Ceramic-on-Ceramic Total Hip Replacement: Five Cases of Early Delta Ceramic Liner Fracture

McCourt, Ellen; Mawdsley, M.; Loughead, Jonathan

doi:10.1007/978-3-642-45266-6_10

Cited by 2 publications

(3 citation statements)

References 10 publications

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“…[25] McCourt has subsequently reported 5 cases of early delta ceramic liner fracture in UK between 2011 and 2012. [26] In our current cohort of 135 hips, we did observe 1 ceramic liner rim that was damaged, which occurred when the patient suddenly squatted. We speculate that squatting led to repetitive impingement between the rim of the ceramic liner and the stem adjacent to the femoral neck, which might be an important factor in the fracture of the ceramic liner.…”

Section: Discussionmentioning

confidence: 75%

Could larger diameter of 4th generation ceramic bearing increase the rate of squeaking after THA?

Luo

Sun²,

Jin³

et al. 2018

Medicine

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The present study aimed to evaluate the clinical outcomes and bearing-specific complications in a single center of 135 delta ceramic-on-ceramic (COC) total hip arthroplasties (THAs) and explore the occurrence rate of squeaking in 4th generation COC THAs and collate the risk factors for squeaking.We retrospectively analyzed consecutive cohorts of 127 patients (135 hips) who had primary THA with delta COC bearings in our hospital between April 2010 and April 2012. Preoperative Harris hip score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and University of California Los Angeles (UCLA) activity score were evaluated preoperatively and postoperatively. We also evaluated ceramic fracture, squeak, mid-term results, and survival.In our study, the final patient final follow-up date was July 31, 2016. The mean preoperative HHS improved from 39.5 to 93.1 points. Mean preoperative UCLA score was 3.2 points, improving to 8.2 points. The mean preoperative total WOMAC score was 55.5 points and the mean total WOMAC score was 13.3 points at the final follow-up. The Kaplan–Meier survival plot of revision for any reason as the end point was 98.5% and survival with ceramic fracture as the end point was 99.2% at a mean of 70 months’ follow-up. One post-operative ceramic liner rim fracture occurred at 50 months after surgery. Thirteen of the 135 hips produced a squeaking sound. There were no significant differences in gender (P = .56), age (P = .20), body mass index (BMI) (P = .11), diagnosis (P = .46), cup inclination (P = .36), or cup anteversion (P = 1.0) between the squeaking and non-squeaking groups. However, the incidence of squeaking in the 36 mm COC femoral head bearings was higher than in the 28 mm size (13.6% vs 2.1%, P = .033).The 4th generation COC bearing performed well and provides an encouraging rate of survival with no osteolysis or loosening. However, we found that a squeaking sound associated with use of the delta ceramic occurred at a rate of 9.6%, with the larger-diameter heads having significantly higher incidence.

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Section: Discussionmentioning

confidence: 75%

Could larger diameter of 4th generation ceramic bearing increase the rate of squeaking after THA?

Luo

Sun²,

Jin³

et al. 2018

Medicine

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“…Improvements in modern generation ceramics have reduced incidences of fracture with reports of fourth generation BIOLOX delta liner fractures as low as 0.03%. 2,4 Mechanical testing of BIOLOX delta ceramic hip implants has focused on edge loading and fatigue in attempt to produce fracture but the material has shown resilience to these conditions. 5,6 The material, manufactured as a thin-walled cup in this study, has shown an ability to withstand impacts comparable to lateral falls and car crashes in worst case conditions including high inclination angle and subluxed head positioning, further demonstrating its fracture resistance.…”

Section: Discussionmentioning

confidence: 99%

“…3 The rate of fracture of BIOLOX delta ceramics, however, is extremely low and often reported at 0.03%. 2,4 Any fracture of this material can be catastrophic, leading to the retention of ceramic debris in the joint capsule which is abrasive and a challenge to fully remove in revision surgery. Current methods for testing the survivorship of ceramic liners focus mainly on edge loading of the cup under walking conditions and fatigue impaction tests.…”

Section: Introductionmentioning

confidence: 99%

Resistance of a novel ceramic acetabular cup to critical impact loads

Villiers

Collins

2020

Proc Inst Mech Eng H

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A novel thin-walled direct-to-bone fixation ceramic cup was tested under critical impact loads simulating lateral fall and car crash scenarios. Three sizes of BIOLOX delta ceramic cups (total hip replacement cup with bearing diameter of 32 mm and two hip resurfacing cups with bearing diameters of 40 and 64mm) were implanted into reamed Sawbones blocks representing acetabulae. Three cups of each size were fully supported by the block and three were implanted with 15° of the cup’s outer diameter unsupported by the block. All testing was conducted with the corresponding bearing diameter heads lateralised by approximately 1 mm to represent worst case subluxed hips and all then subjected to test, replicating a lateral fall impact followed by a car crash impact. All cups passed lateral fall conditions without visible damage, although some movement of the cups was measured and damage to the blocks was observed. Five out of six of each cup size survived the car crash impacts with one fracture per size. In all cases, this was in the fully supported condition representing the highest cup inclination angle. The car crash impact force was equivalent to that reported to fracture the acetabulum and in all simulated cases, the Sawbones block showed signs of damage. Survival of five cups per size suggests the pelvis is much more likely to fracture before the cup. The ability of the cups to withstand these critical impact forces indicates they are unlikely to fracture in normal clinical use and should meet the more challenging demands of active patients likely to receive this device.

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Ceramic-on-Ceramic Total Hip Replacement: Five Cases of Early Delta Ceramic Liner Fracture

Cited by 2 publications

References 10 publications

Could larger diameter of 4th generation ceramic bearing increase the rate of squeaking after THA?

Could larger diameter of 4th generation ceramic bearing increase the rate of squeaking after THA?

Resistance of a novel ceramic acetabular cup to critical impact loads

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