Ceramic-on-Ceramic Total Hip Arthroplasty with Large Diameter Heads: A Systematic Review

Castagnini, Francesco; Cosentino, Monica; Bracci, Giovanni; Masetti, Claudio; Faldini, Cesare; Traina, Francesco

doi:10.1159/000508982

Cited by 11 publications

(8 citation statements)

References 21 publications

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“…The wear resistance of acetabular Liner was always a key factor that we must consider for young patients. Though the volumetric wear rates of polyethylene lining were very low 0.022 mm/year, proving highly crosslinked polyethylene was durable in THAs [17] and hip abnormal noise was mainly appeared in ceramic-onceramic THAs [18], the advantages of 4th-COC were also obvious in our experience [19]. However, most research on Crowe II/III had few such detailed surgical date [14].…”

Section: Prothesismentioning

confidence: 61%

Mid-term outcomes after total hip arthroplasty in 106 Crowe II/III hips: different hip center positions

Jia

Pan

et al. 2022

Eur J Med Res

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Background Under the obvious acetabular superolateral bone defect of Crowe II/III hips, this study aimed to investigate the difference in surgical technique of different hip center positions from the surgical data and clinical outcomes. Methods From July 2007 to December 2016, 87 patients (106 Crowe II/III hips) consecutively received total hip arthroplasty (THA). The minimum follow-up time was 5 years. The mean limb length discrepancy was 1.97 ± 1.81 cm. Twenty-four hips had surgical histories. The patients were divided into three groups according to the acetabular prosthesis positions, depending on the Crowe classification, respectively, group 1 (Crowe I), group 2 (Crowe II) and group 3 (Crowe III). The surgical data and clinical results were used to evaluate the outcome of different surgical techniques of different hip center positions, including surgical time, blood loss, blood transfusion, number of osteotomy hips, osteotomy length, the distribution of prothesis, postoperative inpatient days, Harris hip scores, Visual Analogue Scale (VAS), Back Pain Function Scale (BPFS) and complications. Results The mean follow-up time was 8.93 ± 2.55 years. Nineteen hips performed intraoperative osteotomy. From group 1 to group 3, the mean osteotomy length were 0.53 ± 1.11 cm, 0.05 ± 0.22 cm, and 0.00 ± 0.00 cm, respectively (p = 0.083); the surgical time were 142.57 ± 57.94 min, 118.4 ± 41.22 min, and 120.00 ± 84.85 min, respectively (p = 0.324); the blood loss were 498.21 ± 368.53 mL, 333.33 ± 167.62 mL, and 350.00 ± 212.13 mL, respectively (p = 0.255); the blood transfusion were 288.48 ± 381.68 mL, 128.00 ± 235.17 mL, and 385.00 ± 219.20 mL, respectively (p = 0.199); the postoperative inpatient days were 7.95 ± 4.42 d, 7.47 ± 4.29 d, and 6.50 ± 0.71 d, respectively (p = 0.831). Among the groups, the distribution of acetabular prosthesis, acetabular liner, acetabular prosthesis sizes, femoral head sizes and femoral prothesis distal sizes were not significantly different (p > 0.05). Only the distribution of femoral prosthesis was significantly different (p = 0.046); the Harris, VAS, BPFS, and the distribution of complications were not significantly different (p > 0.05). Conclusions We provided a framework to guide decision-making in Crowe II/III hips for surgeons: the surgical technique of different hip center positions was stable and had good outcomes, but the acetabular prothesis position and femoral prothesis should be determined according to the intraoperative situation. Level of evidence Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

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Section: Prothesismentioning

confidence: 61%

Mid-term outcomes after total hip arthroplasty in 106 Crowe II/III hips: different hip center positions

Jia

Pan

et al. 2022

Eur J Med Res

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“…Last, a large femoral head with a diameter of 36 mm was used in almost all implants (98.3%). It has been shown that CoC bearings decrease the cumulative long‐term risk of dislocation compared with that for CoP bearings 38 , especially when implanted with a large‐diameter (≥32 mm) femoral head 39 , 40 . HO was seen in 12 (6.7%) of all postoperative hips.…”

Section: Discussionmentioning

confidence: 99%

Fourth‐Generation Ceramic‐on‐Ceramic THA in Patients with Ankylosing Spondylitis: A Minimum 10‐Year Follow‐Up

et al. 2022

Orthopaedic Surgery

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Objective To report the long‐term outcomes of total hip arthroplasty (THA) with fourth‐generation ceramic‐on‐ceramic (CoC) bearing in patients with ankylosing spondylitis (AS). Methods We retrospectively identified 180 primary THAs performed in 110 patients with AS, including 100 (90.9%) men and 10 women (9.1%), from 2009 to 2011.The mean age of the patients at surgery was 33 years (range, 16 to 65 years). Cementless prostheses with fourth‐generation CoC bearings were used in all patients. Survivorship of the implants and postoperative complications were calculated. Functional improvement was assessed by the hip flexion‐extension range of motion (ROM) and Harris hip score (HHS). A special noise assessment questionnaire was performed at the last follow‐up. The cumulative incidence of noise was calculated by the Kaplan–Meier method with 95% confidence intervals (CIs). Clinical characteristics and functional outcomes were compared in the hips with noise to those without noise. Results The mean follow‐up was 11 years (range, 10 to 12 years), and survivorship of the implants was 99.4% at the most recent follow‐up. The complications included dislocation (one hip, 0.6%), periprosthetic joint infection (one hip, 0.6%), mild to moderate pain (five hips, 2.8%), heterotopic ossification (12 hips, 6.7%), and noise (52 hips, 28.9%). The flexion‐extension ROM improved significantly with a median from 10° (range, 0 ~ 130°) to 100° (30 ~ 130°) after THA (p < 0.001), and the HHS increased significantly from 41 ± 20 to 90 ± 8 (p < 0.001). The cumulative incidence of noise at 0.5, 5, and 10 years was 6.1% (95% CI, 2.6 ~ 9.6), 16.7% (95% CI, 11.2 ~ 22.1), and 28.9% (95% CI, 22.2 ~ 35.5), respectively, and that of squeaking at 0.5, 5, and 10 years was 4.4% (95% CI, 1.4 ~ 7.4), 13.3% (95% CI, 8.4 ~ 18.3), and 23.9% (95% CI, 17.6 ~ 30.1), respectively. None of the patients with noise generation in the hip reported it affecting daily activities or causing dissatisfaction. No differences in age, sex, BMI, disease duration, bilateral THA, the frequency of bony ankylosis, the proportion of using a 36‐mm‐diameter femoral head, pre/postoperative flexion‐extension ROM, or pre/postoperative HHS were found between hips with noise and those without noise (p > 0.05). Conclusion THAs with fourth‐generation CoC bearings exhibit excellent long‐term survival and clinical outcomes in patients with AS, with a very low dislocation rate. The incidence of noise associated with CoC bearings in THA performed in patients increases over time, but it does not affect postoperative hip function or daily activities.

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“…The benefits of using LDH in the primary setting includes a reduction in the risk of impingement (allowing for a greater range of movement and a decreased risk of dislocation); improved abductor function and hip kinematics; and a reduced long-term risk of implant loosening. 56 Our study analysis functional outcomes for the use of LDH in the revision setting. This study demonstrates an improvement in functional outcomes when using LDH for revision surgery.…”

Section: Discussionmentioning

confidence: 99%

Monobloc press-fit cups with large-diameter bearings are safe in revision total hip arthroplasty

et al. 2022

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BACKGROUND Instability is a major cause of failure of revision total hip arthroplasty (THA) which can be avoided with the use of monobloc press-fit cups with large diameter heads (LDH). OBJECTIVE This consecutive case series analyses whether LDH monobloc components are a safe and clinically beneficial option for revision THA. METHODS This consecutive case series includes 47 revision THA with LDH monobloc acetabular cup. Acetabular bone defects were Paprosky type I (42), type IIA (2) and type IIC (3). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Forgotten Joint Score (FJS) and the Patient’s Joint Perception (PJP) scores were analysed and a radiographic evaluation for signs of implant dysfunction was performed. RESULTS After a mean follow-up of 4.5 years, there were 5 (10.6%) acetabular cup re-revisions: 2 loss of primary fixation and 3 instabilities. Implant survivorship at 4-years was 89.4% (95% CI: 89.3 to 89.5). Recurrent hip dislocation was reported in 1 patient (2.1%) and remains under conservative treatment. The mean WOMAC and FJS were 19.5 (16.8; 0.0 to 58.3) and 57.3 (28.9; 6.3 to 100.0), respectively. Regarding the PJP, 3 (8.8%) patients perceived their hip as natural, 8 (23.5%) as an artificial joint with no restriction, 14 (41.2%) with minor restriction and 9 (26.5%) with major restriction. CONCLUSION In cases of revision THA with limited bone loss, press-fit primary fixation with LDH monobloc acetabular components are valuable options that offer excellent mid-term out-comes with low re-revision and joint instability rates.

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Ceramic-on-Ceramic Total Hip Arthroplasty with Large Diameter Heads: A Systematic Review

Cited by 11 publications

References 21 publications

Mid-term outcomes after total hip arthroplasty in 106 Crowe II/III hips: different hip center positions

Mid-term outcomes after total hip arthroplasty in 106 Crowe II/III hips: different hip center positions

Fourth‐Generation Ceramic‐on‐Ceramic THA in Patients with Ankylosing Spondylitis: A Minimum 10‐Year Follow‐Up

Monobloc press-fit cups with large-diameter bearings are safe in revision total hip arthroplasty

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