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Heimann AF, Swartz GN, Bains SS, Dubin JA, Katanbaf R, Delanois RE, Murphy SB. Long-Term Outcomes of Third-Generation Ceramic-on-Ceramic Bearings in Cementless Primary Total Hip Arthroplasty: A 25-Year Survival Analysis. J Arthroplasty 2025:S0883-5403(25)00243-8. [PMID: 40107579 DOI: 10.1016/j.arth.2025.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2025] [Revised: 03/09/2025] [Accepted: 03/10/2025] [Indexed: 03/22/2025] Open
Abstract
BACKGROUND The demand for total hip arthroplasty (THA) in younger patients, particularly those under 65 years, has increased markedly in recent years. Ceramic-on-ceramic (CoC) bearings offer promising benefits, including reduced wear and osteolysis, with excellent short- to mid-term survival. However, long-term data on their performance in younger populations remain limited. This study aimed to investigate: (1) overall implant survival, (2) complications and reasons for revision, and (3) patient-reported outcomes at long-term follow-up after primary THA with third-generation CoC bearings. METHODS A retrospective analysis was performed on 231 patients (294 hips) who underwent cementless THA with third-generation CoC bearings between May 1999 and September 2004. The mean age at surgery was 50 years (range, 17 to 76). Clinical and radiographic outcomes were assessed at a minimum follow-up of 10 years, and the mean follow-up was 17 years (range, 10 to 25). Overall, 87 patients (108 hips, 38%) were lost to follow-up, leaving a total of 145 patients (186 hips) for further analysis. Kaplan-Meier survival analysis was used to estimate implant survival, with implant revision for any reason defined as a primary end point. Complications, reasons for revision, and patient-reported outcomes (Merle d'Aubigné-Postel score) were also evaluated. RESULTS Kaplan-Meier analysis demonstrated an implant survival rate of 93% at 25 years. At long-term follow-up, 12 hips (6.5%) required revision for either bearing failure (six hips), acetabular component failure (four hips), or femoral component failure (two hips). There were six cases of hip squeaking (3.2%) reported, none requiring revision. Functional outcomes improved significantly, with mean Merle d'Aubigné-Postel scores rising from 10.7 preoperatively to 17.6 at the final follow-up. Radiographic evaluations showed no cases of osteolysis or loosening. CONCLUSIONS Third-generation CoC bearings in cementless THA offer excellent long-term survival, low complication rates, and good to excellent functional outcomes, highlighting their durability and performance over a 25-year period.
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Affiliation(s)
- Alexander F Heimann
- Department of Orthopaedic Surgery and Traumatology, HFR-Cantonal Hospital, University of Fribourg, Fribourg, Switzerland; Center for Computer Assisted and Reconstructive Surgery, New England Baptist Hospital, Boston, Massachusetts
| | - Gabrielle N Swartz
- The Rubin Institute for Advanced Orthopedics, Lifebridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Sandeep S Bains
- The Rubin Institute for Advanced Orthopedics, Lifebridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Jeremy A Dubin
- The Rubin Institute for Advanced Orthopedics, Lifebridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Reza Katanbaf
- The Rubin Institute for Advanced Orthopedics, Lifebridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Ronald E Delanois
- The Rubin Institute for Advanced Orthopedics, Lifebridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Stephen B Murphy
- Center for Computer Assisted and Reconstructive Surgery, New England Baptist Hospital, Boston, Massachusetts
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Park CW, Jeong SJ, Cho K, Kim SY, Lim SJ, Park YS. Bearing-Related Complications of Total Hip Arthroplasty Using Fourth-Generation Ceramic-On-Ceramic Articulations: Does Articular Noise Increase Over Time? J Arthroplasty 2024; 39:2536-2541.e1. [PMID: 38735552 DOI: 10.1016/j.arth.2024.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 05/05/2024] [Accepted: 05/06/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND We previously reported the mean 6-year outcomes of total hip arthroplasty (THA) using fourth-generation ceramic-on-ceramic (CoC) articulations. With extended observations, this study aimed to report the mean 12-year outcomes focusing on bearing-related complications of CoC THA. METHODS We reviewed primary CoC THAs performed between May 2009 and April 2012 at a single institution. Of the 831 hips (739 patients), 716 hips (635 patients) that satisfied a minimum 10-year follow-up were included. The mean age at operation was 54 years (range, 16 to 83). The occurrence of bearing-specific complications, including ceramic fractures and noise generation, was evaluated. The mean follow-up duration was 12 years (range, 10 to 14). RESULTS A total of 2 (0.3%) ceramic liner fractures occurred, as previously reported. No additional ceramic fractures were observed during the extended follow-up period. However, the cumulative incidence of audible noise increased from 6.4 (48 of 749) to 8.2% (59 of 716). Of the 59 hips with noise, 26 (44.1%) developed noise within 1 year, whereas 13 (22.0%) presented with noise more than 5 years after THA. The noise was described as clicking in 35 hips (4.9%) and as squeaking in 24 hips (3.4%). No revision surgeries were performed for noise, except in 2 cases of concomitant liner fractures. The implant survivorship free of any revision was 98.1% at 12 years. CONCLUSIONS No additional ceramic fractures were identified in this extension study at a minimum follow-up of 10 years. However, the prevalence of articular noise has increased from 6.4 to 8.2% since the previous report. Possible late-onset noise should be considered when performing CoC THA in younger patients.
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Affiliation(s)
- Chan-Woo Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sang-Jin Jeong
- Department of Orthopedic Surgery, Myongji hospital, Hanyang University School of Medicine, Goyang, South Korea
| | - Kyungjun Cho
- Department of Orthopedic Surgery, Osan Hankook Hospital, Osan, South Korea
| | - Si Yeon Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung-Jae Lim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Youn-Soo Park
- Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Darwish MM, Bergman NR, Hiscock RJ. Ceramic-on-Ceramic Total Hip Arthroplasty Using a Double Tapered, Proximally Coated Stem: 15 to 24-year Clinical and Radiologic Follow-Up. J Arthroplasty 2024; 39:2323-2328. [PMID: 38649064 DOI: 10.1016/j.arth.2024.04.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 04/13/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Total hip arthroplasty implant choice profoundly affects survivorship, complications, and failure modes. This study evaluates the long-term (average 18 year) outcomes of ceramic-on-ceramic hip arthroplasty using uncemented shells and stems. Despite an impressive 20-year cumulative percent revision of 5.9%, the hydroxyapatite proximally coated femoral components evaluated in this study have seen declining use since 2003. METHODS A review of 349 consecutive total hip arthroplasties from 1999 to 2007 was matched to 272 cases with registry data. A survivorship analysis included 274 hips (Group A) after excluding patients lost to follow-up and navigated cases. Group B comprised 135 patients who had complete datasets spanning a minimum of 15 years. RESULTS Kaplan-Meier analysis identified a 95.6% survivorship plateau at 16 to 24 years, with no significant impact from age, sex, component size, or original pathology. In Group B, EuroQol-5 Dimensions-5 Levels (EQ5D5L) scores indicated favorable outcomes in mobility, self-care, activities, pain/discomfort, and anxiety/depression, with an EQ5D visual analog score mean of 79.24. Functional scores, including the Harris Hip Score, Oxford Hip Score, and Forgotten Joint Score, showed positive outcomes. Radiologic assessments revealed no osteolysis or loose components, with a mean Engh score of 21.69. Dorr classification identified bone quality variations. Better Engh scores corresponded to higher levels of patient satisfaction. Age at surgery was correlated with better functional scores, while sex influenced various outcomes. CONCLUSIONS This comprehensive study, spanning an average of 18.23 years, combined multiple patient-reported outcome measures with extensive clinical and radiologic follow-up. It reported a notably high survivorship rate for this implant combination but highlighted the declining use of the hydroxyapatite proximally coated femoral stem used in this study, potentially facing withdrawal risks in Australia. LEVEL OF EVIDENCE Therapeutic Level IV.
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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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Niu E, Fu J, Li H, Ni M, Hao L, Zhou Y, Xu C, Chen J. Primary Total Hip Arthroplasty With Ceramic-On-Ceramic Articulations: Analysis of a Single-Center Series of 1,083 Hips at a Minimum of 10-Year Follow-Up. J Arthroplasty 2023; 38:1539-1544. [PMID: 36529193 DOI: 10.1016/j.arth.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND There are limited long-term results of using ceramic-on-ceramic (CoC) bearings in total hip arthroplasty (THA) in a large number of patient cohorts. The purpose of this study was to evaluate the minimum 10-year clinical and radiological outcomes and survivorship in a single surgeon series of CoC-THA. METHODS Among the 1,039 patients (1,391 hips) who underwent primary THA at our institution between 2008 and 2011, 49 patients (69 hips) experienced paralysis or death, and 194 patients (239 hips, 19%) were lost to follow-up. The remaining 796 patients (1,083 hips) were assessed at a mean of 11 years (range, 10 to 13 years) using the modified Harris hip score (mHHS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and a questionnaire on articular noises. Survival analysis was used to estimate the survivorship. Radiological evaluation was performed on 869 hips at the final follow-up. RESULTS Survivorship at 11 years was 98.3% for revision or aseptic loosening, and 98.2% for reoperation. At the final follow-up, the mean mHHS and WOMAC scores were 93 (range, 12 to 100) and 14.4 (range, 3 to 66), respectively. There were 131 (12%) hips that experienced squeaking, but no patient required revision. No fracture of the ceramic was observed. Radiological evaluation at the final follow-up revealed that 3 (0.3%) hips exhibited loosening, 2 (0.2%) had femoral osteolysis, 81(9.3%) acquired radiolucencies, and 35 (4%) showed heterotopic ossification. CONCLUSION This CoC bearing for THA had a high survivorship and excellent functional outcomes for at least 10 years.
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Affiliation(s)
- Erlong Niu
- Medical School of Chinese PLA, Beijing, China; Department of Orthopedics, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jun Fu
- Department of Orthopedics, The First Medical Center of Chinese PLA General Hospital, Beijing, China; Senior Department of Orthopedics, Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Hao Li
- Department of Orthopedics, The First Medical Center of Chinese PLA General Hospital, Beijing, China; Senior Department of Orthopedics, Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Ming Ni
- Department of Orthopedics, The First Medical Center of Chinese PLA General Hospital, Beijing, China; Senior Department of Orthopedics, Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Libo Hao
- Department of Orthopedics, The First Medical Center of Chinese PLA General Hospital, Beijing, China; Senior Department of Orthopedics, Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Yonggang Zhou
- Department of Orthopedics, The First Medical Center of Chinese PLA General Hospital, Beijing, China; Senior Department of Orthopedics, Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Chi Xu
- Department of Orthopedics, The First Medical Center of Chinese PLA General Hospital, Beijing, China; Senior Department of Orthopedics, Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Jiying Chen
- Department of Orthopedics, The First Medical Center of Chinese PLA General Hospital, Beijing, China; Senior Department of Orthopedics, Fourth Medical Center of PLA General Hospital, Beijing, China
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Ten-year survival of ceramic-on-ceramic total hip arthroplasty in patients younger than 60 years: a systematic review and meta-analysis. J Orthop Surg Res 2021; 16:679. [PMID: 34794457 PMCID: PMC8600788 DOI: 10.1186/s13018-021-02828-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/03/2021] [Indexed: 01/10/2023] Open
Abstract
Background Total hip arthroplasty (THA) with ceramic-on-ceramic (CoC) was created to minimise wear debris and aseptic loosening. A decade ago, a meta-analysis showed a 10-year survival rate of just 89%. Based on the excellent tribology of the current CoC, significant improvement of implant survivorship is expected. In patients younger than 60, we conducted a meta-analysis to assess 10-year survival and complications after using current primary CoC THA. Materials and methods PubMed, Scopus, EMBASE, Virtual Health Library, and Cochrane Library were used to scan for published trials that met the inclusion criteria until January 2019. The qualified studies were subjected to a systematic review and proportional analysis, and the randomised controlled trials (RCTs) were included in a comparison meta-analysis. Results Thirteen studies were included 156 findings. The total number of hips was 2278. Nine studies were cohort, and four were RCTs between ceramic and polyethylene cups. The analysis revealed an average age of 44 years (range 24–54). The 10-year survival 96% (95% CI; 95.4–96.8%), aseptic loosening rate 0.516. (95% CI; 0.265–0.903), ceramic fracture rate 0.620 (95% CI; 0.34–1.034) and squeaking rate 2.687 (95% CI; 1.279–4.593). A comparison meta-analysis revealed the risk ratio (RR) for revision was 0.27 (95% CI; 0.15–0.47), and for aseptic loosening 0.15 (0.03–0.70) favouring CoC, while RR for component fracture was 1.62 (95% CI; 0.27–9.66) favouring the polyethylene. Conclusion In patients under sixty, current CoC THAs are correlated with better 10-year outcomes than before and have high survivorship rates. Level of evidence: Level I.
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Feng B, Ren Y, Cao S, Lin J, Jin J, Qian W, Weng X. Comparison of ceramic-on-ceramic bearing vs ceramic-on-highly cross-linked polyethylene-bearing surfaces in total hip arthroplasty for avascular necrosis of femoral head: a prospective cohort study with a mid-term follow-up. J Orthop Surg Res 2019; 14:388. [PMID: 31775827 PMCID: PMC6882238 DOI: 10.1186/s13018-019-1410-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 10/10/2019] [Indexed: 11/18/2022] Open
Abstract
Background The ideal bearing surface for patients of avascular necrosis (AVN) undergoing total hip arthroplasty (THA) remains controversial. The purpose of this study is to evaluate the clinical outcomes, health-related quality of life (HRQL), and wear of the bearing surface between ceramic-on-ceramic (CoC) and ceramic-on-highly cross-linked polyethylene (CoXPE) THA for patients of AVN after midterm follow-up. Methods We performed a retrospective case-control analysis of 93 CoC and 77 CoXPE consecutive THAs for patients of AVN. The cases were followed at a minimum 5 years follow-up (average 7 years). Harris hip score (HHS) score and bearing-related complications were assessed. The health-related quality of life (HRQL) was assessed with the Short Form 36 (SF-36). Plain radiographs and computed tomography (CT) were used for radiographic evaluation. Results Both the CoC group and CoXPE group showed statistically significant improvements in HHS scores with no difference between the two bearing surfaces. There was no significant difference as for SF-36 at the latest follow-up between two groups, except for significant higher scores in the dimensions of general health in the CoC group (75.7 vs 64.7, P = 0.032). No radiographic evidence of osteolysis and loosening was present at the final follow-up. The mean wear rate of the CoC was 0.0096 mm/year and the CoXPE was 0.047 mm/year after evaluation with reconstructed CT. Conclusions CoC THAs acts as well as CoXPE THAs for patients with femoral head avascular necrosis after midterm follow-up. CoC bearing can significantly decrease the wearing rate than CoXPE bearing.
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Affiliation(s)
- Bin Feng
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, 100730, China
| | - Yi Ren
- Peking Union Medical College, Beijing, 100730, China
| | - Shiliang Cao
- Peking Union Medical College, Beijing, 100730, China
| | - Jin Lin
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, 100730, China
| | - Jin Jin
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, 100730, China
| | - Wenwei Qian
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, 100730, China
| | - Xisheng Weng
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, 100730, China.
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Chan CK, Lee DH, Yoon TR, Park KS. Persistent noise after ceramic-on-ceramic total hip replacement due to bearing coupling size mismatch: A case report. J Orthop Sci 2019; 24:936-938. [PMID: 28390755 DOI: 10.1016/j.jos.2017.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 02/23/2017] [Accepted: 03/22/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Chee-Ken Chan
- NOCERAL, Department of Orthopaedic Surgery, Faculty of Medicine, University Malaya, 59100, Kuala Lumpur, Malaysia
| | - Dong-Hyun Lee
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, Jeonnam, South Korea
| | - Taek-Rim Yoon
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, Jeonnam, South Korea
| | - Kyung-Soon Park
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, Jeonnam, South Korea.
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Primary total hip arthroplasty with fourth-generation ceramic bearings: Clinical and survival results with a minimum follow-up of 5 years. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019. [DOI: 10.1016/j.recote.2018.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Novoa-Parra CD, Pelayo-de Tomás JM, Gómez-Aparicio S, López-Trabucco RE, Morales-Suárez-Varela M, Rodrigo-Pérez JL. Primary total hip arthroplasty with fourth-generation ceramic bearings: Clinical and survival results with a minimum follow-up of 5 years. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018; 63:110-121. [PMID: 30348517 DOI: 10.1016/j.recot.2018.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 06/26/2018] [Accepted: 07/18/2018] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the clinical results and survival of primary hip prosthesis with ceramic delta bearings (C-C) with a minimum follow-up of 5years. MATERIAL AND METHOD A total of 205 primary hip arthroplasties performed between 2008 and 2012 were studied. The clinical results, pre-surgical and at 5years of follow-up were evaluated using the Harris Hip Score (HHS), the Short Form-36 (SF-36), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the visual analogue scale (VAS). The position of the prosthetic components, periprosthetic osteolysis, loosening of the prosthetic components and ruptures of the ceramic components were studied radiologically. The adverse events related to bearings were recorded according to their diameter, paying special attention to prosthetic dislocations and the presence of noise. Survival with an endpoint of prosthetic revision for any cause was estimated using the Kaplan-Meier method. RESULTS Significant improvements were obtained in the HHS (88.7% of good/excellent results), SF36, WOMAC and EVA, P<.001. There were 19 adverse events related to the prosthesis (4 periprosthetic fractures, 4 dislocations, 2 superficial infections, 1 mobilization of the cup, 2 noises, 4 aseptic loosenings and 2 breaks of the prosthetic neck); 47.3% needed revision. The cumulative survival of the prostheses was 97.5% (95%CI: 96.4-98.5). No differences were found in survival, prosthetic adverse events, noise incidence or dislocations and clinical results among the different diameters used. CONCLUSIONS Primary hip prostheses with fourth-generation ceramic bearings showed good survival in the medium term, and good clinical results.
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Affiliation(s)
- C D Novoa-Parra
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Dr. Peset, Valencia, España.
| | - J M Pelayo-de Tomás
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Dr. Peset, Valencia, España; Departamento de Anatomía Humana, Universidad de Valencia, Valencia, España
| | - S Gómez-Aparicio
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Dr. Peset, Valencia, España
| | - R E López-Trabucco
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Dr. Peset, Valencia, España
| | - M Morales-Suárez-Varela
- Departamento de Medicina Preventiva, Universidad de Valencia, Valencia, España; CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, España
| | - J L Rodrigo-Pérez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Dr. Peset, Valencia, España; Departamento de Anatomía Humana, Universidad de Valencia, Valencia, España
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Lim SJ, Ryu HG, Eun HJ, Park CW, Kwon KB, Park YS. Clinical Outcomes and Bearing-Specific Complications Following Fourth-Generation Alumina Ceramic-on-Ceramic Total Hip Arthroplasty: A Single-Surgeon Series of 749 Hips at a Minimum of 5-Year Follow-Up. J Arthroplasty 2018; 33:2182-2186.e1. [PMID: 29599034 DOI: 10.1016/j.arth.2018.02.045] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 02/08/2018] [Accepted: 02/08/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this study is to evaluate the minimum 5-year outcomes and bearing-specific complications in a single surgeon series of fourth-generation alumina ceramic-on-ceramic total hip arthroplasties (THAs). METHODS We retrospectively analyzed 667 patients (749 hips) who underwent primary THAs by a single surgeon using fourth-generation alumina ceramic bearings. There were 315 men and 352 women with a mean age of 54.2 years. The surgeon used cementless prostheses with an identical design and BIOLOX Delta ceramics in all hips, using a 36-mm head in 472 hips (63%) and a 32-mm head in 227. The mean follow-up duration was 6.5 years (range, 5 to 8 years). RESULTS The mean Harris hip score improved from 45.6 points preoperatively to 91.3 points at final follow-up. All but 1 acetabular cup and all femoral stems were well fixed. No radiographic evidence of osteolysis was identified at final follow-up. There were 2 (0.3%) ceramic liner fractures and no ceramic head fractures. A total of 48 hips (6.4%) exhibited audible noise (29 clickings and 19 squeakings), but no patient required revision. Other complications were 1 dislocation, 1 deep infection, 3 iliopsoas tendonitis, and 6 periprosthetic femoral fractures. Kaplan-Meier survivorship for revision for any reason was 98.6% (95% confidence interval, 97.7-99.5) at 6.5 years. CONCLUSION Delta ceramic-on-ceramic THAs had a high rate of survivorship without radiographic evidence of osteolysis at 6.5-year follow-up. However, we found 0.3% ceramic liner fractures and 6.4% audible noises associated with the use of Delta ceramics.
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Affiliation(s)
- Seung-Jae Lim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung-Gon Ryu
- Department of Orthopaedic Surgery, Seoul Medical Center, Seoul, Korea
| | - Hyeon-Jun Eun
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chan-Woo Park
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyeu-Back Kwon
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Youn-Soo Park
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Lee YK, Ha YC, Yoo JI, Jo WL, Kim KC, Koo KH. Mid-term results of the BIOLOX delta ceramic-on-ceramic total hip arthroplasty. Bone Joint J 2017; 99-B:741-748. [DOI: 10.1302/0301-620x.99b6.bjj-2016-0486.r3] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 01/18/2017] [Indexed: 11/05/2022]
Abstract
Aims We conducted a prospective study of a delta ceramic total hip arthroplasty (THA) to determine the rate of ceramic fracture, to characterise post-operative noise, and to evaluate the mid-term results and survivorship. Patients and Methods Between March 2009 and March 2011, 274 patients (310 hips) underwent cementless THA using a delta ceramic femoral head and liner. At each follow-up, clinical and radiological outcomes were recorded. A Kaplan-Meier analysis was undertaken to estimate survival. Results Four patients (four hips) died and 18 patients (20 hips) were lost to follow-up within five years. The remaining 252 patients (286 hips) were followed for a mean of 66.5 months (60 to 84). There were 144 men (166 hips) and 108 women (120 hips) with a mean age of 49.7 years (16 to 83) at surgery. The mean pre-operative Harris Hip Score of 47.1 points improved to 93.8 points at final follow-up. Six patients reported squeaking in seven hips; however, none were audible. Radiolucent lines involving Gruen zones one and/or seven were seen in 52 hips (18.2%). No hip had detectable wear, focal osteolysis or signs of loosening. One hip was revised because of fracture of the ceramic liner, which occurred due to an undetected malseating of the ceramic liner at the time of surgery. One hip was revised for a periprosthetic fracture of the femur, and one hip was treated for periprosthetic joint infection. The six-year survivorship with re-operation for any reason as the endpoint was 99.0% (95% confidence interval 97.8% to 100%). Discussion The rate of delta ceramic fracture was 0.3% (one of 286). While ceramic head fracture was dominant in previous ceramic-on-ceramic THA, fracture of the delta ceramic liner due to malseating is a concern. Cite this article: Bone Joint J 2017;99-B:741–8.
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Affiliation(s)
- Y. K. Lee
- Seoul National University Bundang Hospital, 82
Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do
463-707, South Korea
| | - Y. C. Ha
- Chung-Ang University College of Medicine, 102
Heukseok-ro, Dongjak-ku, Seoul
156-755, South Korea
| | - J-I. Yoo
- Gyeongsang National University Hospital, 90
Chilamdong, Jinju, Gyeongnamdo
660-702, South Korea
| | - W. L. Jo
- St. Mary’s Hospital, 222, Banpo-daero, Seocho-gu, Seoul, 06591, South
Korea
| | - K-C. Kim
- Dankook University Hospital, 119
Dandae-ro, Dongnam-gu, Cheonan
si, Chungnam 31116, South
Korea
| | - K. H. Koo
- Seoul National University Bundang Hospital, 82
Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do
463-707, South Korea
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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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Abstract
Objectives Our study aimed to examine not only the incidence but also the
impact of noise from two types of total hip replacement articulations:
ceramic-on-ceramic and ceramic-on-polyethylene. Methods We performed a case-controlled study comparing subjective and
objective questionnaire scores of patients receiving a ceramic-on-ceramic
or a ceramic-on-polyethylene total hip replacement by a single surgeon. Results There was a threefold higher incidence of noise from patients
in the ceramic-on-ceramic group compared with the control group.
The impact of this noise was significant for patients both subjectively
and objectively. Conclusions This study reports a high patient impact of noise from ceramic-on-ceramic
total hip replacements. This has led to a change in practice by
the principal author. Cite this article: Bone Joint Res 2014;3:183–6.
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Affiliation(s)
- M C Wyatt
- Wellington Regional Hospital, Riddiford Street, Newtown, Wellington 6021, New Zealand
| | - S Jesani
- Wellington Regional Hospital, Riddiford Street, Newtown, Wellington 6021, New Zealand
| | - C Frampton
- University of Otago, Christchurch, New Zealand
| | - P Devane
- Wellington Regional Hospital, Riddiford Street, Newtown, Wellington 6021, New Zealand
| | - J G Horne
- Wellington Regional Hospital, Riddiford Street, Newtown, Wellington 6021, New Zealand
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