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Tourabaly I, Courtin C, Baraduc E, Nogier A. Age, activity, and native femoral offset are associated with articular noise in ceramic on ceramic total hip arthroplasty (THA) with custom stems. INTERNATIONAL ORTHOPAEDICS 2024; 48:3091-3099. [PMID: 39331068 DOI: 10.1007/s00264-024-06299-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Accepted: 08/24/2024] [Indexed: 09/28/2024]
Abstract
PURPOSE To report the prevalence of articular noise following total hip arthroplasty (THA) with custom stems and ceramic-on-ceramic (CoC) bearings, to determine the risk factors for articular noise, and the effect of articular noise on quality of life (QoL). METHODS A consecutive series of uncemented primary THAs using custom stems implanted between 01/02/ 2014-01/04/2017 were evaluated. The cohort comprised 479 patients (529 hips, 301 males and 228 females), aged 55.9 ± 11.6 with a BMI of 25.8 ± 4.3 kg/m2. Postoperative assessment included Oxford hip score (OHS), forgotten joint score (FJS), and a dedicated questionnaire on articular noise. Descriptive statistics were used to summarise the data. Regression analyses were performed to study factors associated with presence of noise. RESULTS At a minimum follow-up of five years, 431 patients (476 hips) were available for postoperative assessment. OHS was 45.3 ± 6.1, FJS was 83.6 ± 24.7, and 69 patients (71 hips, 15%) reported articular noise. The impact of noise on QoL was 1.4 ± 2.1. Multivariable analyses confirmed that the presence of articular noise was associated with younger age (OR,0.95; 95%CI,0.93-0.97; p < 0.001), smaller native femoral offset (OR, 0.95; 95%CI,0.90-1.00;p = 0.034), as well as intense (OR, 3.15; 95%CI, 1.15-9.79; p = 0.033) and very intense physical activity (OR, 4.71; 95%CI, 1.52-16.15; p = 0.009). CONCLUSION The prevalence of articular noise following primary THA with custom stems and CoC bearings was 15%, but the impact of noise on QoL was minimal for most patients. Younger, highly active patients should be advised of an increased likelihood of noise from CoC THA, particularly if they have low native femoral offset on preoperative imaging.
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Affiliation(s)
- Idriss Tourabaly
- Service de Chirurgie Orthopédique, Clinique Maussins-Nollet, Ramsay Santé, Rue de Romainville 67, 75019, Paris, France
- Clinique Nollet, Rue Brochant 23, 75017, Paris, France
| | - Cyril Courtin
- Service de Chirurgie Orthopédique, Clinique Trenel, Rue du Dr Trenel 575, 69560, Sainte-Colombe, France
| | - Elodie Baraduc
- Service de Chirurgie Orthopédique, Clinique Maussins-Nollet, Ramsay Santé, Rue de Romainville 67, 75019, Paris, France
- Clinique Nollet, Rue Brochant 23, 75017, Paris, France
- Service de Chirurgie Orthopédique, Clinique Trenel, Rue du Dr Trenel 575, 69560, Sainte-Colombe, France
| | - Alexis Nogier
- Service de Chirurgie Orthopédique, Clinique Maussins-Nollet, Ramsay Santé, Rue de Romainville 67, 75019, Paris, France.
- Clinique Nollet, Rue Brochant 23, 75017, Paris, France.
- Service de Chirurgie Orthopédique, Clinique Trenel, Rue du Dr Trenel 575, 69560, Sainte-Colombe, France.
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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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Li Z, Niu EL, Fu J, Zhou YG, Chai W, Hao LB, Chen JY, Xu C. A Nomogram That Characterizes a Patient's Odds of Developing Squeaking After Fourth-generation Ceramic-on-ceramic THA. Clin Orthop Relat Res 2023; 481:1322-1336. [PMID: 36749832 PMCID: PMC10263255 DOI: 10.1097/corr.0000000000002573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/05/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND Although ceramic-on-ceramic (CoC) bearings result in the lowest wear rate of any bearing combination, postoperative squeaking remains worrisome. However, data concerning squeaking in long-term follow-up studies are still lacking, especially for fourth-generation CoC THA. QUESTIONS/PURPOSES (1) After keeping the prosthesis in place for 10 years, what percentage of patients treated with fourth-generation CoC THA implants report squeaking, and are there points in time when squeaking occurs more frequently? (2) What are the characteristics, association with hip function, and factors associated with squeaking? (3) Can we create a nomogram that characterizes a patient's odds of experiencing squeaking based on the factors associated with it? METHODS Between January 2009 and December 2011, 1050 patients received primary THAs at our institution, 97% (1017) of whom received fourth-generation CoC THAs because this was the preferred bearing during this period. Of the 1017 eligible patients, 5% (54) underwent THAs performed by low-volume surgeons, 3% (30) were implanted with cemented prostheses, 2% (22) died, 1% (10) were immobile, 1% (six) underwent revision surgery, and 17% (169) were lost to follow-up before 10 years, leaving 726 patients for analysis here at a mean of 11 ± 1 years. In the study cohort, 64% (464) were male and 36% (262) were female, with a mean age of 44 ± 13 years at primary THA. We extracted data about articular noise from follow-up records in our institutional database and used a newly developed questionnaire to ascertain the percentage of patients who reported squeaking at the latest follow-up interval. Although not validated, the questionnaire was modeled on previous studies on this topic. The longitudinal pattern for squeaking was explored to find timepoints when squeaking occurs more frequently. Based on the questionnaire data, we calculated the percentages of frequent, reproducible, and avoidable squeaking. Hip function was evaluated with the Harris Hip Score and WOMAC score and compared between the squeaking and nonsqueaking groups. Factors associated with squeaking, which were examined in a multivariate analysis, were used to develop a nomogram. RESULTS At 10 years, 16% (116 of 726) of patients reported squeaking. Two squeaking peaks were determined, at 0 to 1 year and 8 to 10 years. Frequent, reproducible, and avoidable squeaking accounted for 42% (36 of 86), 20% (17 of 86), and 41% (35 of 86), respectively. The mean Harris Hip Score (93 ± 4 versus 94 ± 5; p = 0.81) and WOMAC score (16 ± 13 versus 15 ± 13; p = 0.23) did not differ between patients with squeaking and those without. After controlling for potential confounding variables such as etiology and head offset, we found that patients younger than 46 years (odds ratio 2.5 [95% confidence interval 1.5 to 5.0]; p < 0. 001), those who were male (OR 2.0 [95% CI 1.1 to 3.5]; p = 0.04), those having a total flexion and extension arc of less than 50° (OR 2.0 [95% CI 1.2 to 3.3]; p = 0.02), and those with the Corail hip implant (OR 4.1 [95% CI 2.1 to 7.7]; p < 0. 001) were more likely to report squeaking. We created a nomogram that can be used at the point of care that can help clinicians identify patients at a higher risk of experiencing squeaking; this nomogram had good performance (area under the receiver operating characteristic curve of 77%). CONCLUSION As a potential late complication, squeaking after fourth-generation CoC THA is of concern and may be related to increased stripe wear. We recommend that surgeons use this nomogram to assess the odds of squeaking before selecting a bearing, especially in patients at high risk, to facilitate shared decision-making and improve patient satisfaction. Future external validation of the model is still needed to enhance its applicability.Level of Evidence Level III, therapeutic study.
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Affiliation(s)
- Zhuo Li
- School of Medicine, Nankai University, Tianjin, PR China
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, PR China
| | - Er-Long Niu
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, PR China
- 305 Hospital of PLA, Beijing, PR China
| | - Jun Fu
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, PR China
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, PR China
| | - Yong-Gang Zhou
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, PR China
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, PR China
| | - Wei Chai
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, PR China
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, PR China
| | - Li-Bo Hao
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, PR China
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, PR China
| | - Ji-Ying Chen
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, PR China
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, PR China
| | - Chi Xu
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, PR China
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, PR China
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The occurrence of squeaking under wear testing standards for ceramic on ceramic total hip replacements. J Mech Behav Biomed Mater 2023; 138:105616. [PMID: 36565691 DOI: 10.1016/j.jmbbm.2022.105616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 11/22/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
Ceramic on ceramic total hip replacement clinical reports may on occasion note a noise or squeaking. There is much debate on whether this is an actual concern, but some medical centres want to avoid any possible negative impact on the patients' wellbeing due to the noise generated. The aim of this study was to determine what sound frequencies can be picked up from hip testing standards for ceramic on ceramic under different lubrication conditions. The ISO-14242-1 (35° cup angle) and ISO-14242-4 (55° cup angle with a 4 mm translational mismatch) standards were used for testing with dry, water and serum lubrication conditions up to 10000 cycles. No sound was detected for water and serum conditions under standard walking (ISO-14242-1) testing. An audible noise with a frequency range of 0.4-0.8 kHz was picked up within 600 cycles under water and edge loading (ISO-14242-4) conditions. All dry testing produced a high pitch squeak when the frequency was higher than 2 kHz. One sample under dry edge loading conditions had an audible noise of 0.8 kHz, considered not as squeaking, as it was not high pitch. Dry testing for both, standard walking (ISO-14242-1) and edge loading (ISO-14242-4) conditions, which resulted in a high pitch noise, had a frequency range of 2-8 kHz and 5-9 kHz respectively. One sample tested with edge loading and serum produced a faint squeak noise after 6000 cycles with a frequency of 7 kHz. Edge loading due to ISO-14242-4 conditions had an increased torque which may be playing a role in increased friction leading to noise. Edge loading conditions were more prone to the generation of audible noise and squeaking whilst under lubricated conditions.
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Murylev VY, Elizarov PM, Muzychenkov AV, Rukin YA, Kukovenko GA, Alekseev SS, Elizarov MP. Сomparative analysis of large diameter bearing ceramic monoblock acetabular components. J Orthop 2022; 34:67-73. [PMID: 36035201 PMCID: PMC9411175 DOI: 10.1016/j.jor.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/07/2022] [Indexed: 10/31/2022] Open
Abstract
Introduction The goal of total hip arthroplasty (THA) is to provide ease to patients with persistent and exhausting pain. Durability is the main challenge associated with any tribological pair, with the aim of minimizing wear and thus avoiding problems with aseptic loosening of components and osteolysis. When polyethylene inserts are used in young patients, we should always consider their disadvantages, e.g., increased wear of the interacting components. Proper selection of friction pairs allows prolonged implant life. Ceramic-on-ceramic (CoC) friction pairs should provide long-term wear of the friction components. Objectives To evaluate the mid-term results of using the monoblock Maxera Cup (Zimmer Biomet) acetabular system in cementless THA. Methods We operated on 151 patients using the monoblock Maxera Cup (Zimmer Biomet) acetabular system. The mean follow-up duration was 6 years (73.8 ± 11.7 months). Fifty-seven women and 94 men aged 19-64 years were surgically treated. All 170 THA cases in 151 patients were divided into 3 groups according to the diameters of the CoC friction pairs used (40, 44, and 48 mm). As a control group, we have taken 50 patients who received 50 THA using a standard 36 mm CoC friction pair. The achieved functional results were evaluated using the HHS scale, WOMAC scale, and SF36 scale. We also evaluated the mean duration of surgical intervention and blood loss. Results When assessing long-term results, the average HHS significantly increased from 34.10 (before surgery) to 87.50 (postoperation) points in the 1st group, from 46.24 to 96.5 points in the 2nd group, and from 38.70 to 92.10 points in the 3rd group. From preoperative examination to 1 year after surgery, there was a 2.4-fold improvement in the functional results in group 1 and 1,8 and 2.9 -fold improvement in groups 2 and 3, indicating excellent treatment results. Inconsistent creaking in the implanted joint was noted in only 2.6% of cases in which a CoC friction pair with a diameter of 44 mm was used. We did not observe any complications associated with aseptic or septic loosening of the components either clinically or radiologically during the 7-year follow-up period after surgery in the entire patient population. Conclusions 1Use of the CoC monoblock allowed us to expect an increase in the life cycle of the implant and provided good joint function and perception by the patient.2Monoblock cups provided good joint function and perception by the patient.3Acoustic effects, in the form of minor creaking, did not affect the functional results.
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Affiliation(s)
- Valery Yu Murylev
- First Moscow State Medical University named after I.M. Sechenov (Sechenov University), Ministry of Health of Russia St. Trubetskaya, 8/2, 119991, Moscow, Russia
- GBUZ City Clinical Hospital. S.P. Botkin of the Moscow Department of Health, 2nd Botkinsky pr-d, 5, 125284, Moscow, Russia
| | - Pavel M. Elizarov
- First Moscow State Medical University named after I.M. Sechenov (Sechenov University), Ministry of Health of Russia St. Trubetskaya, 8/2, 119991, Moscow, Russia
- GBUZ City Clinical Hospital. S.P. Botkin of the Moscow Department of Health, 2nd Botkinsky pr-d, 5, 125284, Moscow, Russia
| | - Aleksei V. Muzychenkov
- First Moscow State Medical University named after I.M. Sechenov (Sechenov University), Ministry of Health of Russia St. Trubetskaya, 8/2, 119991, Moscow, Russia
- GBUZ City Clinical Hospital. S.P. Botkin of the Moscow Department of Health, 2nd Botkinsky pr-d, 5, 125284, Moscow, Russia
| | - Yaroslav A. Rukin
- First Moscow State Medical University named after I.M. Sechenov (Sechenov University), Ministry of Health of Russia St. Trubetskaya, 8/2, 119991, Moscow, Russia
| | - Grigory A. Kukovenko
- First Moscow State Medical University named after I.M. Sechenov (Sechenov University), Ministry of Health of Russia St. Trubetskaya, 8/2, 119991, Moscow, Russia
- GBUZ City Clinical Hospital. S.P. Botkin of the Moscow Department of Health, 2nd Botkinsky pr-d, 5, 125284, Moscow, Russia
| | - Semen S. Alekseev
- GBUZ City Clinical Hospital. S.P. Botkin of the Moscow Department of Health, 2nd Botkinsky pr-d, 5, 125284, Moscow, Russia
| | - Michail P. Elizarov
- First Moscow State Medical University named after I.M. Sechenov (Sechenov University), Ministry of Health of Russia St. Trubetskaya, 8/2, 119991, Moscow, Russia
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Almomani MA, Fares MM, Almesidieen EM. Toward long-live ceramic on ceramic hip joints: In vitro investigation of squeaking of coated hip joint with layer-by-layer reinforced PVA coatings. E-POLYMERS 2022. [DOI: 10.1515/epoly-2022-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
This study attempts to find a promising solution for the squeaking of ceramic on ceramic (COC) bearing surfaces by introducing reinforced poly(vinylalcohol) (PVA) layer-by-layer coatings on the bearing surface of Stryker Trident femoral head. A customized hip simulator was established to provide a realistic simulation of the normal gait (flexion–extension) of the hip joint, and to examine squeaking for coated and uncoated femoral heads. Different characterization techniques were employed to study the coatings’ structure. The PVA macromolecules were successfully cross-linked via epichlorohydrin agent, and chemically bonded onto the surface, forming a superior reinforced PVA coating on the femoral head’s surface. These coatings play a dominant role in increasing the pre-squeaking age of the hip joint due to reduction in hard-on-hard contact and femoral head liner clearance with their good viscoelastic properties. Which cause, damping friction-induced vibrations. This improvement resembles novel-type, long-life, and stable hip joint biomaterials with distinguished and promising pre-squeaking age.
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Affiliation(s)
- Mohammed A. Almomani
- Department of Industrial Engineering, Faculty of Engineering, Jordan University of Science and Technology , P.O. Box 3030 , Irbid 22110 , Jordan
| | - Mohammad M. Fares
- Department of Chemical Sciences, Faculty of Art and Science, Jordan University of Science and Technology , P.O. Box 3030 , Irbid 22110 , Jordan
| | - Elham M. Almesidieen
- Department of Industrial Engineering, Faculty of Engineering, Jordan University of Science and Technology , P.O. Box 3030 , Irbid 22110 , Jordan
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Baruffaldi F, Mecca R, Stea S, Beraudi A, Bordini B, Amabile M, Sudanese A, Toni A. Squeaking and other noises in patients with ceramic-on-ceramic total hip arthroplasty. Hip Int 2020; 30:438-445. [PMID: 31328560 DOI: 10.1177/1120700019864233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Noise in ceramic-on-ceramic (CoC) total hip arthroplasty (THA) is a potential symptom of abnormal bearing wear. Squeaking and other prosthetic hip noises are multi-factorial phenomena that can be analysed and may provide prognostic information. METHODS 46 patients with noisy CoC bearings were investigated using X-ray, computed tomography and joint fluid analysis, and classified into either high or low risk of ceramic liner fracture groups according to previously published guidelines. Noise events from the bearings of 16 high risk cases which were subsequently revised were compared with 30 patients in the low risk control group who did not undergo revision. Noise events were analysed for their physical characteristics using a standardised protocol and classified as either low frequency and short duration 'clicking' or long duration and high frequency 'squeaking'. RESULTS The peak frequency of squeaking during forward walking was significantly higher for patients in the case group who were revised, compared with the control group. The patient-reported onset of squeaking (46 months postoperatively) was earlier than short-noise emissions (82 months). In the standardised sequence of movements, short-noise always occurred more frequently than squeaking. Small heads (28 mm) were more likely to develop short-noise, while large heads (⩾32 mm) were more likely to develop squeaking. DISCUSSION Noise evaluation may provide additional value for predicting failure of CoC bearings, though some questions should be better investigated in a dedicated prospective trial.
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Affiliation(s)
- Fabio Baruffaldi
- Laboratory of Medical Technology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Rosaria Mecca
- Laboratory of Medical Technology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Susanna Stea
- Laboratory of Medical Technology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alina Beraudi
- Laboratory of Medical Technology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Barbara Bordini
- Laboratory of Medical Technology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marilina Amabile
- Laboratory of Medical Technology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alessandra Sudanese
- Orthopaedics-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee Replacement, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Aldo Toni
- Orthopaedics-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee Replacement, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Buj-Corral I, Domínguez-Fernández A, Gómez-Gejo A. Effect of Printing Parameters on Dimensional Error and Surface Roughness Obtained in Direct Ink Writing (DIW) Processes. MATERIALS 2020; 13:ma13092157. [PMID: 32392727 PMCID: PMC7254269 DOI: 10.3390/ma13092157] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/16/2020] [Accepted: 04/25/2020] [Indexed: 12/24/2022]
Abstract
Prostheses made from ceramic materials have the advantages of producing little debris and having good durability, compared with those made from metal and plastic. For example, hip prostheses require a porous external area that allows their fixation by means of osseointegration and a solid internal area that will be in contact with the femoral head. The manufacturing of complex ceramic shapes, by means of machining processes, for example, is complicated and can lead to breakage of the parts because of their fragility. The direct ink writing (DIW) process allows the printing of ceramic pastes into complex shapes that achieve their final strength after a heat treatment operation. This paper studies both the dimensional error and surface finish of porous zirconia prismatic parts prior to sintering. The variables considered are infill, layer height, printing speed, extrusion multiplier and bed temperature. The responses are the dimensional error of the lateral walls of the samples and an areal roughness parameter, the arithmetical mean height, Sa. Mathematical models are found for each response, and multiobjective optimization is carried out by means of the desirability function. The dimensional error depends mainly on the interaction between layer height and infill, while the roughness on the interaction between infill and printing speed. Thus, infill is an important factor for both responses. In the future, the behavior of compact printed parts will be addressed.
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Zhao CC, Qu GX, Yan SG, Cai XZ. Squeaking in fourth-generation ceramic-on-ceramic total hip replacement and the relationship with prosthesis brands: meta-analysis and systematic review. J Orthop Surg Res 2018; 13:133. [PMID: 29859126 PMCID: PMC5984797 DOI: 10.1186/s13018-018-0841-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/21/2018] [Indexed: 02/06/2023] Open
Abstract
Background Postoperative squeaking in patients who applied the fourth-generation ceramic bearing in primary hip replacement has not been reported systematically; we aim to study the squeaking incidence in the fourth-generation ceramic bearing and related risk factors for squeaking, and we also attempt to explore the relationship between squeaking and prosthetic brands. Methods The PubMed, Embase, and Cochrane library were searched, and 14 articles were finally included. Patients’ demographic data, surgical-related information, and prosthesis data were extracted. The occurrence rate of squeaking was calculated by meta-analysis, and subgroup analysis was performed based on prosthetic brands and follow-up time. Regression analysis was further applied to investigate the relationship between various risk factors and squeaking. Results The squeaking incidence in patients with the fourth-generation ceramic bearing was 3%. Age, gender, body mass index, and abduction and anteversion angles of acetabular cup might have no influence on squeaking. The squeaking incidence was significantly high with the presence of Delta Motion cup (DePuy, Warsaw, Indiana) and Secure-Fit stem (Stryker, Kalamazoo, MI), and the overall incidence of DePuy femoral stem was relatively small except for the Summit femoral stem. And there was no significant difference of squeaking incidence between less than 5-year and more than or equal to 5-year follow-up subgroups. Conclusions In our study, squeaking in the fourth-generation ceramic bearing occurred at a rate of 3%; occurrence rate was high when the Delta Motion cup was applied. We hope for more relevant researches to focus on this issue. Electronic supplementary material The online version of this article (10.1186/s13018-018-0841-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chen-Chen Zhao
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Jiefang Road 88, Hangzhou, 310009, China.,Orthopaedic Research Laboratory, Zhejiang University, Jiefang Road 88, Hangzhou, China
| | - Guo-Xin Qu
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Jiefang Road 88, Hangzhou, 310009, China.,Orthopaedic Research Laboratory, Zhejiang University, Jiefang Road 88, Hangzhou, China
| | - Shi-Gui Yan
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Jiefang Road 88, Hangzhou, 310009, China.,Orthopaedic Research Laboratory, Zhejiang University, Jiefang Road 88, Hangzhou, China
| | - Xun-Zi Cai
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Jiefang Road 88, Hangzhou, 310009, China. .,Orthopaedic Research Laboratory, Zhejiang University, Jiefang Road 88, Hangzhou, China.
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Roffe L, FitzPatrick AJ, Rodgers GW, Woodfield TBF, Hooper GJ. Squeaking in ceramic-on-ceramic hips: No evidence of contribution from the trunnion morse taper. J Orthop Res 2017; 35:1793-1798. [PMID: 27736012 DOI: 10.1002/jor.23458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 10/04/2016] [Indexed: 02/04/2023]
Abstract
Squeaking in ceramic-on-ceramic (CoC) total hip arthroplasty (THA) was investigated with an acoustic monitoring device to distinguish between squeaking emanating from the trunnion morse taper (TMT) connection versus the articular surface. 82 patients with implant problems scheduled for revision were selected and acoustic emissions (AE) with simple movements monitored. Five of these patients with CoC implants underwent surgery and their retrieved implant components were analyzed in vitro. In vivo recordings of all 82 patients found audible squeaks produce frequency content across the entire 0-50 kHz spectrum. Of the five CoC implants the in vivo peak frequency range of flexion/extension motions was 0.8 kHz and comparable to the range of in vitro testing (0.2 kHz). In vitro TMT connection motions were very large comparatively, producing a higher average peak frequency range of 22.5 kHz. All retrieved implants showed evidence of wear at the TMT connection. These findings suggest, the TMT connection does not directly cause audible squeaking. Wear occurring at this junction may contribute to debris which disrupt lubrication, increase friction, and produce noise. This observation supports current evidence suggesting that squeaking is from the bearing surface. Our findings are the first to demonstrate that in CoC THA the recordable noise of a hip squeak does not originate nor have contribution from the TMT connection. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1793-1798, 2017.
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Affiliation(s)
- Lloyd Roffe
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch, 4345, Christchurch, New Zealand
| | - Anthony J FitzPatrick
- Department of Mechanical Engineering, University of Canterbury, 8140, Christchurch, New Zealand
| | - Geoffrey W Rodgers
- Department of Mechanical Engineering, University of Canterbury, 8140, Christchurch, New Zealand
| | - Tim B F Woodfield
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch, 4345, Christchurch, New Zealand
| | - Gary J Hooper
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch, 4345, Christchurch, New Zealand
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FitzPatrick AJ, Rodgers GW, Hooper GJ, Woodfield TB. Development and validation of an acoustic emission device to measure wear in total hip replacements in-vitro and in-vivo. Biomed Signal Process Control 2017. [DOI: 10.1016/j.bspc.2016.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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Wu GL, Zhu W, Zhao Y, Ma Q, Weng XS. Hip Squeaking after Ceramic-on-ceramic Total Hip Arthroplasty. Chin Med J (Engl) 2017; 129:1861-6. [PMID: 27453238 PMCID: PMC4976577 DOI: 10.4103/0366-6999.186654] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective: The present study aimed to review the characteristics and influencing factors of squeaking after ceramic-on-ceramic (CoC) total hip arthroplasty (THA) and to analyze the possible mechanisms of the audible noise. Data Sources: The data analyzed in this review were based on articles from PubMed and Web of Science. Study Selection: The articles selected for review were original articles and reviews found based on the following search terms: “total hip arthroplasty”, “ceramic-on-ceramic”, “hip squeaking”, and “hip noise.” Results: The mechanism of the squeaking remains unknown. The possible explanations included stripe wear, edge loading, a third body, fracture of the ceramic liner, and resonance of the prosthesis components. Squeaking occurrence is influenced by patient, surgical, and implant factors. Conclusions: Most studies indicated that squeaking after CoC THA was the consequence of increasing wear or impingement, caused by prosthesis design, patient characteristics, or surgical factors. However, as conflicts exist among different articles, the major reasons for the squeaking remain to be identified.
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Affiliation(s)
- Guo-Liang Wu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Wei Zhu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yan Zhao
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Qi Ma
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xi-Sheng Weng
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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Halasi T, Kieser D, Frampton CM, Hooper GJ. Midterm analysis of the seleXys cup with ceramic inlay. Arthroplast Today 2016; 3:171-175. [PMID: 28913402 PMCID: PMC5585767 DOI: 10.1016/j.artd.2016.10.003] [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: 08/25/2016] [Revised: 09/21/2016] [Accepted: 10/01/2016] [Indexed: 11/29/2022] Open
Abstract
Background Ceramic-on-ceramic (CoC) articulations in total hip replacement (THR) has been accepted as giving reliable mid-term results; however recent studies have reported higher revision rates of some implants. This study analyses the nationwide results of the seleXys TPS cup and the Bionit2 liner (Mathys, Bettlach, Switzerland) with respect to implant survival, cause for revision and mortality rates compared to other CoC articulations using the same stem. Methods Utilising the New Zealand Joint Registry, we compared the seleXys TPS cup with Bionit2 liner used with an uncemented Twinsys femoral stem to every other uncemented CoC THR using the same stem. Multivariate analysis was used to determine the effects of patient age, gender, ASA score and implant head size on these rates. Results Between 2006 and 2013 a total of 1035 seleXys THRs were performed on 862 patients. The comparison group had 375 THRs on 280 patients. There were 77 revisions (1.4/100 component years) in the study group and two in the comparison group (0.12/100 component years). Overall hazards ratio for revision was 12.22 times higher and female gender was associated with an increased risk (hazards ratio 1.77). Causes for revision were disturbing noises (23.4%), acetabular loosening (20.8%), and fracture of the liner (18.2%). Mortality rates were not significantly different (P = .567). Conclusions The seleXys TPS cup with the Bionit2 ceramic inlay coupling has an unacceptably high failure rate. We recommend avoiding this implant coupling and would advise that patients treated with this implant need close clinical and radiological follow-up.
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Affiliation(s)
| | - David Kieser
- Corresponding author. Department of Orthopaedic Surgery and MSM, University of Otago, Riccarton Avenue, Christchurch, New Zealand. Tel.: +64 3 364 0640.Department of Orthopaedic Surgery and MSMUniversity of OtagoRiccarton AvenueChristchurchNew Zealand
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Burgo FJ, Mengelle DE, Ozols A, Fernandez C, Autorino CM. The damping effect of cement as a potential mitigation factor of squeaking in ceramic-on-ceramic total hip arthroplasty. Bone Joint Res 2016; 5:531-537. [PMID: 27811144 PMCID: PMC5131093 DOI: 10.1302/2046-3758.511.bjr-2016-0058.r1] [Citation(s) in RCA: 3] [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] [Indexed: 12/12/2022] Open
Abstract
Objectives Studies reporting specifically on squeaking in total hip arthroplasty have focused on cementless, and not on hybrid, fixation. We hypothesised that the cement mantle of the femur might have a damping effect on the sound transmitted through the metal stem. The objective of this study was to test the effect of cement on sound propagation along different stem designs and under different fixation conditions. Methods An in vitro model for sound detection, composed of a mechanical suspension structure and a sound-registering electronic assembly, was designed. A pulse of sound in the audible range was propagated along bare stems and stems implanted in cadaveric bone femurs with and without cement. Two stems of different alloy and geometry were compared. Results The magnitudes of the maximum amplitudes of the bare stem were in the range of 10.8 V to 11.8 V, whereas the amplitudes for the same stems with a cement mantle in a cadaveric bone decreased to 0.3 V to 0.7 V, implying a pulse-attenuation efficiency of greater than 97%. The same magnitude is close to 40% when the comparison is made against stems implanted in cadaveric bone femurs without cement. Conclusion The in vitro model presented here has shown that the cement had a remarkable effect on sound attenuation and a strong energy absorption in cement mantle and bone. The visco-elastic properties of cement can contribute to the dissipation of vibro-acoustic energy, thus preventing hip prostheses from squeaking. This could explain, at least in part, the lack of reports of squeaking when hybrid fixation is used. Cite this article: F. J. Burgo, D. E. Mengelle, A. Ozols, C. Fernandez, C. M. Autorino. The damping effect of cement as a potential mitigation factor of squeaking in ceramic-on-ceramic total hip arthroplasty. Bone Joint Res 2016;5:531–537. DOI: 10.1302/2046-3758.511.BJR-2016-0058.R1.
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Affiliation(s)
- F J Burgo
- Department of Orthopaedics and Traumatology, Unit of Hip and Knee Reconstructive Surgery, Hospital Universitario Austral, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - D E Mengelle
- Department of Orthopaedics and Traumatology, Unit of Hip and Knee Reconstructive Surgery, Hospital Universitario Austral, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - A Ozols
- Buenos Aires University, Av. Paseo Colón 850, C1063ACV Ciudad Autónoma de Buenos Aires, Argentina
| | - C Fernandez
- Buenos Aires University, Av. Paseo Colón 850, C1063ACV Ciudad Autónoma de Buenos Aires, Argentina
| | - C M Autorino
- Department of Orthopaedics and Traumatology, Unit of Hip and Knee Reconstructive Surgery, Hospital Universitario Austral, Universidad de Buenos Aires, Buenos Aires, Argentina
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Piriou P, Ouenzerfi G, Migaud H, Renault E, Massi F, Serrault M. A numerical model to reproduce squeaking of ceramic-on-ceramic total hip arthroplasty. Influence of design and material. Orthop Traumatol Surg Res 2016; 102:S229-34. [PMID: 27033843 DOI: 10.1016/j.otsr.2016.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 02/24/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Modern ceramic (CoC) bearings for hip arthroplasty (THA) have been used in younger patients who expect improved survivorship. However, audible squeaking produced by the implant is an annoying complication. Previous numerical simulations were not able to accurately reproduce in vitro and in vivo observations. Therefore, we developed a finite element model to: (1) reproduce in vitro squeaking and validate the model by comparing it with in vivo recordings, (2) determine why there are differences between in vivo and in vitro squeaking frequencies, (3) identify the stem's role in this squeaking, (4) predict which designs and materials are more likely to produce squeaking. HYPOTHESIS A CoC THA numerical model can be developed that reproduces the squeaking frequencies observed in vivo. MATERIAL AND METHODS Numerical methods (finite element analysis [ANSYS]) and experimental methods (using a non-lubricated simulated hip with a cementless 32mm CoC THA) were developed to reproduce squeaking. Numerical analysis was performed to identify the frequencies that cause vibrations perceived as an acoustic emission. The finite element analysis (FEA) model was enhanced by adjusting periprosthetic bone and soft tissue elements in order to reproduce the squeaking frequencies recorded in vivo. A numerical method (complex eigenvalue analysis) was used to find the acoustic frequencies of the squeaking noise. The frequencies obtained from the model and the hip simulator were compared to those recorded in vivo. RESULTS The numerical results were validated by experiments with the laboratory hip simulator. The frequencies obtained (mean 2790Hz with FEA, 2755Hz with simulator, decreasing to 1759Hz when bone and soft tissue were included in the FEA) were consistent with those of squeaking hips recorded in vivo (1521Hz). The cup and ceramic insert were the source of the vibration, but had little influence on the diffusion of the noise required to make the squeaking audible to the human ear. The FEA showed that diffusion of squeaking was due to an unstable vibration of the stem during frictional contact. The FEA predicted a higher rate of squeaking (at a lower coefficient of friction) when TZMF™ alloy is used instead of Ti6Al4V and when an anatomic press-fit stem is used instead of straight self-locking designs. DISCUSSION The current FEA model is reliable; it can be used to assess various stem designs and alloys to predict the different rates of squeaking that certain stems will likely produce. LEVEL OF EVIDENCE Level IV in vitro study.
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Affiliation(s)
- P Piriou
- Clinique du parc, 6, avenue du Morvan, 71400 Autun, France
| | - G Ouenzerfi
- Institut National des Sciences Appliquées de Lyon (INSA), Laboratoire de Mécanique des Contacts et des Structures, bâtiment Jean-d'Alembert, 18-20, rue des Sciences, 69621 Villeurbanne cedex, France
| | - H Migaud
- Université de Lille, Département Universitaire de Chirurgie Orthopédique et de Traumatologie, place de Verdun, 59000 Lille, France.
| | - E Renault
- Tornier, 161, rue Lavoisier, 38334 Montbonnot, France
| | - F Massi
- Institut National des Sciences Appliquées de Lyon (INSA), Laboratoire de Mécanique des Contacts et des Structures, bâtiment Jean-d'Alembert, 18-20, rue des Sciences, 69621 Villeurbanne cedex, France
| | - M Serrault
- Clinique Saint-Dominique, 99, rue de Messei, 61100 Flers, France
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Abstract
The leading indication for revision total hip arthroplasty (THA) remains aseptic loosening owing to wear. The younger, more active patients currently undergoing THA present unprecedented demands on the bearings. Ceramic-on-ceramic (CoC) bearings have consistently shown the lowest rates of wear. The recent advances, especially involving alumina/zirconia composite ceramic, have led to substantial improvements and good results in vitro. Alumina/zirconia composite ceramics are extremely hard, scratch resistant and biocompatible. They offer a low co-efficient of friction and superior lubrication and lower rates of wear compared with other bearings. The major disadvantage is the risk of fracture of the ceramic. The new composite ceramic has reduced the risk of fracture of the femoral head to 0.002%. The risk of fracture of the liner is slightly higher (0.02%). Assuming that the components are introduced without impingement, CoC bearings have major advantages over other bearings. Owing to the superior hardness, they produce less third body wear and are less vulnerable to intra-operative damage. The improved tribology means that CoC bearings are an excellent choice for young, active patients requiring THA. Cite this article: Bone Joint J 2016;98-B(1 Suppl A):14–17.
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Affiliation(s)
- U. Sentuerk
- Charité University Hospital Berlin, Charitéplatz
1, 10117 Berlin, Germany
| | - P. von Roth
- Charité University Hospital Berlin, Charitéplatz
1, 10117 Berlin, Germany
| | - C. Perka
- Charité University Hospital Berlin, Charitéplatz
1, 10117 Berlin, Germany
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17
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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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18
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Kang BJ, Ha YC, Ham DW, Hwang SC, Lee YK, Koo KH. Third-generation alumina-on-alumina total hip arthroplasty: 14 to 16-year follow-up study. J Arthroplasty 2015; 30:411-5. [PMID: 25449586 DOI: 10.1016/j.arth.2014.09.020] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/16/2014] [Accepted: 09/23/2014] [Indexed: 02/01/2023] Open
Abstract
Ceramic-on-ceramic articulation has the lowest wear with little osteolysis. However, the wear and osteolysis in long-term follow-up are not known. Another concern is ceramic fracture, which might occur after repeated stress during a long period. Ninety hips (76 patients with a mean age of 47 years) that underwent cementless total hip arthroplasty using third-generation ceramic-on-ceramic articulation were followed for 14-16 years. At final follow-up, there was no measurable ceramic wear and no periprosthetic osteolysis was identified. No ceramic fracture occurred during the follow-up. One hip was revised because of late infection. All prostheses were bone-ingrown. Two patients experienced a grinding sensation. However, no patient had squeak. The mean Harris hip score at the final evaluation was 89 points and the survival rate was 98.9%.
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Affiliation(s)
- Bun-Jung Kang
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine, Jinju, South Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Dae-Woong Ham
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Sun-Chul Hwang
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine, Jinju, South Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
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19
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Rieger JS, Jaeger S, Kretzer JP, Rupp R, Bitsch RG. Loosening detection of the femoral component of hip prostheses with extracorporeal shockwaves: a pilot study. Med Eng Phys 2015; 37:157-64. [PMID: 25553960 DOI: 10.1016/j.medengphy.2014.11.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 10/16/2014] [Accepted: 11/16/2014] [Indexed: 11/25/2022]
Abstract
The diagnosis of aseptic loosening of hip implants is often challenging. A vibrational analysis of the bone-implant interface could be an alternative method to analyze the fixation of endoprostheses. We assessed an innovative and new approach for excitation by using extracorporeal shockwaves in this study. In three cadaver specimens total hip arthroplasty was performed bilaterally. Four different states of implant loosening were simulated. Three accelerometers were fixed at the medial condyle, the greater trochanter, and the crest of the ilium. The bone-implant compound was excited with highly standardized extracorporeal shock waves. Resonance spectra between 100 Hz and 5000 Hz were recorded. This technique permitted a good adaptation to varying soft tissue conditions. The main resonance frequency of the hip joints occurred at about 2000 Hz. The analysis of the measured spectra showed an interrelation between the state of loosening and the frequency values of the resonances. In case of a stem loosening, there were significant shifts of the resonance into the lower frequency area between 386 Hz and 847 Hz. With this novel technique the degree of stem loosening could be assessed in a soft tissue considering configuration. This study forms a first step for future establishment of a non-invasive, non-radiological and fast applicable diagnostic procedure for early detection of endoprostheses loosening before manifest presence of clinical signs.
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Affiliation(s)
- Johannes S Rieger
- Heidelberg University Hospital, Department of Orthopedics, Trauma Surgery and Paraplegiology, Laboratory of Biomechanics and Implant Research, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany
| | - Sebastian Jaeger
- Heidelberg University Hospital, Department of Orthopedics, Trauma Surgery and Paraplegiology, Laboratory of Biomechanics and Implant Research, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany
| | - Jan Philippe Kretzer
- Heidelberg University Hospital, Department of Orthopedics, Trauma Surgery and Paraplegiology, Laboratory of Biomechanics and Implant Research, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany
| | - Rüdiger Rupp
- Heidelberg University Hospital, Spinal Cord Injury Center, Experimental Neurorehabilitation, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany
| | - Rudi G Bitsch
- Heidelberg University Hospital, Department of Orthopedics, Trauma Surgery and Paraplegiology, Laboratory of Biomechanics and Implant Research, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany.
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20
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Owen DH, Russell NC, Smith PN, Walter WL. An estimation of the incidence of squeaking and revision surgery for squeaking in ceramic-on-ceramic total hip replacement: a meta-analysis and report from the Australian Orthopaedic Association National Joint Registry. Bone Joint J 2014; 96-B:181-7. [PMID: 24493182 DOI: 10.1302/0301-620x.96b2.32784] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Squeaking arising from a ceramic-on-ceramic (CoC) total hip replacement (THR) may cause patient concern and in some cases causes patients to seek revision surgery. We performed a meta-analysis to determine the incidence of squeaking and the incidence of revision surgery for squeaking. A total of 43 studies including 16,828 CoC THR that reported squeaking, or revision for squeaking, were entered into the analysis. The incidence of squeaking was 4.2% and the incidence of revision for squeaking was 0.2%. The incidence of squeaking in patients receiving the Accolade femoral stem was 8.3%, and the incidence of revision for squeaking in these patients was 1.3%.
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Affiliation(s)
- D H Owen
- Trauma and Orthopaedic Research Unit, Building 6 Level 1, The Canberra Hospital, PO Box 11, Woden ACT, 2606, and Australian National University Medical School, Level 2, Peter Baume Building 42, Linnaeus Way, Canberra, ACT, 0200, Australia
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Hothan A, Morlock M, Hoenig E. The effect of body weight on the choice of material for the bearing couple in artificial hip joints. ACTA ACUST UNITED AC 2013. [DOI: 10.1053/j.sart.2014.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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22
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Vibration transfer in the ball–stem contact interface of artificial hips. Med Eng Phys 2013; 35:1513-7. [DOI: 10.1016/j.medengphy.2013.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 01/20/2013] [Accepted: 04/07/2013] [Indexed: 11/21/2022]
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Fan N, Morlock MM, Bishop NE, Huber G, Hoffmann N, Ciavarella M, Chen GX, Hothan A, Witt F. The influence of stem design on critical squeaking friction with ceramic bearings. J Orthop Res 2013; 31:1627-32. [PMID: 23813771 DOI: 10.1002/jor.22413] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 05/28/2013] [Indexed: 02/04/2023]
Abstract
Ceramic-on-ceramic hip joints have been reported to squeak, a phenomenon that may occur in compromised lubrication conditions. One factor related to the incidence of in vivo squeaking is the stem design. However, it has not yet been possible to relate stem design to squeaking in deteriorating lubrication conditions. The purpose of this study was to determine critical friction factors for different stem designs. A hip simulator was used to measure the friction factor of a ceramic bearing with different stem designs and gradually deteriorating lubrication represented by evaporation of a volatile fluid lubricant. The critical squeaking friction factor was measured at the onset of squeaking for each stem. Critical friction was higher for the long cobalt chrome (0.32 ± 0.02) and short titanium stems (0.39 ± 0.02) in comparison with a long titanium stem (0.29 ± 0.02). The onset of squeaking occurred at a friction factor lower than that measured for dry conditions, in which squeaking is usually investigated experimentally. The results suggest that shorter or heavier stems might limit the possibility of squeaking as lubrication deteriorates. The method developed can be used to investigate the influence of design parameters on squeaking probability.
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Affiliation(s)
- Na Fan
- Tribology Research Institute, Southwest Jiaotong University, Chengdu, 610031, China
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Kiyama T, Kinsey TL, Mahoney OM. Can squeaking with ceramic-on-ceramic hip articulations in total hip arthroplasty be avoided? J Arthroplasty 2013; 28:1015-20. [PMID: 23540532 DOI: 10.1016/j.arth.2012.10.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Revised: 06/24/2012] [Accepted: 10/12/2012] [Indexed: 02/01/2023] Open
Abstract
Squeaking is a recognized complication of total hip arthroplasty with ceramic on ceramic bearings but the etiology has not been well identified. We evaluated 183 hips in 148 patients who had undergone ceramic-on-ceramic noncemented total hip arthroplasties at one center between 1997-2007 by standardized telephone interviews and radiographic review. Audible squeaking was reported from 22 hips (12% of 183) of 19 patients. Prevalence of squeaking was associated with younger age; obesity; lateralized cup position; use of beta titanium alloy femoral components and shortened head length options; and higher reported activity level, greater pain, and decreased satisfaction at the time of the interview. Squeaking was described as having little personal significance by most patients. Squeaking might be preventable in part through medialization of the acetabular cup and avoidance of the use of shortened femoral necks.
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Affiliation(s)
- Takahiko Kiyama
- Department of Orthopaedic Surgery, Fukuoka Sano Hospital, Yame, Fukuoka, Japan
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Bishop NE, Hothan A, Morlock MM. High friction moments in large hard-on-hard hip replacement bearings in conditions of poor lubrication. J Orthop Res 2013; 31:807-13. [PMID: 23239536 DOI: 10.1002/jor.22255] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 10/05/2012] [Indexed: 02/06/2023]
Abstract
Disappointing clinical results for large diameter metal replacement bearings for the hip are related to compromised lubrication due to poor cup placement, which increases wear as well as friction moments. The latter can cause overload of the implant-bone interfaces and the taper junction between head and stem. We investigated the influence of lubrication conditions on friction moments in modern hip bearings. Friction moments for large diameter metal and ceramic bearings were measured in a hip simulator with cup angles varying from 0° to 60°. Two diameters were tested for each bearing material, and measurements were made in serum and in dry conditions, representing severely compromised lubrication. Moments were lower for the ceramic bearings than for the metal bearings in lubricated conditions, but approached those for metal bearings at high cup inclination. In dry conditions, friction moments increased twofold to 12 Nm for metal bearings. For ceramic bearings, the increase was more than fivefold to over 25 Nm. Although large diameter ceramic bearings demonstrate an improvement in friction characteristics in the lubricated condition, they could potentially replicate problems currently experienced due to high friction moments in metal bearings once lubrication is compromised.
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Affiliation(s)
- Nicholas E Bishop
- Biomechanics Section, TUHH Hamburg University of Technology, Denickestrasse 15, D-21073 Hamburg, Germany.
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McDonnell SM, Boyce G, Baré J, Young D, Shimmin AJ. The incidence of noise generation arising from the large-diameter Delta Motion ceramic total hip bearing. Bone Joint J 2013; 95-B:160-5. [PMID: 23365022 DOI: 10.1302/0301-620x.95b2.30450] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Noise generation has been reported with ceramic-on-ceramic articulations in total hip replacement (THR). This study evaluated 208 consecutive Delta Motion THRs at a mean follow-up of 21 months (12 to 35). There were 141 women and 67 men with a mean age of 59 years (22 to 84). Patients were reviewed clinically and radiologically, and the incidence of noise was determined using a newly described assessment method. Noise production was examined against range of movement, ligamentous laxity, patient-reported outcome scores, activity level and orientation of the acetabular component. There were 143 silent hips (69%), 22 (11%) with noises other than squeaking, 17 (8%) with unreproducible squeaking and 26 (13%) with reproducible squeaking. Hips with reproducible squeaking had a greater mean range of movement (p < 0.001) and mean ligament laxity (p = 0.004), smaller median head size (p = 0.01) and decreased mean acetabular component inclination (p = 0.02) and anteversion angle (p = 0.02) compared with the other groups. There was no relationship between squeaking and age (p = 0.13), height (p = 0.263), weight (p = 0.333), body mass index (p = 0.643), gender (p = 0.07) or patient outcome score (p = 0.422). There were no revisions during follow-up. Despite the surprisingly high incidence of squeaking, all patients remain satisfied with their hip replacement.
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Affiliation(s)
- S M McDonnell
- Knee & Hip Fellow Nuffield Orthopaedic Centre, Oxford, Windmill Road, Headington, Oxford OX3 7LD, UK
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Al-Hajjar M, Fisher J, Tipper JL, Williams S, Jennings LM. Wear of 36-mm BIOLOX® delta ceramic-on-ceramic bearing in total hip replacements under edge loading conditions. Proc Inst Mech Eng H 2013; 227:535-42. [DOI: 10.1177/0954411912474613] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ceramic-on-ceramic bearings have become of great interest due to the substantial improvements in the manufacturing techniques and material properties and due to polyethylene wear debris–induced osteolysis and the issues with metal wear debris and ion release by metal-on-metal bearings. Edge loading conditions due to translational malpositioning (microseparation conditions) have been shown to replicate clinically relevant wear mechanisms and increase the wear of ceramic-on-ceramic bearings; thus, it was necessary to test new bearing materials and designs under these adverse conditions. The aim of this study was to assess the effect of increasing head size on the wear of BIOLOX® delta ceramic-on-ceramic bearings under edge loading conditions due to rotational (steep cup inclination angle) and translational (microseparation) malpositioning. In this study, six 36-mm ceramic-on-ceramic bearings (BIOLOX delta, CeramTec, Germany) were tested under standard and edge loading conditions using the Leeds II hip simulator and compared to the 28-mm bearings tested and published previously under identical conditions. The mean wear rate under standard gait conditions was below 0.1 mm3/million cycles for both the 28-mm and the 36-mm ceramic-on-ceramic bearings, and increasing the inclination angle did not affect the wear rates. The introduction of microseparation to the gait cycle increased the wear rate of ceramic-on-ceramic bearing and resulted in stripe wear on the femoral heads. Under microseparation conditions, the wear rate of size 36-mm bearings (0.22 mm3/million cycles) was significantly higher ( p = 0.004) than that for size 28-mm bearings (0.13 mm3/million cycles). This was due to the larger contact area for the larger bearings and deprived lubrication under edge loading conditions. The wear rate of BIOLOX delta ceramic-on-ceramic bearings under microseparation conditions was still very low ( <0.25 mm3/million cycles) compared to earlier generation ceramic-on-ceramic bearings (BIOLOX forte, 1.84 mm3/million cycles) and other bearing materials such as metal-on-metal bearings (2–8 mm3/million cycles).
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Affiliation(s)
- Mazen Al-Hajjar
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
| | - John Fisher
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
- Leeds Musculoskeletal Biomedical Research Unit, The Leeds Teaching Hospital NHS Trust, University of Leeds, Leeds, UK
| | - Joanne L Tipper
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
- Leeds Musculoskeletal Biomedical Research Unit, The Leeds Teaching Hospital NHS Trust, University of Leeds, Leeds, UK
| | - Sophie Williams
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
| | - Louise M Jennings
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
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Owen D, Russell N, Chia A, Thomas M. The natural history of ceramic-on-ceramic prosthetic hip squeak and its impact on patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2012; 24:57-61. [PMID: 23412267 DOI: 10.1007/s00590-012-1142-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 11/28/2012] [Indexed: 12/30/2022]
Abstract
BACKGROUND Ceramic-on-ceramic (CoC) total hip arthroplasty (THA) has been scrutinised for a high incidence of post-operative squeak. The psychological and social consequences, and subsequent request for revision surgery are not well documented. METHODS Seventy consecutive primary CoC THA operated on by a single surgeon at a single institution were enroled and followed for an average 7.1 years. Information was obtained from routine post-operative review, medical records, mailed questionnaire and periodic phone interview. RESULTS Of 70 THA, 69 were available for follow-up. Seventeen (24.6 %) reported at least one instance of squeak, occurring on average 34.2 months post-operatively. Five (7.5 %) recalled being warned preoperatively of squeak as a potential complication. Six reported infrequent squeak and 11 frequent squeak. Ten were concerned, reporting embarrassment, harassment and anxiety regarding the longevity of their THA. One patient was planning revision surgery. DISCUSSION This study demonstrates the highest published prevalence of squeaking CoC THA and highlights the importance of warning patients of this potential complication.
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Affiliation(s)
- David Owen
- Department of Orthopaedics and Trauma, The Canberra Hospital, Yamba Drive, Garran, ACT, 2605, Australia
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Sanders A, Tibbitts I, Brannon R. Concomitant evolution of wear and squeaking in dual-severity, lubricated wear testing of ceramic-on-ceramic hip prostheses. J Orthop Res 2012; 30:1377-83. [PMID: 22354674 PMCID: PMC3374887 DOI: 10.1002/jor.22080] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 01/09/2012] [Indexed: 02/04/2023]
Abstract
Ceramic-on-ceramic (CoC) hip bearings were tested in short-term wear tests with a systematically varied contact force. Continuous vibration and intermittent surface roughness measurements were obtained to elucidate potential causes of in vivo hip joint squeaking. The three-phase test comprised alternating cycles of edge loading (EL) and concentric articulation (CA), always using ample serum lubricant. A 50,000-cycle wear trial in which the contact force during CA was distant from the head's wear patch yielded no squeaking and practically no liner roughening. In 10-cycle trials of an edge-worn head coupled with a pristine liner, the contact force was varied in magnitude and point of application; immediate, recurrent squeaking occurred only when the contact force exceeded a critical threshold value and was centered upon the head's wear patch. In a 27,000-cycle wear trial with the contact force applied near the margin of the head's wear patch, recurrent squeaking emerged progressively as the liner's inner surface was roughened via its articulation with the worn portion of the head. The results reveal key conditions that yield recurrent squeaking in vitro in various scenarios without resorting to implausible dry conditions. A fundamental theory explains that hip squeaking is induced by myriad stress waves emanating from asperity collisions; yet, the root cause is edge loading.
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Affiliation(s)
- Anthony Sanders
- Department of Mechanical Engineering, University of Utah, Salt Lake City, Utah, 84112,Ortho Development Corp., 12187 S. Business Park Dr., Draper, UT, 84020
| | - Ira Tibbitts
- Department of Mechanical Engineering, University of Utah, Salt Lake City, Utah, 84112
| | - Rebecca Brannon
- Department of Mechanical Engineering, University of Utah, Salt Lake City, Utah, 84112
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Chevillotte C, Pibarot V, Carret JP, Bejui-Hugues J, Guyen O. Hip squeaking: a 10-year follow-up study. J Arthroplasty 2012; 27:1008-13. [PMID: 22425297 DOI: 10.1016/j.arth.2011.11.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2011] [Revised: 09/16/2011] [Accepted: 11/27/2011] [Indexed: 02/01/2023] Open
Abstract
The aim of the study was to analyze the incidence of squeaking with ceramic-on-ceramic total hip arthroplasty (THA) after 10 years of follow-up and the potential complications that could occur related to this phenomenon. One hundred THAs implanted between November 1999 and December 2000 were evaluated. Incidence of squeaking was investigated clinically with a questionnaire. Implant positioning was analyzed on x-rays and computer tomography. Of the 100 THAs, 5 patients presented with squeaking. All of them were active, sporty, and heavy men. Functional scores were comparable with nonsqueaking patients. There was no malpositioning on the x-ray analysis, no wear, and no loosening. We could not demonstrate any relation between squeaking and ceramic fracture. Squeaking noise appeared at a mean of 66 months postsurgery. It appears to be an isolated phenomenon without any consequences at 10-year follow-up.
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Affiliation(s)
- Christophe Chevillotte
- Department of Orthopedic Surgery, Pavillon T, Hôpital Edouard Herriot, Lyon Cedex 03, France
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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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Yeung E, Bott PT, Chana R, Jackson MP, Holloway I, Walter WL, Zicat BA, Walter WK. Mid-term results of third-generation alumina-on-alumina ceramic bearings in cementless total hip arthroplasty: a ten-year minimum follow-up. J Bone Joint Surg Am 2012; 94:138-44. [PMID: 22258000 DOI: 10.2106/jbjs.j.00331] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Alumina ceramic-on-ceramic bearings have gained popularity in hip arthroplasty because of their properties of low wear and chemical inertness. In a previous study, we reported the excellent clinical results in a series of cementless ceramic-on-ceramic primary total hip arthroplasties at a minimum of five years of follow-up. The purpose of the present study was to determine the results in the same patient cohort at a minimum of ten years of follow-up. METHODS A series of 301 consecutive primary cementless total hip arthroplasties was assessed clinically and radiographically. Clinical information was available for 244 hips in 227 surviving patients at a minimum of ten years of follow-up, and radiographic information was available for 184 hips in 172 patients. RESULTS Twenty-six (9.2%) of the patients had died of an unrelated cause and eight (2.7%) had undergone revision arthroplasty by the time of the latest follow-up. The average Harris hip score was 94 points, with 95% (232) of the patients having an excellent or good result and <4% (nine) having moderate residual pain. All radiographic assessments showed evidence of stable osseous ingrowth. Nine revisions had been performed, including four femoral component revisions due to periprosthetic fracture, one femoral revision due to aseptic loosening, one femoral revision secondary to a femoral shortening osteotomy for nerve palsy, two acetabular cup revisions due to psoas tendinitis, and a repeat revision in one of the patients with psoas tendinitis due to acetabular osteolysis. The overall survival rate of the implants was 98% (95% confidence interval, 94.2% to 99.6%) at ten years with revision for any reason as the end point. CONCLUSIONS The patients in our series had a good implant survival rate, good function, a low implant wear rate as reported in the previous study, and no further radiographic evidence of failure at ten years after cementless primary total hip arthroplasty with alumina ceramic-on-ceramic bearings.
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Affiliation(s)
- Eric Yeung
- Specialist Orthopaedic Group, Suite 1.08, 3-9 Gillies Street, North Sydney, NSW 2060, Australia.
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Weiss C, Hothan A, Huber G, Morlock MM, Hoffmann NP. Friction-induced whirl vibration: Root cause of squeaking in total hip arthroplasty. J Biomech 2012; 45:297-303. [DOI: 10.1016/j.jbiomech.2011.10.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 10/17/2011] [Accepted: 10/22/2011] [Indexed: 12/12/2022]
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Rehmer A, Bishop NE, Morlock MM. Influence of assembly procedure and material combination on the strength of the taper connection at the head-neck junction of modular hip endoprostheses. Clin Biomech (Bristol, Avon) 2012; 27:77-83. [PMID: 21903309 DOI: 10.1016/j.clinbiomech.2011.08.002] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 07/01/2011] [Accepted: 08/01/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND A stable fixation between femoral head and endoprosthesis taper is necessary to prevent relative motions and corrosion at the taper junction. Although the importance of the component assembly has been recognised, no definitive instructions are available. The purpose of this study was to assess the influence of assembly force, assembly tool and number of hammer strokes on the taper junction strength of various material combinations. METHODS Co-Cr29-Mo (n=10) and Ti-6Al-4V (n=10) neck tapers were assembled with Co-Cr and Al(2)O(3) ceramic heads either by push-on or by impaction with single or multiple hammer blows. The strength of the taper-head connection was evaluated by measuring the head pull-off forces according to ISO 7206-10 and the turn-off moment capacity. FINDINGS The taper strength linearly increased with assembly forces (P<0.001). Co-Cr heads combined with Co-Cr tapers showed significantly lower pull-off forces and turn-off moments than the combination with Ti tapers (0.001<P<0.025). Multiple impaction did not increase taper strength (0.063 <P<0.995). Ceramic and Co-Cr heads showed similar fixation patterns on Ti tapers. Turn-off moments varied between 6 Nm and 19 Nm, dependent on material combination and assembly force. INTERPRETATION It is suggested that sufficient head-taper junction strength in all bearing conditions is achieved by impaction forces of at least 4 kN. A single impact is sufficient to achieve fixation. Special attention should be paid to the assembly of Co-Cr heads on Co-Cr tapers.
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Affiliation(s)
- Annelie Rehmer
- TUHH, Hamburg University of Technology, Biomechanics Section, Hamburg, Germany.
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