on-polyethylene (CoP). At 10 years follow-up after the operation due to ceramic fracture, the patient is now pain free with full range of motion of the revised hip. Conclusion Establishment of diagnostic routes and recommended protocols for CoC bearing fracture would allow easier recognition of potential fracture and diminish its consequences for the patients.
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Affiliation(s)
- Matevž Topolovec
- Valdoltra Orthopaedic Hospital, Jadranska c. 31, 6280 Ankaran, Slovenia
| | - Ingrid Milošev
- Valdoltra Orthopaedic Hospital, Jadranska c. 31, 6280 Ankaran, Slovenia.,Department of Physical and Organic Chemistry, Jožef Stefan Institute, Jamova 39, 1000 Ljubljana, Slovenia
| | - Andrej Cör
- Valdoltra Orthopaedic Hospital, Jadranska c. 31, 6280 Ankaran, Slovenia
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Taniguchi K, Quacinella M, Barlow B. Squeaking Is Common and Increases Over Time Among Patients With Long-term Follow-up After Ceramic-on-ceramic THA. Clin Orthop Relat Res 2021; 479:736-744. [PMID: 33724977 PMCID: PMC8083802 DOI: 10.1097/corr.0000000000001472] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 08/06/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Ceramic-on-ceramic (CoC) is a durable bearing with excellent wear characteristics, but squeaking remains a concern. The proportion of patients who report squeaking varies widely between studies performed at short- and mid-term follow-up. QUESTIONS/PURPOSES (1) What proportion of patients treated with CoC THA bearings report squeaking at a minimum of 10 years of follow-up? (2) Are patient, implant, or radiographic factors associated with squeaking? (3) Are THAs that squeak more likely to be revised than those that do not? (4) Are patient-reported functional outcome scores lower between THAs that squeak and THAs that do not squeak at long-term follow-up? METHODS Between January 1, 2003 and August 31, 2008 a total of 80 patients received THAs with third-generation alumina-on-alumina bearings at one center. Of the original 80 patients, 1% (1 of 80) had died, and 21% (17 of 80) were lost to follow-up before 10 years, leaving 62 patients for analysis at a median (range) of 14 years (11 to 16). Ceramic-on-ceramic THA represented 23% (80 of 343) of all primary THAs performed during the study period. Ceramic-on-ceramic THA was used preferentially in patients younger than 50 years of age. The mean (range) age of patients in the cohort was 44 ± 11 years (18 to 65). Sixty-eight percent (42 of 62) were men. Two separate manufacturers' implants were included. There were uncemented acetabular and femoral components included in this study. All CoC bearings were third-generation alumina-on-alumina. Squeaking was determined through a mailed questionnaire or telephone interview. The 10-question survey developed by the researchers queried patients whether audible "squeaking" could be heard from their hip replacement. Patients were asked to write in their description of the noise to distinguish squeaking from other noises not relevant to the current study. Implant information, component position, and patient demographics were obtained via chart review and postoperative radiographs reviewed by one of the investigators not involved with the index operative procedure. Using revision for any reason as an endpoint, a Kaplan-Meier analysis was performed to compare survivorship between THAs that squeaked versus those that did not. Patient-reported outcomes were surveyed using the Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS JR), which comprises six items regarding patient pain and function, raw summed scores range from 0 (perfect hip health) to 24 (total hip disability). RESULTS Squeaking was self-reported by 53% (33 of 62) of patients in this group. Squeaking was more common in patients who received the titanium-molybdenum-zirconium-iron stem than in patients with the titanium-aluminum-vanadium stem (63% [29 of 46] versus 31% [4 of 13]; odds ratio 3.8 [95% CI 1.02 to 14.4]; p = 0.046). We found no differences in the likelihood a patient would report squeaking based on component position, component size, patient age, sex, or BMI. Ten-year survivorship free from revision was not lower in patients who reported squeaking (91% [95% CI 74 to 97] versus 90% [95% CI 71 to 96]; p = 0.69). Patient-reported outcome scores (HOOS JR) were not lower in those who reported squeaking (3 ± 3 [95% CI 1.5 to 4.0] versus 3 ± 5 [95% CI 1.5 to 5.5]; p = 0.59). CONCLUSION At long-term follow-up, we found that CoC bearing squeaking in patients who underwent THA is more common than previously reported. Survivorship was lower than expected in this cohort, and most revisions in this series were for squeaking. Although implant-dependent, surgeons should counsel patients about the potential for squeaking in CoC THA, which may occur years after index procedure. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Kevin Taniguchi
- K. Taniguchi, M. Quacinella, B. Barlow, Naval Medical Center San Diego, San Diego, CA, USA
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Lucchini S, Castagnini F, Giardina F, Tentoni F, Masetti C, Tassinari E, Bordini B, Traina F. Cementless ceramic-on-ceramic total hip arthroplasty in post-traumatic osteoarthritis after acetabular fracture: long-term results. Arch Orthop Trauma Surg 2021; 141:683-691. [PMID: 33417021 DOI: 10.1007/s00402-020-03711-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 12/06/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Total hip arthroplasty (THA) is the standard procedure for post-traumatic osteoarthritis (OA) of the hip after acetabular fracture. However, it is not as simple as a primary THA, challenging the surgeon with anatomical deformity and intra and postoperative complications. In the current literature, there is a lack of studies reporting long-term results. May ceramic-on-ceramic (CoC) bearings provide good clinical and radiological outcomes at a long-term follow-up in patients undergoing THA following acetabular fracture? MATERIALS AND METHODS We retrospectively analyzed 68 patients (mean age 47 years [range 22-75)] who underwent cementless modular neck stem THA, all implants CoC bearings (50 previously operatively treated and 18 non-operatively treated) after a specific CT study protocol at our Institute since 2000-2008. Clinical outcomes, prosthetic components' osseointegration, survival rate, and reasons for revision were analyzed. Minimum clinical and radiological follow-up was 10 years. RESULTS HHS improved significantly after surgery from 37.6 ± 14.1 to 88.4 ± 11.6. 8 revision surgeries were performed, none for infection: we reported 2 stem aseptic loosening, 2 periprosthetic femoral fractures and 4 modular neck fractures. One implant noise (third-generation ceramic coupling) was described. Cup osseointegration was present (according to Moore the presence of at least 3 radiological criteria defines an effective osseointegration) in 67 patients (98.5%). After a 10 years follow-up, survival rate resulted 88.4%, sensibly higher than most of results reported in the current literature. CONCLUSION The high survival rate may be related to CoC: no osteolysis and no infections were reported. Also acetabular cup loosening incidence was sensibly lower (1.47%) among loosening rate described by other authors. Clinical and radiological outcomes were decent, probably due to modular prosthesis design. Modular necks are a solution which can help achieving a proper functional reconstruction of the hip (offset, center of rotation), but should be avoided in young and overweight patients because of the high risk of fracture. CoC bearings in THAs in post-traumatic OA after acetabular fracture showed good results despite the fact that specific ceramic-related issues have to be considered.
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Affiliation(s)
- Stefano Lucchini
- Orthopaedic-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.
| | - Francesco Castagnini
- Orthopaedic-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Federico Giardina
- Orthopaedic-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Francesco Tentoni
- Orthopaedic-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Claudio Masetti
- Orthopaedic-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Enrico Tassinari
- Orthopaedic-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Barbara Bordini
- Medical Technology Laboratory, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10-1/13, 40136, Bologna, Italy
| | - Francesco Traina
- Orthopaedic-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
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Lee S, Yoo JJ, Kim HJ. Impingement Between the Metal Stem and the Ceramic Liner in Total Hip Arthroplasty: The Neck Is Not the Only Place Where Impingement Occurs. J Bone Joint Surg Am 2021; 103:139-145. [PMID: 33269897 DOI: 10.2106/jbjs.20.00354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND It is assumed that impingement between the ceramic liner and the stem increases the possibility of a liner fracture in total hip arthroplasty with a ceramic-on-ceramic bearing. The purpose of this study was to analyze the pattern of the impingement by evaluating the notches (U-shaped indented wear scars engraved on the stem) on radiographs to determine when and where impingement develops and to analyze the factors affecting its occurrence. METHODS Among the primary total hip arthroplasty cases using a ceramic-on-ceramic bearing performed from November 1997 to December 2003, 244 cases of 197 patients (123 male patients and 74 female patients) that had follow-up of ≥15 years were included. All of the radiographs were examined with special regard to the notches and the cup positions. RESULTS Notches were detected at 77 sites of 57 cases (23.4%) for the first time between 8 months and 14.8 years after the surgical procedure. They were located on the neck or the shoulder of the stem. Shoulder notches were detected only in the cases with a short-neck head. Shoulder notches were found in 29 cases (20.0% of short-neck cases). Cup inclination was lower (p = 0.01) and anteversion was higher (p = 0.01) in the group with notches than the group without notches. There were 5 cases of ceramic head fracture. One of them experienced another ceramic liner fracture, assumed to be caused by prosthetic shoulder impingement, after the revision surgical procedure. CONCLUSIONS The results of this study suggest that impingement between the stem and the ceramic liner occurs in a considerable proportion of patients who underwent total hip arthroplasty not only on the neck but also on the shoulder of the stem. Forceful and abrupt impingement on the stem shoulder can cause ceramic liner fracture. Impingement between the stem shoulder and the ceramic liner should be considered in designing a stem. It seems to be prudent to recommend that patients avoid squatting or sitting cross-legged on the floor as much as possible. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Sunhyung Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
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Biotribology in Arthroplasty: Worn Surfaces Investigation on Ceramic Hip Femoral Heads Considering Wettability. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10248919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ceramic-on-ceramic bearings for total hip replacement are considered the best choice to avoid problems such as osteolysis and wear, mainly related to soft bearings. The aim of this work was to investigate in a comparative way different kinds of ceramic femoral heads for total hip replacements from a biotribological point of view, discussing the results obtained in terms of topographies, presence of metal transfer (MT) phenomena, and wettability on their worn surfaces in a tribological framework. Different ceramic femoral heads derived from in vitro wear tests, retrieved form patients, and brand new total hip replacements were investigated. The patients group had an average age of 60 years (ranging from 27 to 83). In most cases, the cause of failure was aseptic loosening of the acetabular component. Roughness analyses were performed to measure the tribological surface evolution of the material; an SEM and EDS investigation on the explanted heads proves and quantified MT, while the wettability was measured through a novel optical laboratory set-up with the aim to furnish useful data in the framework of synovial lubrication phenomena acting in the tribosystem. For the average roughness measurements on explanted specimens were considered three parameters (Ra = the average area between the roughness profile and its mean line; Rt = the vertical distance from the deepest valley to the highest peak of the roughness profile; and Rsk = it is the skewness and it is a measure of the asymmetry of the amplitude distribution function. In other words, the skewness indicates whether a surface is dominated by peaks or by valleys) and their values were: Ra 0.22 ± 0.12 μm, Rt 34.5 ± 13.5 μm and Rsk −0.01 ± 11.3; on the new specimens we measured Ra 0.01 ± 0.001 μm, Rt 0.12 ± 0.09 μm, and Rsk = 5.67 ± 8.7; for the in vitro specimens they were Ra 0.05 ± 0.12 μm, Rt 0.71 ± 1.4 μm and Rsk 7.73 ± 20.6. The wettability angle measurements showed hydrophilic surfaces for all femoral heads considered in this study with small differences between the three investigated categories, allowing to discuss their effects on the biobearings’ lubrication phenomena.
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Materials for Hip Prostheses: A Review of Wear and Loading Considerations. MATERIALS 2019; 12:ma12030495. [PMID: 30764574 PMCID: PMC6384837 DOI: 10.3390/ma12030495] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 01/31/2019] [Accepted: 01/31/2019] [Indexed: 12/15/2022]
Abstract
Replacement surgery of hip joint consists of the substitution of the joint with an implant able to recreate the articulation functionality. This article aims to review the current state of the art of the biomaterials used for hip implants. Hip implants can be realized with different combination of materials, such as metals, ceramics and polymers. In this review, we analyze, from international literature, the specific characteristics required for biomaterials used in hip joint arthroplasty, i.e., being biocompatible, resisting heavy stress, opposing low frictional forces to sliding and having a low wear rate. A commentary on the evolution and actual existing hip prostheses is proposed. We analyzed the scientific literature, collecting information on the material behavior and the human-body response to it. Particular attention has been given to the tribological behavior of the biomaterials, as friction and wear have been key aspects to improve as hip implants evolve. After more than 50 years of evolution, in term of designs and materials, the actual wear rate of the most common implants is low, allowing us to sensibly reduce the risk related to the widespread debris distribution in the human body.
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Walls A, Tucker A, Warnock DS, Beverland D. Catastrophic ceramic liner failure-The subtle signs of a non-engaged ceramic liner. J Orthop 2018; 15:363-365. [PMID: 29881154 DOI: 10.1016/j.jor.2018.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 02/14/2018] [Indexed: 10/18/2022] Open
Abstract
Ceramic earrings have an established and successful history in total hip replacement. Occasionally, these articulations have problems, which include squeaking and implant fracture.
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Affiliation(s)
- Andrew Walls
- Musgrave Park Hospital, Stockmans Lane, Belfast, BT9 7JB, Northern Ireland, UK
| | - Adam Tucker
- Musgrave Park Hospital, Stockmans Lane, Belfast, BT9 7JB, Northern Ireland, UK
| | - David S Warnock
- Musgrave Park Hospital, Stockmans Lane, Belfast, BT9 7JB, Northern Ireland, UK
| | - David Beverland
- Musgrave Park Hospital, Stockmans Lane, Belfast, BT9 7JB, Northern Ireland, UK
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Hannouche D, Zingg M, Miozzari H, Nizard R, Lübbeke A. Third-generation pure alumina and alumina matrix composites in total hip arthroplasty: What is the evidence? EFORT Open Rev 2018; 3:7-14. [PMID: 29657840 PMCID: PMC5890134 DOI: 10.1302/2058-5241.3.170034] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Wear, corrosion and periprosthetic osteolysis are important causes of failure in joint arthroplasty, especially in young patients. Ceramic bearings, developed 40 years ago, are an increasingly popular choice in hip arthroplasty. New manufacturing procedures have increased the strength and reliability of ceramic materials and reduced the risk of complications. In recent decades, ceramics made of pure alumina have continuously improved, resulting in a surgical-grade material that fulfills clinical requirements. Despite the track record of safety and long-term results, third-generation pure alumina ceramics are being replaced in clinical practice by alumina matrix composites, which are composed of alumina and zirconium. In this review, the characteristics of both materials are discussed, and the long-term results with third-generation alumina-on-alumina bearings and the associated complications are compared with those of other available ceramics. Cite this article: EFORT Open Rev 2018;3:7-14. DOI: 10.1302/2058-5241.3.170034
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Affiliation(s)
- Didier Hannouche
- Department of Orthopaedic Surgery and Traumatology, Geneva University Hospital, Switzerland
| | - Matthieu Zingg
- Department of Orthopaedic Surgery and Traumatology, Geneva University Hospital, Switzerland
| | - Hermes Miozzari
- Department of Orthopaedic Surgery and Traumatology, Geneva University Hospital, Switzerland
| | - Remy Nizard
- Department of Orthopaedic Surgery, AP-HP, Hôpital Lariboisière, Paris University, Paris, France
| | - Anne Lübbeke
- Department of Orthopaedic Surgery and Traumatology, Geneva University Hospital, Switzerland
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García-Rey E, Cruz-Pardos A, García-Cimbrelo E. The evolution of an uncemented acetabular component in alumina-on-alumina total hip arthroplasty has improved clinical outcome. Bone Joint J 2017; 99-B:749-758. [DOI: 10.1302/0301-620x.99b6.bjj-2016-0045.r3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 10/05/2016] [Indexed: 11/05/2022]
Abstract
Aims To determine the effect of a change in design of a cementless ceramic acetabular component in fixation and clinical outcome after total hip arthroplasty Patients and Methods We compared 342 hips (302 patients) operated between 1999 and 2005 with a relatively smooth hydroxyapatite coated acetabular component (group 1), and 337 hips (310 patients) operated between 2006 and 2011 using a similar acetabular component with a macrotexture on the entire outer surface of the component (group 2). The mean age of the patients was 53.5 (14 to 70) in group 1 and 53.0 (15 to 70) in group 2. The mean follow-up was 12.7 years (10 to 17) for group 1 and 7.2 years (4 to 10) for group 2. Results No hips were revised due to complications related to bearing fracture or to stem loosening. A total of 15 acetabular components were revised for aseptic loosening in group 1 and two in group 2. The survival rate for acetabular component aseptic loosening at eight years was 96.8% (95% confidence interval (CI) 94.8 to 98.7) for group 1 and 99.2% (95% CI 98.0 to 100) for group 2. The risk for aseptic loosening of the acetabular component was higher in group 1 (p = 0.04, Hazard Ratio (HR) 4.99), dysplastic acetabula (p = 0.01, HR 4.12), components outside Lewinnek´s zone (p < 0.001, HR 6.13) and in those with a hip rotation centre distance greater than 5 mm (p = 0.005, HR 4.09). Conclusion Alumina ceramic-on-ceramic THA is an excellent option for young patients. Although newer components appeared to improve fixation, acetabular reconstruction is essential to obtain a satisfactory outcome. Cite this article: Bone Joint J 2017;99-B:749–58.
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Affiliation(s)
- E. García-Rey
- Hospital La Paz-Idi Paz, Orthopaedics
Department, Madrid, Spain
| | - A. Cruz-Pardos
- Hospital La Paz-Idi Paz, Orthopaedics
Department, Madrid, Spain
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12
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Winston BA, Kagan RP, Huff TW. Delayed diagnosis of catastrophic ceramic liner failure with resultant pelvic discontinuity and massive metallosis. Arthroplast Today 2016; 3:77-82. [PMID: 28695178 PMCID: PMC5485230 DOI: 10.1016/j.artd.2016.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 11/04/2016] [Accepted: 11/09/2016] [Indexed: 12/28/2022] Open
Abstract
With newer-generation ceramic components used in total hip arthroplasty, component fracture is a rare complication. However rare, when ceramic component fracture does occur, prompt identification and revision is necessary as delay can lead to dramatic failure with resultant metallosis as the extremely hard ceramic debris abrades remaining components. We present a case of a 70-year-old woman with ceramic liner fracture and an estimated 10-year delay in intervention with failure resulting in pelvic discontinuity and massive metallosis with associated cutaneous manifestation. She was treated with a complex revision and reconstruction and is 2 years postrevision without major complication.
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Affiliation(s)
- Benjamin A Winston
- Department of Orthopedics and Rehabilitation, The Oregon Health Science University, Portland, OR, USA
| | - Ryland P Kagan
- Department of Orthopedics and Rehabilitation, The Oregon Health Science University, Portland, OR, USA
| | - Thomas W Huff
- Department of Orthopedics and Rehabilitation, The Oregon Health Science University, Portland, OR, USA
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13
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Noise characteristics in ceramic-on-ceramic vs. metal-on-polyethylene total hip arthroplasty: a comparative study. Hip Int 2016; 26:492-497. [PMID: 27689505 DOI: 10.5301/hipint.5000383] [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] [Accepted: 03/03/2016] [Indexed: 02/04/2023]
Abstract
INTRODUCTION A comparison of noise in ceramic-on-ceramic (CoC) bearings and metal-on-polyethylene (MoP) bearings after total hip arthroplasty (THA) was undertaken. Noise associated with MoP implants is rarely reported and has not been linked to squeaking. METHODS A noise characterising hip questionnaire and Oxford Hip Score (OHS) was sent to 1,000 THA patients; there were 509 respondents 282 CoC and 227 MoP; mean age 63.7 years (range 45-92 years), mean follow up 33 months (range 6-156 months). RESULTS Of 282 repsondents 47 (17%) of the CoC patients reported noise compared to 19 (8%) of the MoP patients (p = 0.048); 9 CoC patients and 4 MoP patients reported squeaking. Overall, 27% patients with noise reported avoiding recreational activities because of it and patients with noisy hips scored on average 5 points less on the OHS (CoC: p = 0.04 and MoP: p = 0.007). DISCUSSION This is the first study to report squeaking from MoP THAs. The squeaking hip phenomenon is not exclusive to CoC THAs. Noisy hip implants may have social implications, and patients should be aware of this. We have shown a relationship between noise and a lower OHS. However, longer follow-up is needed to link noise to a poorly functioning implant.
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Is a ceramic-on-ceramic bearing really superior to ceramic-on-polyethylene for primary total hip arthroplasty? A systematic review and meta-analysis of randomised controlled trials. Hip Int 2016; 25:191-8. [PMID: 25684252 DOI: 10.5301/hipint.5000223] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2014] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The outcomes of using a ceramic-on-ceramic (CoC) vs ceramic-on-polyethylene (CoP) bearing surface for primary total hip arthroplasty (THA) are much debated. We performed a systematic review and meta-analysis of randomised controlled trials (RCTs) to compare and evaluate the outcomes of these 2 bearing surfaces. MATERIALS AND METHODS Electronic databases (PubMed/Medline, CENTRAL, Embase and Web of Science) were systematically searched for RCTs investigating the association between bearing surfaces and outcomes following primary THA. Two investigators independently reviewed studies for eligibility, assessed the risk of bias, extracted and analysed the data. RESULTS In total, 13 RCTs including a total of 2,488 THAs were identified. The Harris Hip Score appeared to be similar between CoC and CoP THAs. The acetabular liner wear rate was lower in CoC than CoP THA, but the meta-analysis showed that the incidence of component-related noise and overall ceramic fracture in CoC group were 14.73 times and 6.02 times higher than CoP THA, respectively. There were no statistically significant differences in rates of radiolucent line formation (>1 mm), osteolysis, loosening, revision with follow-up ≥ 5 years, intraoperative femoral fracture, dislocation, deep infection, deep venous thrombosis and leg length discrepancy between CoC and CoP THAs. CONCLUSIONS There appears to be no clear evidence favouring the use of either a CoC or CoP bearing surfaces in primary THA, further studies with high-quality and longer term follow-up to provide more evidence on this topic are still required.
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Levy YD, Munir S, Donohoo S, Walter WL. Review on squeaking hips. World J Orthop 2015; 6:812-820. [PMID: 26601063 PMCID: PMC4644869 DOI: 10.5312/wjo.v6.i10.812] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/21/2015] [Accepted: 09/28/2015] [Indexed: 02/06/2023] Open
Abstract
Squeaking is a well-recognized complication for hard-on-hard bearings. The nature of squeaking is not yet completely understood however it is considered a multifactorial phenomenon. Patient, implant, and surgical factors play a role in squeaking. It is believed that mechanisms damaging the fluid film lubrication in which these bearings function optimally have a critical role. Such mechanisms include edge loading, stripe wear, impingement, third body particles and ceramic fracture. The resonance of metallic parts can produce noise in the human audible range hence the implant metallurgic composition and design may play a role. Implant positioning can facilitate impingement and edge loading enhancing the occurrence of squeaking. The recent introduction of large heads (> 36 mm) 4th generation ceramic-on-ceramic bearing may accentuate the conditions facilitating noise formation; however the current literature is insufficient. Clinically, squeaking may manifest in extreme hip positions or during normal gait cycle however it is rarely associated with pain. Evaluations of patients with squeaking include clinical and radiographic assessments. Computer tomography is recommended as it can better reveal ceramic breakage and implant malposition. The treatments for most squeaking patients include reassurance and activity modification. However for some, noise can be a problem, requiring further surgical intervention. In the occurrence of ceramic fracture, implant failure, extreme components malposition, instability and impingement, surgery should be advised. This review will aim to discuss the current literature regarding squeaking.
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Endo Y, Renner L, Schmidt-Braekling T, Mintz DN, Boettner F. Imaging of ceramic liner fractures in total hip arthroplasty: the value of CT. Skeletal Radiol 2015; 44:1189-92. [PMID: 25744811 DOI: 10.1007/s00256-015-2122-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 01/25/2015] [Accepted: 02/15/2015] [Indexed: 02/02/2023]
Abstract
Fracture of a ceramic liner of a total hip arthroplasty is rare and is radiographically occult if not displaced. We report on two patients in whom ceramic liner fracture was radiographically occult but was diagnosed on subsequent CT scan through appropriate windowing.
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Affiliation(s)
- Yoshimi Endo
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
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17
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Abstract
We reviewed 380 hip resurfacings cases between December 1999 and Dec 2012. 11 cases (2.89%) squeaked postoperatively. Mean follow-up was 88.6 months (19-130 months). Mean time to squeak was 11.3 months (3-22 months). Ten (91%) cases were male and nine (81%) cases had a Birmingham hip resurfacing. Cases were matched for age, gender, BMI and implant to three controls. Radiographs were analysed using EBRA (Einzel-Bild-Roentgen-Analysis, University of Innsbruck, Austria) software to evaluate cup orientation. There was no significant difference between the mean inclination angle of the cups (p = 0.26) or the mean anteversion angle (p = 0.29). There was no difference in serum cobalt (p = 0.20) or serum chromium (p = 0.45) levels at latest follow-up. Three of the 11 (27.3%) cases had revision surgery at a mean follow-up of 101 months (72-117 months). Squeaking was not influenced by patient demographic parameters and resolved in all cases that did not undergo revision surgery. Males with a resurfacing head size <50 mm had significantly increased odds of squeaking when compared to controls (odds ratio = 26.6; 95% CI = 1.2-573.3; p<0.05). Based on our findings, we do not recommend that squeaking on its own should be an indication for revision of hip resurfacing components.
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De Pasquale D, Stea S, Squarzoni S, Bordini B, Amabile M, Catalani S, Apostoli P, Toni A. Metal-on-metal hip prostheses: correlation between debris in the synovial fluid and levels of cobalt and chromium ions in the bloodstream. INTERNATIONAL ORTHOPAEDICS 2015; 38:469-75. [PMID: 24122048 DOI: 10.1007/s00264-013-2137-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 09/19/2013] [Indexed: 12/12/2022]
Abstract
PURPOSE Hip prostheses with metal-on-metal (MoM) coupling can release cobalt-chromium particles and ions. The aim of this work is to verify the correlation between particles in the synovial fluid and circulating ions. METHODS Forty patients were enrolled; particles from synovial fluid were analysed by SEM–EDX (Scanning Electron Microscopy-Energy Dispersion X-rays analysis) and levels of circulating Co and Cr were assayed by ICP-MS (inductively-coupled plasma mass spectrometry). RESULTS In 16 cases we did not find any particles in the synovial fluid and the Co level in whole blood was 0.05–4.42 ppb; in seven with few particles the blood level was 2.2–15.6 ppb; in six cases with several particles the level was 5.0–54.3 ppb; finally, in 11 cases we isolated not only Co-Cr particles, but also Cr particles with low or absent Co and in these patients the circulating level of Co was 23.8–109.6 ppb. Co in serumand Cr level both whole blood and serum have shown a similar trend to Co; the correlation between all these values and the corresponding particles is statistically significant in all cases. CONCLUSION Co and Cr both in serum and whole blood represents a systemic representation of the particle release at local level and can therefore be used to confirm a diagnosis and monitor the wear process of MoM articular prostheses.
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Lee DW, Hwang SK. Primary Total Hip Arthroplasty Using Third Generation Ceramic-Ceramic Articulation: Results after a Minimum of Three-years of Follow-up. Hip Pelvis 2014; 26:84-91. [PMID: 27536564 PMCID: PMC4971121 DOI: 10.5371/hp.2014.26.2.84] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 06/12/2014] [Accepted: 06/16/2014] [Indexed: 11/24/2022] Open
Abstract
Purpose This study assessed the short term clinicoradiological results of primary total hip arthroplasty using third generation ceramic-ceramic articulation Accolade TMZF femoral stems. Materials and Methods Two hundred and seventy two patients (294 hips) with primary total hip arthroplasty using third generation ceramic-ceramic articulation Accolade TMZF femoral stems who had been followed-up for a minimum of 3 years were included. Clinicoradiological results were analyzed and postoperative complications were observed. Results At final follow-up, mean Harris hip score was increased from 52 to 94 points. On radiogical evaluation, the average acetabular inclination was 42 degrees and the average acetabular anteversion was 15 degrees. Neither osteolysis nor loosening were observed around the acetabulum or proximal femur. Among 294 acetabular cups, 293 cups (99.66%) achieved stable fixation. Regarding the 294 femoral stems, 286 (97.28%) had bony fixation, 7 (2.38%) had fibrous fixation, and none were found to have unstable stem fixation. Proximal bone resorption was observed in 17 hips (5.78%; only Grade 1) and radiolucent lines were observed in 88 hips (29.93%), however, all were around the distal smooth portion of the stems. Postoperative complications included dislocation in 6 hips (2.04%), heterotopic ossification in 3 hips (1.02%), ceramic fractures in 4 hips (1.36%), superficial infection in 1 hip (0.34%), and squeaking in 8 hips (2.72%). Conclusion The short term clinicoradiological results of primary total hip arthroplasty using third generation ceramic-ceramic articulation and Accolade TMZF femoral stems together with Secur-Fit acetabular cups were satisfactory. However, problems such as ceramic fractures and squeaking after arthroplasty were observed. Additional studies are necessary in order to develop methods that may reduce or eliminate these complications.
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Affiliation(s)
- Dong Woo Lee
- Department of Orthopedics, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sung Kwan Hwang
- Department of Orthopedics, Yonsei University Wonju College of Medicine, Wonju, Korea
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Nine MJ, Choudhury D, Hee AC, Mootanah R, Osman NAA. Wear Debris Characterization and Corresponding Biological Response: Artificial Hip and Knee Joints. MATERIALS (BASEL, SWITZERLAND) 2014; 7:980-1016. [PMID: 28788496 PMCID: PMC5453097 DOI: 10.3390/ma7020980] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 12/03/2013] [Accepted: 12/10/2013] [Indexed: 12/12/2022]
Abstract
Wear debris, of deferent sizes, shapes and quantities, generated in artificial hip and knees is largely confined to the bone and joint interface. This debris interacts with periprosthetic tissue and may cause aseptic loosening. The purpose of this review is to summarize and collate findings of the recent demonstrations on debris characterization and their biological response that influences the occurrence in implant migration. A systematic review of peer-reviewed literature is performed, based on inclusion and exclusion criteria addressing mainly debris isolation, characterization, and biologic responses. Results show that debris characterization largely depends on their appropriate and accurate isolation protocol. The particles are found to be non-uniform in size and non-homogeneously distributed into the periprosthetic tissues. In addition, the sizes, shapes, and volumes of the particles are influenced by the types of joints, bearing geometry, material combination, and lubricant. Phagocytosis of wear debris is size dependent; high doses of submicron-sized particles induce significant level of secretion of bone resorbing factors. However, articles on wear debris from engineered surfaces (patterned and coated) are lacking. The findings suggest considering debris morphology as an important parameter to evaluate joint simulator and newly developed implant materials.
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Affiliation(s)
- Md J Nine
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur 50603, Malaysia.
| | - Dipankar Choudhury
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur 50603, Malaysia.
- Faculty of Mechanical Engineering, Brno University of Technology, Technická 2896/2, Brno 61669, Czech Republic.
| | - Ay Ching Hee
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur 50603, Malaysia.
| | - Rajshree Mootanah
- Medical Engineering Research Group, Department of Engineering and the Built Environment, Faculty of Science and Technology, Anglia Ruskin University, Chelmsford, Essex CM1 1SQ, UK.
| | - Noor Azuan Abu Osman
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur 50603, Malaysia.
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Beraudi A, Catalani S, Montesi M, Stea S, Sudanese A, Apostoli P, Toni A. Detection of cobalt in synovial fluid from metal-on-metal hip prosthesis: correlation with the ion haematic level. Biomarkers 2013; 18:699-705. [PMID: 24134776 DOI: 10.3109/1354750x.2013.846413] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Hip replacement with large metal-on-metal (MoM) coupling has recently been under attention for its metal ions release, inducing several disorders. Since the blood level toxicity threshold for cobalt is known, the aim of this work is to determine whether Co serum and blood levels correlate with the synovial fluid level. Beside this, the synovial fluid Co from patients without prosthesis has also been measured. Co has been determined in 54 samples (32 unilateral MoM and 22 controls) with inductively coupled plasma mass spectrometry in the three matrices. In the prosthesized group, cobalt was significantly higher compared with controls and in the synovial fluid it strongly correlated with whole blood Co (p = 0.847) and serum (p = 0.855). Moreover, the Co levels into whole blood and serum were significantly different. In conclusion, haematic Co concentration correctly reflects Co local level.
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Affiliation(s)
- Alina Beraudi
- Medical Technology Laboratory, PROMETEO Laboratory, Rizzoli RIT Department-Research, Innovation & Technology, Rizzoli Orthopaedic Institute , Bologna , Italy
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Fracture of ceramic bearing surfaces following total hip replacement: a systematic review. BIOMED RESEARCH INTERNATIONAL 2013; 2013:157247. [PMID: 23844356 PMCID: PMC3697280 DOI: 10.1155/2013/157247] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Accepted: 06/03/2013] [Indexed: 12/17/2022]
Abstract
Ceramic bearing surfaces are increasingly used for total hip replacement, notwithstanding that concern is still related to ceramic brittleness and its possible mechanical failure. The aim of this systematic review is to answer three questions: (1) Are there risk factors for ceramic component fracture following total hip replacement? (2) Is it possible to perform an early diagnosis of ceramic component failure before catastrophic fracture occurs? (3) Is it possible to draw guidelines for revision surgery after ceramic components failure? A PubMed and Google Scholar search was performed and reference citations from publications identified in the literature search were reviewed. The use of 28 mm short-neck femoral head carries an increased risk of fracture. Acetabular component malposition might increase the risk of ceramic liner fractures. Synovial fluid microanalysis and CT scan are promising in early diagnosis of ceramic head and liner failure. Early revision is suggested in case of component failure; no consensus exists about the better coupling for revision surgery. Ceramic brittleness remains a major concern. Due to the increased number of ceramic on ceramic implants, more revision surgeries and reports on ceramic components failure are expected in the future. An algorithm of diagnosis and treatment for ceramic hip failure is proposed.
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Abstract
The aim of this study was to detect risk factors for ceramic liner fractures. 26 cementless ceramic on ceramic (COC) total hip arthroplasties (THA) revised because of ceramic liner fracture in 24 patients were compared with 49 well-functioning COC THA performed in 49 patients. Demographic parameters, type of ceramic of the liner, size and neck length of the femoral head, cup abduction angle, cup anteversion, femoral off-set, height of the centre of rotation and the incidence of noisy hips during follow-up examination were compared. A greater number of cups placed outside the optimal range of cup anteversion was found in the fracture group (p = 0.03). An audible noise was detected in 21 cases (80.7%) in the fracture group and in 3 cases (6.1%) in the non-fracture group (p = 0.001). A cup anteversion angle out of the optimal range of 15˚+/-10˚ was found to be a risk factor for ceramic liner fracture and the presence of a noisy hip frequently anticipated the failure. In our opinion neck-to-cup impingement with head subluxation and edge loading on the liner rim could have an important role in the onset of noise and subsequent liner failure, and cup malposition contributes to this mechanism of failure.
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24
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De Pasquale D, Stea S, Beraudi A, Montesi M, Squarzoni S, Toni A. Ceramic debris in hip prosthesis: correlation between synovial fluid and joint capsule. J Arthroplasty 2013; 28:838-41. [PMID: 23489725 DOI: 10.1016/j.arth.2013.01.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 01/02/2013] [Accepted: 01/16/2013] [Indexed: 02/01/2023] Open
Abstract
Detection of ceramic particles in synovial fluids allows early diagnosis of ceramic damage, but there is no evidence of a relationship between ceramic debris in the articular space and in the joint capsule. The aim of the present study is to verify if the particles isolated in the synovial fluid are comparable with those stored in the capsular tissue. Twenty-one patients were enrolled. Both synovial fluid and capsular samples were collected during revision surgery and ceramic particles were isolated and analyzed by scanning electron microscopy and energy-dispersive X-ray microanalysis. It resulted a significant correlation between the samples couples (18 out of 21). This study confirms that the synovial fluid analysis can give a clear definition of the presence of particles in the joint capsule.
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Affiliation(s)
- Dalila De Pasquale
- Medical Technology Laboratory, Istituto Ortopedico Rizzoli, Bologna, Italy
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25
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Beraudi A, Montesi M, Traina F, Falcioni S, Stea S, Toni A. Uncemented primary total hip arthroplasty, presentation of pain, and expression of osteonectin. Artif Organs 2013; 37:561-6. [PMID: 23495858 DOI: 10.1111/aor.12035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Osteonectin (ON) is an important matrix glycoprotein highly expressed in bone. In several in vitro and animal model studies, ON was used as indicator of the state of osseointegration of implanted devices. There are, however, no studies on ON expression in the synovial fluid of patients with total hip joint replacement (THJR). The purpose of our study was to determine the ON concentration in synovial fluid from three groups of patients: primary uncemented THJR with hip pain ("pain" group; n = 15) and without pain ("no-pain" group; n = 12), and patients with osteoarthitis scheduled to receive a primary THJR (control group; n = 5). For the prosthesized groups, the statistical nature of the correlation between ON concentration and patient age, in situ life of the THJR, presence of periprosthetic osteolysis, and presence of debris in the synovial fluid was individually investigated. ON concentration was determined using enzyme-linked immunosorbent assay, the presence of periprosthetic osteolysis was established using X-radiography and Engh's criteria, and the presence of debris was determined using digestion and EDX spectroscopy. ON concentration was significantly lower in the "pain" group compared with the "no-pain" one (median values 19.0 and 53.2 ng/mL, respectively). ON concentration in the control group (median value: 16.9 ng/mL) was comparable with that reported in the literature. In the prosthesized groups, ON concentration was not correlated with patient age, in situ life of the prosthesis, presence of periprosthetic osteolysis, or presence of debris in the synovial fluid. Our results suggest that cases of unexplained pain in THJR patients could be treated by paying special attention to the osseointegration status of the implant by using ON concentration as an early indicator of this status.
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Affiliation(s)
- Alina Beraudi
- Medical Technology Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy.
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Abstract
BACKGROUND Hypothesized risk factors for fracture of ceramic liners include impingement, edge-loading, and cup malpositioning. These risk factors are similar to those for generation of stripe wear. However, it is unclear whether the biomechanical conditions contributing to stripe wear generation also increase the risk for ceramic liner fracture QUESTIONS/PURPOSES We asked whether (1) head stripe wear propensity; and (2) cup orientation would correlate with alumina liner fracture risk for instances of normal and elevated body weight. METHODS An eXtended Finite Element Method (XFEM) model was developed to investigate these mechanisms. Liner fracture risk for 36-mm alumina bearings was studied by simulating two fracture-prone motions: stooping and squatting. Twenty-five distinct cup orientations were considered with variants of both acetabular inclination and anteversion. Four separate body mass indices were considered: normal (25 kg/m(2)) and three levels of obesity (33, 42, and 50 kg/m(2)). Material properties were modified to simulate alumina with and without the presence of dispersed microflaws. The model was validated by corroboration with two previously published ceramic liner fracture studies. RESULTS Of 200 XFEM simulations with flaw-free alumina, fracture occurred in eight instances, all of them involving obesity. Each of these occurred with cups in ≤ 37° inclination and in 0° anteversion. For 200 corresponding simulations with microflawed alumina, fracture propensity was greatest for cups with higher (edge loading-associated) scraping wear. Fracture risk was greatest for cups with lower inclination (average 42° for fractured cases versus 48° for nonfractured cases) and lower anteversion (9° versus 20°). CONCLUSIONS Fracture propensity for 36-mm liners was elevated for cups with decreased anteversion and/or inclination and under conditions of patient obesity. CLINICAL RELEVANCE Factors causing stripe wear, including obesity and cup malpositioning, also involve increased risk of ceramic liner fracture and merit heightened concern.
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Trivellin G, Sandri A, Bizzotto N, Marino MA, Mezzari S, Sambugaro E, Regis D. Ceramic liner fatigue fracture: 3-D CT findings in a late recurrent THA dislocation. Orthopedics 2013; 36:e101-e104. [PMID: 23276339 DOI: 10.3928/01477447-20121217-26] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Dislocation is one of the most common complications of total hip arthroplasty (THA). To the authors' knowledge, late recurrent dislocation of a THA with a ceramic-on-ceramic coupling secondary to fatigue fracture of the ceramic liner has never been described. A 76-year-old woman with right hip osteoarthritis underwent cementless modular THA with a ceramic-on-ceramic coupling. Approximately 10 years postoperatively, she experienced right hip pain with no trauma, which resolved in 14 days. Family members reported that the patient had shown a progressive cognitive and muscular decline in the previous months. Six months later, the patient was admitted for THA dislocation, which was immediately reduced. Computed tomography revealed that the right acetabular component had a retroversion of 4° and an inclination angle of 45°. An orthopedic brace was applied, but dislocation recurred 2 days after discharge. A 3-dimensional CT reconstruction showed a fracture of the ceramic liner in the posterolateral region. The patient underwent revision surgery, and the ceramic liner breakage was confirmed. After removal of the acetabular components, a cemented polyethylene cup was implanted. The stability of the stem was verified. The existing modular neck was replaced with a chromium-cobalt neck, and a new ceramic head was applied. At 7-month follow-up, the patient had good functional recovery with no hip instability. Fatigue failure of a ceramic liner should be considered as responsible for late dislocation after ceramic-on-ceramic THA. As part of the diagnostic strategy, 3-dimensional CT reconstruction should be used to evaluate ceramic liner breakage.
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Affiliation(s)
- Giacomo Trivellin
- Department of Orthopaedic Surgery, Azienda Ospedaliera Universitaria Integrata, Polo Chirurgico Confortini, Verona, Italy.
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Zywiel MG, Brandt JM, Overgaard CB, Cheung AC, Turgeon TR, Syed KA. Fatal cardiomyopathy after revision total hip replacement for fracture of a ceramic liner. Bone Joint J 2013; 95-B:31-7. [DOI: 10.1302/0301-620x.95b1.30060] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Symptomatic cobalt toxicity from a failed total hip replacement is a rare but devastating complication. It has been reported following revision of fractured ceramic components, as well as in patients with failed metal-on-metal articulations. Potential clinical findings include fatigue, weakness, hypothyroidism, cardiomyopathy, polycythaemia, visual and hearing impairment, cognitive dysfunction, and neuropathy. We report a case of an otherwise healthy 46-year-old patient, who developed progressively worsening symptoms of cobalt toxicity beginning approximately six months following synovectomy and revision of a fractured ceramic-on-ceramic total hip replacement to a metal-on-polyethylene bearing. The whole blood cobalt levels peaked at 6521 µg/l. The patient died from cobalt-induced cardiomyopathy. Implant retrieval analysis confirmed a loss of 28.3 g mass of the cobalt–chromium femoral head as a result of severe abrasive wear by ceramic particles embedded in the revision polyethylene liner. Autopsy findings were consistent with heavy metal-induced cardiomyopathy. We recommend using new ceramics at revision to minimise the risk of wear-related cobalt toxicity following breakage of ceramic components. Cite this article: Bone Joint J 2013;95-B:31–7.
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Affiliation(s)
- M. G. Zywiel
- University of Toronto, Banting
Institute, Division of Orthopaedic Surgery, 100
College Street Room 302, Toronto, Ontario M5G
1L5, Canada
| | - J-M. Brandt
- University of Manitoba, Concordia
Joint Replacement Group, Suite 310-1155 Concordia
Ave, Winnipeg, Manitoba
R2K 2M9, Canada
| | - C. B. Overgaard
- Toronto General Hospital, University
Health Network, EN North 232, 200
Elizabeth Street, Toronto, Ontario
M5G 2C4, Canada
| | - A. C. Cheung
- University of Toronto, University
Health Network, Toronto Western Hospital, 8
MP Room 326, 399 Bathurst Street, Toronto, Ontario
M5T 2S8, Canada
| | - T. R. Turgeon
- University of Manitoba, Concordia
Joint Replacement Group, Suite 310-1155 Concordia
Ave, Winnipeg, Manitoba
R2K 2M9, Canada
| | - K. A. Syed
- University of Toronto, University
Health Network, Toronto Western Hospital, 399
Bathurst Street, 446, 1 East Wing, Toronto, Ontario
M5T 2S8, Canada
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Brockett CL, Williams S, Jin Z, Isaac GH, Fisher J. Squeaking hip arthroplasties: a tribological phenomenon. J Arthroplasty 2013; 28:90-7. [PMID: 22480525 DOI: 10.1016/j.arth.2012.01.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 10/20/2011] [Accepted: 01/19/2012] [Indexed: 02/01/2023] Open
Abstract
The clinical incidence of squeaking has been reported with increasing frequency, with ceramic-on-ceramic bearings seemingly most affected. This study investigated potential causes of squeaking in hard-on-hard hip bearings through 2 sets of experimental conditions. Bearing clearance appeared to affect the incidence of squeaking in metal-on-metal surface arthroplasties. The addition of third-body particles to the interface for total hip arthroplasties also affected the incidence of squeaking. In both studies, the incidence of squeaking correlated well with elevated friction. The findings of this study suggest that a likely cause of squeaking in the hip arthroplasty is adverse tribological conditions caused by suboptimal lubrication. There are numerous factors that may cause the suboptimal lubrication, and therefore, it is unlikely that an individual cause for squeaking will be identified.
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Affiliation(s)
- Claire L Brockett
- Institute of Medical and Biological Engineering, University of Leeds, School of Mechanical Engineering, Leeds, United Kingdom
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Toni A, Baleani M, Bordini B, Stea S, Pilla F, Sudanese A. “Trunionitis”: A Cause for Concern? ACTA ACUST UNITED AC 2012. [DOI: 10.1053/j.sart.2013.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Gallo J, Goodman SB, Lostak J, Janout M. Advantages and disadvantages of ceramic on ceramic total hip arthroplasty: a review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2012; 156:204-12. [PMID: 23069885 DOI: 10.5507/bp.2012.063] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 06/13/2012] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Ceramic on ceramic (COC) total hip arthroplasty (THA) was developed to reduce wear debris and accordingly, the occurrence of osteolysis and aseptic loosening especially in younger patients. Based on the excellent tribological behavior of current COC bearings and the relatively low biological activity of ceramic particles, significant improvement in survivorship of these implants is expected. METHODS We used manual search to identify all relevant studies reporting clinical data on COC THAs in PubMed. The objective was to determine whether current COC THA offers a better clinical outcome and survivorship than non-COC THA. RESULTS Studies with early generation ceramic bearings yielded 68% to 84% mean survivorship at 20 years follow-up which is comparable with the survivorship of non-COC THAs. Studies on current ceramic bearings report a 10-year revision-free interval of 92% to 99%. These outcomes are comparable to the survivorship of the best non-COC THAs. However, there are still concerns regarding fracture of sandwich ceramic liners, squeaking, and impingement of the femoral neck on the rim of the ceramic liner leading to chipping, especially in younger and physically active patients. CONCLUSION Current COC THA leads to equivalent but not improved survivorship at 10 years follow-up in comparison to the best non-COC THA. Based on this review, we recommend that surgeons weigh the potential advantages and disadvantages of current COC THA in comparison to other bearing surfaces when considering young very active patients who are candidates for THA.
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Affiliation(s)
- Jiri Gallo
- Department of Orthopaedics, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic.
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Abstract
BACKGROUND Ceramic-on-ceramic (CoC) bearings have excellent tribologic properties because of the smoothness, hardness, and wettability of the material. Therefore, their use has been proposed in younger, active patients who may wear out a traditional metal-on-polyethylene bearing. The same material properties that are beneficial to tribology may also create problems, however. For example, squeaking and fracture of the bearing materials have been reported to occur. PURPOSE The purpose of this paper was to investigate the literature reporting the complications of ceramic bearings and attempt to provide insight into their implications. METHODS The US National Library of Medicine Database (PubMed) was searched using the terms "ceramic-ceramic total hip replacement," "complications," "squeaking," and "fracture." Only clinical studies with a clear reporting of the incidence of these complications were included. RESULTS The literature reports that squeaking of the CoC bearing occurs in a certain percentage of patients and is likely indicative of edge loading and excessive wear. Other factors, such as patient height, weight, range of motion, and implant design, may contribute to the propensity for squeaking. Fracture is a unique risk of the CoC articulation that requires revision surgery. Though improvements in manufacturing techniques have reduced the fracture risk to a very low percentage, the ceramic material remains susceptible to this complication by impingement and component malposition. CONCLUSIONS Because of these possible negative outcomes associated with the ceramic material, the CoC bearing is too unpredictable to use regularly, and its use should be limited to patients who would benefit the most from it.
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Abstract
Over the past three decades, alumina ceramic, now in its third/fourth generation, has been markedly improved in terms of its mechanical properties, including purity, grain microstructure, and burst strength. In the clinic, it is particularly suitable for young and for very active patients. This paper discusses the development and characteristics of different kinds of ceramics. In addition, ceramics in the third/fourth generation which are used in total hip arthroplasty clinically are reviewed in detail.
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Affiliation(s)
- You-zhi Cai
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Fard-Aghaie MH, Citak M, Correia J, Haasper C, Gehrke T, Kendoff D. Traumatic ceramic femoral head fracture: an initial misdiagnosis. Open Orthop J 2012; 6:362-5. [PMID: 22927896 PMCID: PMC3426826 DOI: 10.2174/1874325001206010362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 06/22/2012] [Accepted: 06/24/2012] [Indexed: 11/22/2022] Open
Abstract
Background and Purpose: Ceramic heads are widely used in modern total hip arthroplasty (THA). Although a rare complication, fractures of ceramic heads are described in the literature, evoking uncertainties regarding the in vivo stability of this material, especially when impaction of a fractured ceramic head can lead to disastrous results. Methods: In this case report, we present a fracture of a ceramic head after trauma. A misinterpretation of the initial radiographs led to severe fragmentation of the ceramic head two weeks after the incident, later resulting in complete destruction of the arthroplasty. Results and Interpretation: Remarkably, radiographs obtained more than one year after the trauma led to this delayed diagnosis. A single radiographic evaluation, especially in patients with persistent pain after major trauma, with a ceramic head in a THA, seems to be insufficient
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Stea S, Traina F, Beraudi A, Montesi M, Bordini B, Squarzoni S, Sudanese A, Toni A. Synovial fluid microanalysis allows early diagnosis of ceramic hip prosthesis damage. J Orthop Res 2012; 30:1312-20. [PMID: 22287092 DOI: 10.1002/jor.22077] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Accepted: 01/03/2012] [Indexed: 02/04/2023]
Abstract
The first clinical sign of ceramic hip prosthesis failure is hip noise. We therefore investigated whether isolation, observation at scanning electron microscopy, and chemical identification with microanalysis of particles from synovial fluid of "noisy hip" could be predictive of ceramic damage. Firstly, the level of "physiological wear" of well functioning ceramic-on-ceramic hip prostheses was assessed with this method, then the test was validated as diagnostic method for liner fracture. Twelve asymptomatic patients were enrolled to demonstrate the first aim; 39 cases of noisy hip (GROUP 1), and 7 cases of pending failure not related to ceramic (GROUP 2) were enrolled for the second aim. The analysis of the synovial fluid of the 12 asymptomatic patients allowed to set the "physiological wear" threshold. The analysis of GROUP 1 hips demonstrated the presence of ceramic particles (2 physiological, 12 mild, and 25 strong). The analysis of GROUP 2 showed a physiological presence of ceramic particles in all cases. Revision surgery in GROUP 1 was performed in 16 hips out 25 with strong ceramic particle presence and 2 out of 12 with mild ceramic particle presence. Failure of the ceramic component was evident in all but one of these cases, while the integrity of components was demonstrated in all seven hips of GROUP 2. Synovial fluid microanalysis can be a useful surrogate in predicting ceramic failure particularly when a strong presence of ceramic particles is observed. On the contrary there is not enough evidence to predict ceramic failure in presence of mild positivity.
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Affiliation(s)
- Susanna Stea
- Medical Technology Lab, Istituto Ortopedico Rizzoli, Bologna, Italy.
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Haq RU, Park KS, Seon JK, Yoon TR. Squeaking after third-generation ceramic-on-ceramic total hip arthroplasty. J Arthroplasty 2012; 27:909-15. [PMID: 22115760 DOI: 10.1016/j.arth.2011.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 10/06/2011] [Indexed: 02/01/2023] Open
Abstract
We retrospectively reviewed records of 1002 patients who underwent a third-generation ceramic-on-ceramic total hip arthroplasty. Fifteen patients complained of squeaking, at any time after their arthroplasty. Of these 15 patients, 14 were evaluated clinically and radiologically. These 14 patients were found to have significantly higher mean body mass index of 25.8 kg/m(2) as compared with all the other patients who did not complain of squeaking (mean, 23.7 kg/m(2)) (P = .022). The acetabular opening angle was significantly lower (mean, 34°) than a matched control group (mean, 38°) (P = .016). Limb length shortening of more than 5 mm was observed in 12 (85.7%) of the 14 patients as compared with only 4 (28.6%) of 14 patients in the matched control group. Flexion and sitting cross legged were identified as the movements, which most commonly (11/12) resulted in squeaking. The incidence of squeaking was found to be low (1.5%), and we identified high body mass index, decreased acetabular opening angle, and limb length shortening as factors associated with squeaking.
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Affiliation(s)
- Rehan-Ul Haq
- Center for Joint Disease, Chonnam National University Hwasun Hospital, 160, Ilsim-Ri, Hwasun-Eup, Hwasun-Gun, Jeonnam, Korea
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Elkins JM, Pedersen DR, Callaghan JJ, Brown TD. Fracture propagation propensity of ceramic liners during impingement-subluxation: a finite element exploration. J Arthroplasty 2012; 27:520-6. [PMID: 21855277 PMCID: PMC3246563 DOI: 10.1016/j.arth.2011.06.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 06/25/2011] [Indexed: 02/01/2023] Open
Abstract
Although improvements in materials engineering have greatly reduced fracture rates in ceramic femoral heads, concerns still exist for liners. Ceramics are vulnerable to fracture due to impact and from stress concentrations (point and line loading) such as those associated with impingement-subluxation. Thus, ceramic cup fracture propensity is presumably very sensitive to surgical cup positioning. A novel fracture mechanics finite element formulation was developed to identify cup orientations most susceptible to liner fracture propagation for several impingement-prone patient maneuvers. Other factors being equal, increased cup inclination and increased anteversion were found to elevate fracture risk. Squatting, stooping, and leaning shoe-tie maneuvers were associated with the highest fracture risk. These results suggest that fracture risk can be reduced by surgeons' decreasing cup abduction and by patients' avoiding of specific activities.
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Affiliation(s)
- Jacob M. Elkins
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa, City, IA,Department of Biomedical Engineering, University of Iowa, Iowa City, IA
| | - Douglas R. Pedersen
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa, City, IA,Department of Biomedical Engineering, University of Iowa, Iowa City, IA
| | - John J. Callaghan
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa, City, IA,Department of Biomedical Engineering, University of Iowa, Iowa City, IA,Veterans Administration Medical Center, Iowa City, IA
| | - Thomas D. Brown
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa, City, IA,Department of Biomedical Engineering, University of Iowa, Iowa City, IA
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Walter WL, Kurtz SM, Esposito C, Hozack W, Holley KG, Garino JP, Tuke MA. Retrieval analysis of squeaking alumina ceramic-on-ceramic bearings. ACTA ACUST UNITED AC 2012; 93:1597-601. [PMID: 22161920 DOI: 10.1302/0301-620x.93b12.27529] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This multicentre study analysed 12 alumina ceramic-on-ceramic components retrieved from squeaking total hip replacements after a mean of 23 months in situ (11 to 61). The rates and patterns of wear seen in these squeaking hips were compared with those seen in matched controls using retrieval data from 33 'silent' hip replacements with similar ceramic bearings. All 12 bearings showed evidence characteristic of edge-loading wear. The median rate of volumetric wear was 3.4 mm(3)/year for the acetabular component, 2.9 mm(3)/year on the femoral heads and 6.3 mm(3)/year for head and insert combined. This was up to 45 times greater than that of previously reported silent ceramic-on-ceramic retrievals. The rate of wear seen in ceramic components revised for squeaking hips appears to be much greater than in that seen in retrievals from 'silent' hips.
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Affiliation(s)
- W L Walter
- Specialist Orthopaedic Group, Suite 1.08 Mater Clinic, 3-9 Gillies Street, Wollstonecraft, New South Wales 2065, Australia.
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Montesi M, Beraudi A, Stea S, Ancarani C, Traina F, Toni A. Monocyte Chemoattractant Protein 1 Expression in Synovial Fluid of Patients With Total Hip Arthroplasty. Artif Organs 2011; 36:487-91. [DOI: 10.1111/j.1525-1594.2011.01400.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Tsitskaris K, Mansouri R, Li PL. Catastrophic ceramic failure in total hip arthroplasty: the role of microseparation. JRSM SHORT REPORTS 2011; 2:96. [PMID: 22279606 PMCID: PMC3265833 DOI: 10.1258/shorts.2011.011108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Thorey F, Sakdinakiattikoon M, Thiengwittayaporn S, Windhagen H. Early Results of Revision Hip Arthroplasty Using a Ceramic Revision Ball Head. ACTA ACUST UNITED AC 2011. [DOI: 10.1053/j.sart.2011.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Zywiel MG, Sayeed SA, Johnson AJ, Schmalzried TP, Mont MA. State of the art in hard-on-hard bearings: how did we get here and what have we achieved? Expert Rev Med Devices 2011; 8:187-207. [PMID: 21627555 DOI: 10.1586/erd.10.75] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Total hip arthroplasty has shown excellent results in decreasing pain and improving function in patients with degenerative disease of the hip. Improvements in prosthetic materials, designs and implant fixation have now resulted in wear of the bearing surface being the limitation of this technology, and a number of hard-on-hard couples have been introduced to address this concern. The purpose of this article is to review the origins, development, survival rates and potential advantages and disadvantages of the following hard-on-hard bearings for total hip arthroplasty: metal-on-metal standard total hip arthroplasty; metal-on-metal hip resurfacing arthroplasty, ceramic-on-ceramic total hip arthroplasty; and ceramic-on-metal bearings. Improvements in the manufacturing of metal-on-metal bearings over the past 50 years have resulted in implants that provide low wear rates and allow for the use of large femoral heads. However, concerns remain regarding elevated serum metal ion levels, potential teratogenic effects and potentially devastating adverse local tissue reactions, whose incidence and pathogenesis remains unclear. Modern total hip resurfacing has shown excellent outcomes over 10 years in the hands of experienced surgeons. Current ceramic-on-ceramic bearings have demonstrated excellent survival with exceptionally low wear rates and virtually no local adverse effects. Concerns remain for insertional chipping, in vivo fracture and the variable incidence of squeaking. Contemporary ceramic-on-metal interfaces are in the early stages of clinical use, with little data reported to date. Hard-on-hard bearings for total hip arthroplasty have improved dramatically over the past 50 years. As bearing designs continue to improve with new and modified materials and improved manufacturing techniques, it is likely that the use of hard-on-hard bearings will continue to increase, especially in young and active patients.
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Affiliation(s)
- Michael G Zywiel
- Division of Orthopaedic Surgery, University of Toronto, 100 College Street Room 302, Toronto, Ontario M5G 1L5, Canada
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Amanatullah DF, Landa J, Strauss EJ, Garino JP, Kim SH, Di Cesare PE. Comparison of surgical outcomes and implant wear between ceramic-ceramic and ceramic-polyethylene articulations in total hip arthroplasty. J Arthroplasty 2011; 26:72-7. [PMID: 21680138 DOI: 10.1016/j.arth.2011.04.032] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 04/20/2011] [Indexed: 02/01/2023] Open
Abstract
The results of a prospective multicenter trial comparing 357 hips randomized to total hip arthroplasty with either ceramic-ceramic or ceramic-polyethylene couplings are presented. No statistically significant difference in clinical outcomes scores between the ceramic-ceramic and ceramic-polyethylene groups was observed at any time interval. The mean linear rate was statistically lower (P < .001) in the ceramic-ceramic group (30.5 μm/year) when compared with the ceramic-polyethylene group (218.2 μm/year). The rates of ceramic implant fracture (2.6%) and audible component-related noise (3.1%) were statistically higher in the ceramic-ceramic group when compared with the ceramic-polyethylene group (P < .05). Lastly, there was no statistically significant difference in the dislocation or revision rate between the groups at the time of last clinical follow-up.
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Affiliation(s)
- Derek F Amanatullah
- Department of Orthopaedic Surgery, University of California at Davis Medical Center, Sacramento, California 95817, USA
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Microseparation and Stripe Wear in Alumina-On-Alumina Hip Implants. Int J Artif Organs 2011; 34:506-12. [DOI: 10.5301/ijao.2011.8457] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2011] [Indexed: 11/20/2022]
Abstract
The combination of materials that still has highest wear resistance for total hip replacement is ceramic-on-ceramic. However, brittleness is a major concern for ceramics: in vivo and in vitro studies on ceramic hip prostheses correlate microseparation with hip noise, ceramic wear, or ceramic liner damage. Ceramic microseparation can lead to edge load, ceramic head wear, and squeaking. The aim of this in vitro study was to investigate whether different angles of inclination influence the wear pattern of alumina-on-alumina hip joints with micro-separation during the swing phase. We also evaluated the wear rate obtained from this in vitro investigation with retrieval specimens obtained at 13 years' mean follow-up. The study was performed using a 12-station hip joint wear simulator (Shore Western, Monrovia, CA, USA) under bovine calf serum used as lubricant. Wear was evaluated by the gravimetric method and the test length was set at two million cycles. After two million cycles, a volumetric loss of 0.11 ±0.03 mm3 and 0.12 ±0.06 mm3 was observed, respectively, for 23° and 63° angles of inclination. In particular, the results obtained in this work revealed an increase of about 12-fold compared to previous results without microseparation conditions. No significant differences were observed between the two different inclinations on the wear patterns of the acetabular cups with a level of significance of α = 0.5. The location and general shape of the stripes wear were similar for the retrieved and simulator balls.
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Laurent MP, Pourzal R, Fischer A, Bertin KC, Jacobs JJ, Wimmer MA. In vivo wear of a squeaky alumina-on-alumina hip prosthesis: a case report. J Bone Joint Surg Am 2011; 93:e27. [PMID: 21471407 PMCID: PMC6882528 DOI: 10.2106/jbjs.i.00930] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Michel P. Laurent
- Department of Orthopaedic Surgery, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612. E-mail address for M.P. Laurent: . E-mail address for J.J. Jacobs: . E-mail address for M.A. Wimmer:
| | - Robin Pourzal
- Materials Science and Engineering, University of Duisburg-Essen, Lotharstrasse 1, 47057 Duisburg, Germany. E-mail address for R. Pourzal: . E-mail address for A. Fischer:
| | - Alfons Fischer
- Materials Science and Engineering, University of Duisburg-Essen, Lotharstrasse 1, 47057 Duisburg, Germany. E-mail address for R. Pourzal: . E-mail address for A. Fischer:
| | - Kim C. Bertin
- Utah Bone & Joint Center, 5323 Woodrow Street #202, Salt Lake City, UT 84107
| | - Joshua J. Jacobs
- Department of Orthopaedic Surgery, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612. E-mail address for M.P. Laurent: . E-mail address for J.J. Jacobs: . E-mail address for M.A. Wimmer:
| | - Markus A. Wimmer
- Department of Orthopaedic Surgery, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612. E-mail address for M.P. Laurent: . E-mail address for J.J. Jacobs: . E-mail address for M.A. Wimmer:
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Traina F, De Fine M, Tassinari E, Sudanese A, Calderoni PP, Toni A. Modular neck prostheses in DDH patients: 11-year results. J Orthop Sci 2011; 16:14-20. [PMID: 21258951 DOI: 10.1007/s00776-010-0018-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Accepted: 10/12/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND Total hip replacement in developmental dysplasia of the hip is a demanding procedure and usually requires dedicated devices and special surgical techniques. Nevertheless, the described techniques have shown variable outcomes. The aim of this study was to assess the 11-year outcomes of an off-the-shelf modular neck prosthesis in dysplastic patients and to evaluate the ability of the modular neck system to adequately restore femoral offset, abductor muscles lever arm and leg length. METHODS We retrospectively evaluated 61 modular neck prostheses implanted in 47 patients between June 1995 and March 2004. The preoperative diagnosis was developmental dysplasia of the hip in all cases. The clinical outcomes were assessed using the Harris hip score and the Western Ontario and McMaster Universities score. The femoral offset, abductor muscles lever arm, height and medialization of the hip center of rotation, and differences in leg length were evaluated on postoperative radiographs. Prosthesis survival was calculated according to the Kaplan-Meier method considering any reason for revision as failure. The average follow-up was 117.2 months (range 57-162 months). RESULTS The cumulative survival at 11 years was 97.5%. One prosthesis failed 5 years after surgery because of a ceramic liner fracture due to an inappropriate obstetric maneuver during labour. At the latest follow-up the mean Harris hip score was 74.7 (range 23-91). Leg length discrepancy was avoided in the majority of cases; femoral offset was almost always restored. CONCLUSIONS The results of this series support the use of modular neck prostheses as an effective alternative in the treatment of developmental dysplasia of the hip. The modularity was very efficient in restoring offset, leg length and maintaining stability with a good mid-long-term follow-up. Unlike other proposed surgical techniques, these good results are achievable by a standard surgical technique and with an off-the-shelf prosthesis.
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Affiliation(s)
- Francesco Traina
- 1st Department of Orthopaedic Surgery, Laboratory for Medical Technology (LTM), Istituti Ortopedici Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
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Abstract
BACKGROUND The alumina-on-alumina bearing surface, which has a high wear resistance and a good biocompatibility, is widely used in THA but recently has been associated with squeaking. While various authors have reported factors associated with squeaking, they remain poorly understood. QUESTIONS/PURPOSES To contribute to the debate on squeaking we therefore asked the following questions: (1) What is the incidence of squeaking in alumina-on-alumina THA? (2) What factors are associated with squeaking in alumina bearings in our practice? METHODS We retrospectively reviewed 168 patients (173 hips) who had primary alumina-on-alumina THAs. The mean age of the patients was 53 years (range, 18 to 81 years). Minimum followup was 5.6 years (average, 7.3 years; range, 5.6-9.4 years). All patients were evaluated clinically and radiographically with attention to periprosthetic osteolysis, squeaking, and ceramic fracture. When the patient reported squeaking, we determined the onset, reproducibility, and activities associated with the squeaking. We recorded patient (gender, age, height, weight, and body mass index) and surgical factors (abduction angle of cup, size and length of ceramic head component, and diameter of cup in the implant). RESULTS Eight of the 168 patients (5%) had squeaking hips. Squeaking was more common in males and in those with large ceramic heads. There were no complications or revisions in the squeaking group. One ceramic liner fracture was associated with trochanteric nonunion. CONCLUSIONS When recommending alumina-on-alumina bearing surfaces to patients they should be clearly informed of the possibility of squeaking. Patients with risk factors for squeaking should be followed at regular intervals.
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Millar NL, Halai M, McKenna R, McGraw IWW, Millar LL, Hadidi M. Uncemented ceramic-on-ceramic THA in adults with osteonecrosis of the femoral head. Orthopedics 2010; 33:795. [PMID: 21053883 DOI: 10.3928/01477447-20100924-13] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Advanced osteonecrosis of the femoral head is increasingly treated with uncemented total hip arthroplasty (THA), particularly in the younger population. While early outcomes appear promising, little is known about the optimum bearing surface in this patient subpopulation. The goal of this study was to evaluate the clinical and radiological outcomes of uncemented ceramic-on-ceramic THA in young adults with osteonecrosis of the femoral head. Twenty-four consecutive patients (24 hips) with osteonecrosis of the femoral head and 24 patients (24 hips) with osteoarthritis were treated with an uncemented ceramic-on-ceramic THA. Mean patient age for the osteonecrosis group was 46 years and for the osteoarthritis group was 50 years. At a mean follow-up of 34 months, functional improvement was significant in both groups (P<.01). The outcome was good to excellent for 85% of patients (17 hips) in the osteonecrosis group and 90% of patients (19 hips) in the osteoarthritis group. Harris and Oxford Hip scores were significantly better (P<.05) in the osteoarthritis group than in the osteonecrosis group at 6 months postoperatively but at no other assessment visit. Our results suggest that ceramic-on-ceramic THA in osteonecrotic patients produces similar clinical and radiological outcomes to those with osteoarthritis at a minimum 24-month follow-up. Ceramic-on-ceramic uncemented THA is therefore a useful adjunct for the treatment of advanced osteonecrosis of the femoral head.
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Affiliation(s)
- Neal L Millar
- Institute of Infection, Immunity, and Inflammation, College of Medicine, Veterinary, and Life Sciences, University Of Glasgow, Scotland, United Kingdom.
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Is alumina-on-alumina ceramic bearings total hip replacement the right choice in patients younger than 50 years of age? A 7- to 15-year follow-up study. Orthop Traumatol Surg Res 2010; 96:616-22. [PMID: 20620127 DOI: 10.1016/j.otsr.2010.02.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2009] [Revised: 01/31/2010] [Accepted: 02/15/2010] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The alumina-on-alumina bearing couple in total hip replacement seems to be well adapted for young and active patients because of the absence of wear and the rarity of osteolysis. Over the long term, doubts persist as to the cementless cup fixation and on the functioning of this bearing system because of possible acoustic emissions during use. HYPOTHESIS In young subjects, the ceramic-on-ceramic bearing system limits wear and osteolysis occurrences, without exposing patients to serious side effects. MATERIAL AND MEHTODS: We report the results, with between 7 and 15 years of follow-up, for 32mm-diameter alumina-on-alumina implants in 76 patients younger than 50 years of age (83 hips), combining cementless press-fit hemispheric cups with titanium stems, [either cemented (63 Osteal™ stems) or cementless (20 Multicône™ stems)], with particular attention paid to cup fixation and noise emissions during implant function. First-generation or Cerafit trellis™ acetabular components had a riveted titanium mesh (31 cases), whereas the most recent (Cerafit hydroxyapatite [HA]™) cups had a porous surface coated with hydroxyapatite (52 cases). RESULTS Three cases of aseptic loosening of the cemented stems were observed as well as late migration of a Cerafit trellis™ cup in the 12th postoperative year. One ceramic insert broke in the eighth postoperative year. With the exception of one case, the patients, questioned retrospectively, reported no audible noise. With aseptic loosening (revised or not), the criterion for failure, the 12-year survival rate was 91±11% for the Cerafit trellis™ acetabular components and 91±16% for the cemented Osteal™ stems. The 9- and 7-year survival rates for the Cerafit HA™ cups and the Multicône™ stems, respectively, were 100%. Including all revisions for any cause, the 10-year survival rate of the entire series was 92%±11%. DISCUSSION Despite the absence of wear and osteolysis, the long-term survival of these implants in young subjects should be improved. Although longer follow-up is necessary to formulate a definitive opinion, we tend to prefer cementless stem and cup fixation in ceramic-on-ceramic bearing systems. LEVEL OF EVIDENCE Level 4 retrospective study.
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