Primary Total Hip Arthroplasty using 3 rd Generation Ceramic-on-Ceramic Articulation

Abstract

Purpose

Ceramic-on-ceramic (CoC) is currently a popular bearing combination in young patients in primary total hip arthroplasty (THA). The purpose of this study was to evaluate clinical and radiographic results and complications of cementless THA with 3^rd generation CoC articulation.

Materials and methods

From April 2001 to January 2008, 310 primary THAs were performed in 300 patients using 3^rd generation CoC articulation. The mean follow-up period was 8.9 years and the mean age at index surgery was 54.6 years. Patient clinical outcome was evaluated with the Harris Hip Score. Radiographic evaluations was performed to analyse osteolysis, implant fixation and loosening.

Results

Mean Harris Hip Score at last follow-up was 95.4 (76-100). Radiographic analysis demonstrated no evidence of stem or cup loosening and there were no cases of osteolysis. Ceramic wear was not detectable on the plain radiograph. Complications requiring revision occurred in 12 cases; 2 ceramic head fractures, 4 dislocations, 2 deep infections and 4 cases of periprosthetic fracture. The cohort had an overall revision rate of 3.9%.

Conclusions

Clinical outcomes using cementless THA with 3^rd generation CoC articulation were satisfactory. Although the mechanical properties of ceramic materials have improved, there are still problems such as ceramic fracture and squeaking. More clinical study and investigation for alternative bearing are necessary to reduce complications. 4^th generation CoC or ceramic on cross linked polyethylene may address some of these issues.

Keywords

Ceramic fracture Squeaking THA

Get full access to this article

View all access options for this article.

References

Santavirta

, Nordstrom

, Metsärinne

, Konttinen

Y.T.

Biocompatibility of polyethylene and host response to loosening of cementless total hip replacement.

Clin Orthop Relat Res. 1993; (297): 100–110.

Schmalzried

T.P.

, Jasty

, Harris

W.H.

Periprosthetic bone loss in total hip arthroplasty. Polyethylene wear debris and the concept of the effective joint space.

J Bone Joint Surg Am. 1992; 74(6): 849–863.

Boutin

[Alumina and its use in surgery of the hip. (Experimental study)].

[Article in French.] Presse Med. 1971; 79(14): 639–640.

Barrack

R.L.

, Burak

, Skinner

H.B.

Concerns about ceramics in THA.

Clin Orthop Relat Res. 2004; 429: 73–79.

Kurtz

S.M.

, Gawel

H.A.

, Patel

J.D.

History and systematic review of wear and osteolysis outcomes for first-generation highly crosslinked polyethylene.

Clin Orthop Relat Res. 2011; 469(8): 2262–2277.

National Joint Registry for England W. Northern Ireland and the Isle of Man. 12th annual report. http://www.njrcentre.org.uk/njrcentre/Portals/0/Documents/England/Reports/12th%20annual%20report/NJR%20Online%20Annual%20Report%202015.pdf. Accessed September 15, 2015.

Harris

W.H.

Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation.

J Bone Joint Surg Am. 1969; 51(4): 737–755.

Jarrett

C.A.

, Ranawat

A.S.

, Bruzzone

, Blum

Y.C.

, Rodriguez

J.A.

, Ranawat

C.S.

The squeaking hip: a phenomenon of ceramic-on-ceramic total hip arthroplasty.

J Bone Joint Surg Am. 2009; 91(6): 1344–1349.

Charnley

The long-term results of low-friction arthroplasty of the hip performed as a primary intervention.

J Bone Joint Surg Br. 1972; 54(1): 61–76.

10.

Heekin

R.D.

, Callaghan

J.J.

, Hopkinson

W.J.

, Savory

C.G.

, Xenos

J.S.

The porous-coated anatomic total hip prosthesis, inserted without cement. Results after five to seven years in a prospective study.

J Bone Joint Surg Am. 1993; 75(1): 77–91.

11.

Gruen

T.A.

, McNeice

G.M.

, Amstutz

H.C.

“Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening.

Clin Orthop Relat Res. 1979; (141): 17–27.

12.

Engh

C.A.

, Hooten

Jr , Zettl-Schaffer

K.F.

Porous-coated total hip replacement.

Clin Orthop Relat Res. 1994; (298): 89–96.

13.

Lee

D.W.

, Hwang

S.K.

Primary total hip arthroplasty using third generation ceramic-ceramic articulation: results after a minimum of three-years of follow-up.

Hip&Pelvis. 2014; 26(2): 84–91.

14.

Engh

C.A.

, Bobyn

J.D.

, Glassman

A.H.

Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results.

J Bone Joint Surg Br. 1987; 69(1): 45–55.

15.

Callaghan

J.J.

, Dysart

S.H.

, Savory

C.G.

The uncemented porous-coated anatomic total hip prosthesis. Two-year results of a prospective consecutive series.

J Bone Joint Surg Am. 1988; 70(3): 337–346.

16.

Boardman

D.L.

A simple and reliable method of estimating radiographic acetabular anteversion. In: Proceedings of the 68th Annual Meeting of the American Academy of Orthopaedic Surgeons (February 28-March 4). San Francisco, CA: American Academy of Orthopaedic Surgeons. 2001; 497.

17.

Garcia-Cimbrelo

, Martinez-Sayanes

J.M.

, Minuesa

, Munuera

Mittelmeier ceramic-ceramic prosthesis after 10 years.

J Arthroplasty. 1996; 11(7): 773–781.

18.

Huo

M.H.

, Martin

R.P.

, Zatorski

L.E.

, Keggi

K.J.

Total hip replacements using the ceramic Mittelmeier prosthesis.

Clin Orthop Relat Res. 1996; 332: 143–150.

19.

Yoo

J.J.

, Kim

Y.M.

, Yoon

K.S.

, Koo

K.H.

, Song

W.S.

, Kim

H.J.

Alumina-on-alumina total hip arthroplasty. A five-year minimum follow-up study.

J Bone Joint Surg Am. 2005; 87(3): 530–535.

20.

Willmann

Ceramic femoral head retrieval data.

Clin Orthop Relat Res. 2000; 379: 22–28.

21.

Koo

K.H.

, Ha

Y.C.

, Jung

W.H.

, Kim

S.R.

, Yoo

J.J.

, Kim

H.J.

Isolated fracture of the ceramic head after third-generation alumina-on-alumina total hip arthroplasty.

J Bone Joint Surg Am. 2008; 90(2): 329–336.

22.

Masonis

J.L.

, Bourne

R.B.

, Ries

M.D.

, McCalden

R.W.

, Salehi

, Kelman

D.C.

Zirconia femoral head fractures: a clinical and retrieval analysis.

J Arthroplasty. 2004; 19(7): 898–905.

23.

Huk

O.L.

, Bansal

, Betts

Polyethylene and metal debris generated by non-articulating surfaces of modular acetabular components.

J Bone Joint Surg Br. 1994; 76(4): 568–574.

24.

Y.C.

, Kim

S.Y.

, Kim

H.J.

, Yoo

J.J.

, Koo

K.H.

Ceramic liner fracture after cementless alumina-on-alumina total hip arthroplasty.

Clin Orthop Relat Res. 2007; (458): 106–110.

25.

Owen

D.H.

, Russell

N.C.

, Smith

P.N.

, Walter

W.L.

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(2): 181–187.

26.

Abdel

M.P.

, Heyse

T.J.

, Elpers

M.E.

Ceramic liner fractures presenting as squeaking after primary total hip arthroplasty.

J Bone Joint Surg Am. 2014; 96(1): 27–31.

27.

Beaupre

L.A.

, Manolescu

, Johnston

D.W.

A randomized trial of ceramic-on-ceramic bearing versus ceramic-on-crossfire-polyethylene bearing in total hip arthroplasty: five-year outcomes.

J Arthroplasty. 2013; 28(3): 485–489.

28.

Dong

Y.L.

, Li

, Xiao

, Bian

Y.Y.

, Weng

X.S.

Ceramic on Ceramic or Ceramic-on-polyethylene for Total Hip Arthroplasty: A Systemic Review and Meta-analysis of Prospective Randomized Studies.

Chin Med J (Engl). 2015; 128(9): 1223–1231.

29.

Choy

W.S.

, Kim

K.J.

, Lee

S.K.

, Bae

K.W.

, Hwang

Y.S.

, Park

C.K.

Ceramic-on-ceramic total hip arthroplasty: minimum of six-year follow-up study.

Clin Orthop Surg. 2013; 5(3): 174–179.

30.

Lewallen

D.G.

, Berry

D.J.

Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Periprosthetic fracture of the femur after total hip arthroplasty: treatment and results to date.

J Bone Joint Surg Am. 1997; 79(12): 1881–1890.