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Castagnini F, Bordini B, Cosentino M, Diquattro E, Gorgone M, Traina F. Head size in Delta ceramic-on-ceramic total hip arthroplasty: a comparative registry study. Arch Orthop Trauma Surg 2024; 144:4163-4170. [PMID: 39225803 DOI: 10.1007/s00402-024-05504-1] [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: 05/25/2024] [Accepted: 08/14/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION Optimal bearing size in total hip arthroplasty (THA) has not been clearly ascertained, but large diameter ceramic balls may improve function and implant stability, with minimal concerns for wear. Delta ceramic-on-ceramic (COC) THA were stratified based on head diameter (32, 36 and 40 mm), aiming to assess: 1) survival rates, reasons for revision and hazard ratios for failure; 2) survival rates and hazard ratios for aseptic loosening, dislocation/primary instability, liner failure. MATERIALS AND METHODS A regional arthroplasty registry was enquired about Delta COC THA performed for primary osteoarthritis, stratified by head size. 13,161 primary cementless THAs were included in the study, with a mean follow-up of 5.7 years (range: 0-17): 3980 (30.2%) 32 mm balls, 8327 (63.3%) 36 mm heads, 854 (6.5%) 40 mm heads. RESULTS The three cohorts achieved similar survival rates (p = 0.99) and adjusted hazard ratios (p > 0.05). No revisions for head breakage or metallosis occurred. When revision for cup aseptic loosening was the endpoint, the survival rates of three cohorts (p = 0.08) and the adjusted hazard ratios (p > 0.05) were similar. The three cohorts achieved comparable survival rates when revision for dislocation/primary instability was the endpoint (p = 0.08). When the endpoint was revision for liner breakage, 32 mm cohort showed higher rates of revision (p = 0.01). No liner failure was detected in the 40 mm cohort. CONCLUSIONS 32 mm, 36 mm and 40 mm provided similar 10-year survival rates in Delta COC THA. 40 mm heads emerged as safe options but did not lower the revisions for dislocations/primary instability. LEVEL OF EVIDENCE IV (therapeutic study).
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Affiliation(s)
- Francesco Castagnini
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.
| | - Barbara Bordini
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Monica Cosentino
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Emanuele Diquattro
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Mara Gorgone
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Francesco Traina
- Head of Ortopedia-Traumatologia e, Chirurgia Protesica e dei Reimpianti d'anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
- DIBINEM, Università di Bologna, Bologna, Italy
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Holleyman RJ, Critchley RJ, Mason JM, Jameson SS, Reed MR, Malviya A. Ceramic Bearings Are Associated With a Significantly Reduced Revision Rate in Primary Hip Arthroplasty: An Analysis From the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man. J Arthroplasty 2021; 36:3498-3506. [PMID: 34238620 DOI: 10.1016/j.arth.2021.05.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Prosthetic joint infection (PJI) is a devastating complication. Studies have suggested reduction in PJI with the use of ceramic bearings. METHODS Adult patients who underwent total hip arthroplasty (THA) using an uncemented acetabular component with ceramic-on-ceramic (CoC), ceramic-on-polyethylene (CoP), or metal-on-polyethylene (MoP) bearing surfaces between 2002 and 2016 were extracted from the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man. A competing risk regression model to investigate predictors of each revision outcome was used. Time-to-event was determined by duration of implantation since primary surgery with competing risks being death or revision. The results were adjusted for age, gender, American Association of Anaesthesiologists grade, body mass index, surgical indication, intraoperative complications, and implant data. RESULTS In total, 456,457 THAs (228,786 MoP, 128,403 CoC, and 99,268 CoP) were identified. Multivariable modeling showed that the risk of revision for PJI was significantly lower with CoC (risk ratio 0.748, P < .001) and CoP (risk ratio 0.775, P < .001) compared to MoP. Significant reduction in risk of aseptic and all-cause revision was also seen. The significant protective effect of ceramic bearing was predominantly seen 2 years after implantation. Aseptic revision beyond 2 years reduced by 18.1% and 24.8% for CoC and CoP (P < .001), respectively. All-cause revision rate beyond 2 years reduced by 21.6% for CoC and 27.1% for CoP (P < .001) CONCLUSION: This study demonstrates an association between the use of ceramic as part of the bearing, with lower rates of revision for all causes, revision for infection, and revision for aseptic causes, supporting ceramic bearings in THA.
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Affiliation(s)
- Richard J Holleyman
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rebecca J Critchley
- Northumbria Healthcare NHS Foundation Trust, Wansbeck General Hospital, Ashington, United Kingdom
| | - James M Mason
- Centre for Heath Economics at Warwick, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Simon S Jameson
- The James Cook University Hospital, Middlesbrough, United Kingdom
| | - Mike R Reed
- Northumbria Healthcare NHS Foundation Trust, Wansbeck General Hospital, Ashington, United Kingdom
| | - Ajay Malviya
- Northumbria Healthcare NHS Foundation Trust, Wansbeck General Hospital, Ashington, United Kingdom; Newcastle University, Newcastle upon Tyne, United Kingdom
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Lavigne M, Vendittoli PA, Virolainen P, Corten K, Martinez M, Zicat B, Peter V, Bloem R, Miazzolo N, Remes V. Large head ceramic-on-ceramic bearing in primary total hip arthroplasty: average 3-year follow-up of a multicentre study. Hip Int 2020; 30:711-717. [PMID: 31296057 DOI: 10.1177/1120700019863376] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Surgeons are increasingly using larger femoral head sizes in total hip arthroplasty (THA) to improve stability and reduce the rate of dislocation, 1 of the leading causes of revision surgery. Large ceramic head sizes up to 48 mm can now be used with monoblock acetabular components. National registries have shown promising results at short-term with large diameter ceramic-on-ceramic THA, with very low revision rates.This study reports on the average 3-year follow up of a press-fit monoblock large diameter acetabular shell with a pre-assembled ceramic liner, with emphasis on the radiographic outcome, complications related to the implantation of the cup, and the patient's clinical outcome. METHODS 170 hips in 169 patients were reviewed at an average 38 ± 5.8 months following surgery. RESULTS The radiographic review revealed no acetabular cup loosening, no osteolysis and no cup migration. 1 acetabular cup was revised for malposition. The patient clinical outcome and the satisfaction rate were excellent. At 3 years, 7.1% of patients complained of groin pain and 3.5% spontaneously reported hip joint generated noise. 1 patient sustained a non-recurrent traumatic hip dislocation 2 years post surgery. CONCLUSIONS New technology should be introduced cautiously on the market. This is especially true for the large diameter ceramic monoblock acetabular component used in this study since it involves a new acetabular component design. At short term, we have not identified new modes of failure with this implant. Longer follow-up is still needed to assess the safety of large ceramic bearing in THA.
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Affiliation(s)
- Martin Lavigne
- Hôpital Maisonneuve Rosemont, University of Montreal affiliated hospital, Montreal, Canada
| | | | | | | | | | - Bernard Zicat
- The Mater Hospital, Concord Hospital, Sydney, Australia
| | - Viju Peter
- Royal Liverpool and Broadgreen University Teaching Hospitals, Liverpool, UK
| | - Rolf Bloem
- Reinier de Graaf Groep, Delft, The Netherlands
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Abstract
Rates of peri-prosthetic joint infection (PJI) in primary total hip and total knee arthroplasty range between 0.3% and 1.9%, and up to 10% in revision cases. Significant morbidity is associated with this devastating complication, the economic burden on our healthcare system is considerable, and the personal cost to the affected patient is immeasurable. The risk of surgical site infection (SSI) and PJI is related to surgical factors and patient factors such as age, body mass index (BMI), co-morbidities, and lifestyle. Reducing the risk of SSI in primary hip and knee arthroplasty requires a multi-faceted strategy including pre-operative patient bacterial decolonization, screening and avoidance of anaemia, peri-operative patient warming, skin antisepsis, povidone-iodine wound lavage, and anti-bacterial coated sutures. This article also considers newer concepts such as the influence of bearing surfaces on infection risk, as well as current controversies such as the potential effects of blood transfusion, laminar flow, and protective hoods and suits, on infection risk. Cite this article: EFORT Open Rev 2020;5:604-613. DOI: 10.1302/2058-5241.5.200004
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Affiliation(s)
- Philip F Dobson
- Trauma and Orthopaedic Surgery, Royal Victoria Infirmary, Newcastle, UK
| | - Michael R Reed
- Trauma and Orthopaedic Surgery, Royal Victoria Infirmary, Newcastle, UK
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Capone A, Bienati F, Torchia S, Podda D, Marongiu G. Short stem total hip arthroplasty for osteonecrosis of the femoral head in patients 60 years or younger: a 3- to 10-year follow-up study. BMC Musculoskelet Disord 2017; 18:301. [PMID: 28716026 PMCID: PMC5513025 DOI: 10.1186/s12891-017-1662-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 07/09/2017] [Indexed: 12/18/2022] Open
Abstract
Background In young patients with osteonecrosis of the femoral head (ONFH), short-stem total hip arthroplasty (THA) could allow a potential advantage in preserving metaphyseal bone-stock, when revision surgery might become necessary. However, only a few studies have evaluated the outcome of short-stem THAs in ONFH. We reviewed the prospectively collected data of a cementless partial neck-retaining short-stem with ceramic-on-ceramic bearings in ONFH patients. Methods Thirty patients (37 hips) younger than 60 years (mean age at surgery, 51.5 years) underwent THA with the NANOS® stem (Smith and Nephew, Marl, Germany) from January 2006 to December 2012. All patients received a 32-mm or 36 mm ceramic femoral head. Harris hip score, WOMAC and UCLA activity score were recorded. Postoperative radiographs were evaluated for bone-implant fixation and osteolysis. Further analysis correlated clinical findings with implants characteristics and patient demographics at mean 5.6 years’ follow-up (range, 3–10 years). Results The clinical and functional results improved significantly (p < 0.001). At latest follow-up, mean HHS, WOMAC, and UCLA activity scores were 90 (range, 71–100), 94 (range, 76–100), and 6.3 (range, 4–10) points, respectively. The diameter of the femoral head did not influence the clinical outcome (p = 0.661). All hips showed bone ingrowth fixation of the acetabular and femoral components. No patients showed osteolysis. No revision for any reason was performed during the study period. Conclusions The excellent clinical results and fixation pattern at mean 5.6 years’ follow-up reveal this implant as a reliable option in advanced stage of ONFH either. Further investigations are crucial to determine the long-term durability and to assess whether the association of ceramic-on-ceramic bearings, can be useful to achieve longer survivorship and lower complications rates. Trial registration Registry number: ISRCTN 91336248; date of registration: 04/07/2017.
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Affiliation(s)
- Antonio Capone
- Orthopaedic Clinic of the Department of Surgical Science, University of Cagliari, Ospedale Marino, Lungomare Poetto 12, 09126, Cagliari, Italy
| | - Fabrizio Bienati
- Orthopaedic Clinic of the Department of Surgical Science, University of Cagliari, Ospedale Marino, Lungomare Poetto 12, 09126, Cagliari, Italy
| | - Stefania Torchia
- Orthopaedic Clinic of the Department of Surgical Science, University of Cagliari, Ospedale Marino, Lungomare Poetto 12, 09126, Cagliari, Italy
| | - Daniele Podda
- Trauma and Orthopaedic Department, Ospedale Santissima Trinità, Via Is Mirrionis 92, 09121, Cagliari, Italy
| | - Giuseppe Marongiu
- Orthopaedic Clinic of the Department of Surgical Science, University of Cagliari, Ospedale Marino, Lungomare Poetto 12, 09126, Cagliari, Italy.
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Buttaro MA, Slullitel PA, García Mansilla AM, Carlucci S, Comba FM, Zanotti G, Piccaluga F. Long-term Outcome of Unconstrained Primary Total Hip Arthroplasty in Ipsilateral Residual Poliomyelitis. Orthopedics 2017; 40:e255-e261. [PMID: 27841928 DOI: 10.3928/01477447-20161108-03] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 09/28/2016] [Indexed: 02/03/2023]
Abstract
Incapacitating articular sequelae in the hip joint have been described for patients with late effects of poliomyelitis. In these patients, total hip arthroplasty (THA) has been associated with a substantial rate of dislocation. This study was conducted to evaluate the long-term clinical and radiologic outcomes of unconstrained THA in this specific group of patients. The study included 6 patients with ipsilateral polio who underwent primary THA between 1985 and 2006. Patients with polio who underwent THA on the nonparalytic limb were excluded. Mean follow-up was 119.5 months (minimum, 84 months). Clinical outcomes were evaluated with the modified Harris Hip Score (mHHS) and the visual analog scale (VAS) pain score. Radiographs were examined to identify the cause of complications and determine the need for revision surgery. All patients showed significantly better functional results when preoperative and postoperative mHHS (67.58 vs 87.33, respectively; P=.002) and VAS pain score (7.66 vs 2, respectively; P=.0003) were compared. Although 2 cases of instability were diagnosed, only 1 patient needed acetabular revision as a result of component malpositioning. None of the patients had component loosening, osteolysis, or infection. Unconstrained THA in the affected limb of patients with poliomyelitis showed favorable long-term clinical results, with improved function and pain relief. Nevertheless, instability may be a more frequent complication in this group of patients compared with the general population. [Orthopedics. 2017; 40(2):e255-e261.].
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7
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Abstract
Corrosion of the head-neck junction of implants used in total hip arthroplasty is a complex problem. Clinical severity appears to be multifactorial, and the predictive variables have yet to be consistently identified in the literature. Corrosion should be considered in the differential diagnosis of hip pain following total hip arthroplasty regardless of the type of bearing surface used. The most common presentation, pain followed by instability, is similar to complications associated with metal-on-metal articulations. The diagnosis of implant corrosion of the head-neck junction can be challenging; an infection workup should be performed along with analysis of serum metal ion levels and cross-sectional imaging. In the short term, a well-fixed stem may be retained, and the exchange of an isolated head with a ceramic femoral head seems to be a promising option for certain implants. Further research with longer follow-up is warranted, and high levels of evidence are needed to determine whether this approach is generalizable.
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8
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Morlock MM, Bünte D, Ettema H, Verheyen CC, Hamberg Å, Gilbert J. Primary hip replacement stem taper fracture due to corrosion in 3 patients. Acta Orthop 2016; 87:189-92. [PMID: 26751766 PMCID: PMC4812083 DOI: 10.3109/17453674.2015.1128780] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- Michael M Morlock
- Institute of Biomechanics, TUHH Hamburg University of Technology, Hamburg, Germany,Correspondence:
| | - Dennis Bünte
- Institute of Biomechanics, TUHH Hamburg University of Technology, Hamburg, Germany
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Lu YD, Yen SH, Kuo FC, Wang JW, Wang CJ. No benefit on functional outcomes and dislocation rates by increasing head size to 36 mm in ceramic-on-ceramic total hip arthroplasty. Biomed J 2016; 38:538-43. [PMID: 27013454 PMCID: PMC6138375 DOI: 10.1016/j.bj.2016.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 07/03/2015] [Indexed: 12/12/2022] Open
Abstract
Background Ceramic-on-ceramic (COC) total hip arthroplasty (THA) has gained popularity since improvements in wear characteristics and longevity. Whether large ceramic femoral heads (≥36 mm) have increased postoperative range of motion (ROM) and a lower dislocation rate is not clear. This study aimed to compare functional outcomes and early complications between large-head (≥36 mm) and smaller-head (≤32 mm) COC prostheses with a minimum follow-up of 12 months. Methods A total of 95 consecutive uncemented COC THAs were performed in 90 patients between January 2012 and July 2013. Of these, 49 patients (smaller-head group) received third generation and 41 patients (large-head group) received fourth generation COC prostheses. Harris hip score (HHS), Western Ontario and McMaster Universities Arthritis index (WOMAC), and ROM of the hip pre- and post-operatively were compared, as well as the presence of early complications. Results Postoperative HHSs (88.4 vs. 89.3, p = 0.34) and WOMAC scores (12.0 vs. 11.0, p = 0.111) were not different between the groups. Postoperative flexion ROM was lower in the smaller-head group (98.8° vs. 106.1°, p < 0.001), but there were no differences in extension, abduction, adduction, internal rotation, and external rotation. One patient in each group reported a grinding noise. There was one dislocation (1.9%) in the smaller-head group, and none in the large-head group (p = 0.371). No infections or loosening of the components occurred. Conclusions Large-head COC articulation provided better flexion, but functional outcomes and early complications are similar to the smaller-head COC.
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Affiliation(s)
- Yu-Der Lu
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Shih-Hsiang Yen
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Feng-Chih Kuo
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jun-Wen Wang
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.
| | - Ching-Jen Wang
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
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Basic principles and uniform terminology for the head-neck junction in hip replacement. Hip Int 2016; 25:115-9. [PMID: 25362881 DOI: 10.5301/hipint.5000204] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2014] [Indexed: 02/04/2023]
Abstract
Recent problems with large head metal on metal hip replacements have spiked renewed interest in the head-neck junction. A thorough knowledge of the principles of the locking mechanism, the assembly technique and affecting factors on the strength of this junction is needed. Currently a confusing variability in terms is used to describe this junction. This overcomplicates an already complex issue. The purpose of this literature review is to collect and list the different terms used and to propose a uniform terminology. Two authors independently searched the electronic databases of PubMed, CINAHL and MEDLINE with specific key words and combinations according to the PRISMA guidelines. The initial search yielded a total of 518 articles with ultimately 53 articles included in the present analysis. No consensus for a uniform term for the 2 sides of the head-stem junction was found. Since there is already pronounced variability in taper designs between different manufacturers (even so similarly named, e.g. "12/14"), a uniform terminology could be the first step to simplify the situation. "Male" and "female taper" is proposed as the appropriate terminology for the stem and head junction in hip replacement, respectively. The importance of the assembly technique understanding the principles of the locking mechanism is emphasised.
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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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Cadossi M, Mazzotti A, Baldini N, Giannini S, Savarino L. New couplings, old problems: Is there a role for ceramic-on-metal hip arthroplasty? J Biomed Mater Res B Appl Biomater 2015; 104:204-9. [DOI: 10.1002/jbm.b.33383] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 12/11/2014] [Accepted: 01/22/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Matteo Cadossi
- Department I of Orthopaedics and Traumatology; Rizzoli Orthopaedic Institute; Bologna Italy
- Department of Biomedical and Neuromotor Sciences; Bologna University; Bologna Italy
| | - Antonio Mazzotti
- Department of Biomedical and Neuromotor Sciences; Bologna University; Bologna Italy
| | - Nicola Baldini
- Department of Biomedical and Neuromotor Sciences; Bologna University; Bologna Italy
- Laboratory for Orthopaedic Pathophysiology and Regenerative Medicine; Rizzoli Orthopaedic Institute; Bologna Italy
| | - Sandro Giannini
- Department I of Orthopaedics and Traumatology; Rizzoli Orthopaedic Institute; Bologna Italy
- Department of Biomedical and Neuromotor Sciences; Bologna University; Bologna Italy
| | - Lucia Savarino
- Laboratory for Orthopaedic Pathophysiology and Regenerative Medicine; Rizzoli Orthopaedic Institute; Bologna Italy
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Tai SM, Munir S, Walter WL, Pearce SJ, Walter WK, Zicat BA. Squeaking in large diameter ceramic-on-ceramic bearings in total hip arthroplasty. J Arthroplasty 2015; 30:282-5. [PMID: 25304938 DOI: 10.1016/j.arth.2014.09.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 09/11/2014] [Accepted: 09/12/2014] [Indexed: 02/01/2023] Open
Abstract
We analyzed the results of 206 consecutive total hip arthroplasties performed using large diameter ceramic-on-ceramic bearings. At an average follow-up of 28months, the mean Harris Hip Score improved from 54 to 92. Fifteen (7.3%) hips were noted to squeak. There was no significant difference between silent and squeaking hips with regards to age, weight, height, BMI, range of movement, femoral head diameter, leg length, and offset or center of rotation. No correlation was present between incidence of squeaking and increasing cup inclination and anteversion. 5.2% of cups orientated within Lewinnek's safe zone squeaked. No hips required revision for squeaking. While large diameter ceramic bearings may produce squeaking, our early results of surgery using large head ceramic bearings are encouraging. However, long-term follow-up is required.
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Affiliation(s)
- Stephen M Tai
- Specialist Orthopaedic Group, North Sydney, New South Wales, Australia
| | - Selin Munir
- Specialist Orthopaedic Group, North Sydney, New South Wales, Australia
| | - William L Walter
- Specialist Orthopaedic Group, North Sydney, New South Wales, Australia
| | - Simon J Pearce
- Specialist Orthopaedic Group, North Sydney, New South Wales, Australia
| | - William K Walter
- Specialist Orthopaedic Group, North Sydney, New South Wales, Australia
| | - Bernard A Zicat
- Specialist Orthopaedic Group, North Sydney, New South Wales, Australia
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Håff A, Löf H, Gunne J, Sjögren G. A retrospective evaluation of zirconia-fixed partial dentures in general practices: An up to 13-year study. Dent Mater 2015; 31:162-70. [DOI: 10.1016/j.dental.2014.11.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 06/27/2014] [Accepted: 11/14/2014] [Indexed: 11/26/2022]
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Abstract
Dislocation remains among the most common complications of, and reasons for, revision of both primary and revision total hip replacements (THR). Hence, there is great interest in maximising stability to prevent this complication. Head size has been recognised to have a strong influence on the risk of dislocation post-operatively. As femoral head size increases, stability is augmented, secondary to an increase in impingement-free range of movement. Larger head sizes also greatly increase the 'jump distance' required for the head to dislocate in an appropriately positioned cup. Level-one studies support the use of larger diameter heads as they decrease the risk of dislocation following primary and revision THR. Highly cross-linked polyethylene has allowed us to increase femoral head size, without a marked increase in wear. However, the thin polyethylene liners necessary to accommodate larger heads may increase the risk of liner fracture and larger heads have also been implicated in causing soft-tissue impingement resulting in groin pain. Larger diameter heads also impart larger forces on the femoral trunnion, which may contribute to corrosion, metal release, and adverse local tissue reactions. Alternative large bearings including large ceramic heads and dual mobility bearings may mitigate some of these risks, and several of these devices have been used with clinical success.
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Affiliation(s)
- H J Cooper
- Lenox Hill Hospital, Department of Orthopaedic Surgery, 130 East 77th Street, New York, 10075, USA
| | - C J Della Valle
- Rush University Medical Center, Department of Orthopaedic Surgery, 1611 West Harrison Street, Chicago, Illinois, 60612, USA
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