Ceramic-on-Ceramic Total Hip Arthroplasty Early Dislocation Rate

Abstract

Wear debris from metal-on-polyethylene articulation in conventional total hip arthroplasty can limit the implant's longevity. Modern ceramic material with high wear resistance and low fracture risk has the potential to extend the lifetime of total hip arthroplasty, which makes the procedure potentially more suitable for young, active patients. Concerns with brittle ceramic material include fracture risk, the "squeak" phenomenon, and potentially a higher dislocation rate secondary to limited neck lengths and liner options. We therefore determined the early dislocation rate in modern ceramic-on-ceramic total hip arthroplasty. In 1635 total hip arthroplasties performed over the 9-year period (1996-2005), we observed three anterior and 15 posterior dislocations (1.1%). All were treated successfully, one with a revision and 17 with closed reduction under general anesthesia. Ceramic-on-ceramic total hip arthroplasty can be a good alternative bearing surface with a low dislocation rate.

THA With Delta Ceramic on Ceramic: Results of a Multicenter Investigational Device Exemption Trial

“…Fourth, because the study was powered using the gold standard measurement tool available at the time (HHS), the study is underpowered to detect subtle differences in performance, fracture rates, or squeaking. Lastly, although our dislocation rate is consistent with reported rates in the literature [5,8], the use of only 28-mm heads likely increased our rate of dislocation. The 36-mm head option, when available, should lower the dislocation rate, and the mechanical properties of the AMC allow manufacturing of the 36-mm liner starting at 52-mm cups.…”

Comparison between 28 mm and 32 mm ceramic-on-ceramic bearings in total hip replacement

“…12,13,40 Larger head sizes have become popular as a method of reducing the incidence of dislocation following THR. 1,[42][43][44] The use of large heads in CoC THR has the potential to reduce the rate of dislocation while minimising the risk of head fracture. However, as the liner has to be thinner in order to accommodate the larger head, there is concern that the risk of liner fracture would be increased by the move to larger head sizes.…”

Incidence of ‘Squeaking’ After Ceramic-on-Ceramic Total Hip Arthroplasty

“…Previous concerns related to COC THA such as fracture and impingement of metal trunion against the ceramic liner have decreased with improvements in the manufacturing process and designs [17]. Another criticism is the potential for increased instability resulting from intraoperative limitations of head and liner options, but a recent multicenter analysis has reduced this concern [3].…”