Ceramics in Total Hip Replacement

Hannouche, Didier; Hamadouche, Moussa; Nizard, Rémy; Bizot, Pascal; Meunier, Alain; Sedel, L.

doi:10.1097/01.blo.0000149996.91974.83

Cited by 213 publications

(130 citation statements)

References 61 publications

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“…The vast majority of the fractures simulated in this investigation occurred for microflawed alumina, in which subcritical microfractures were assumed to be homogenously dispersed throughout the entire liner. Although microscopic imperfections are ubiquitous in modern ceramics [15,39], the probability of such an imperfection being just below critical size and existing precisely at the location of greatest tensile stress (as simulated in the present study) is certainly rather low. As a related matter, the size of a given microflaw will determine the degree of associated reduction of the material's mechanical properties.…”

Section: Discussionmentioning

confidence: 88%

“…The joint contact loads for different BMIs were linearly scaled from the baseline BMI (26.5 kg/m 2 ) of the test subjects. Because microscopic imperfections (which are ubiquitous in sintered ceramic materials [15,39]) decrease the tensile stresses otherwise necessary for fracture, material properties of alumina were varied to simulate liners both with and without microflaws.…”

Section: Methodsmentioning

confidence: 99%

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Do Obesity and/or Stripe Wear Increase Ceramic Liner Fracture Risk? An XFEM Analysis

Elkins

Pedersen

Callaghan

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Hypothesized risk factors for fracture of ceramic liners include impingement, edge-loading, and cup malpositioning. These risk factors are similar to those for generation of stripe wear. However, it is unclear whether the biomechanical conditions contributing to stripe wear generation also increase the risk for ceramic liner fracture Questions/purposes We asked whether (1) head stripe wear propensity; and (2) cup orientation would correlate with alumina liner fracture risk for instances of normal and elevated body weight. Methods An eXtended Finite Element Method (XFEM) model was developed to investigate these mechanisms. Liner fracture risk for 36-mm alumina bearings was studied by simulating two fracture-prone motions: stooping and squatting. Twenty-five distinct cup orientations were considered with variants of both acetabular inclination and anteversion. Four separate body mass indices were considered: normal (25 kg/m 2 ) and three levels of obesity (33, 42, and 50 kg/ m 2 ). Material properties were modified to simulate alumina with and without the presence of dispersed microflaws. The model was validated by corroboration with two previously published ceramic liner fracture studies. Results Of 200 XFEM simulations with flaw-free alumina, fracture occurred in eight instances, all of them involving obesity. Each of these occurred with cups in B 37°inclina-tion and in 0°anteversion. For 200 corresponding simulations with microflawed alumina, fracture propensity was greatest for cups with higher (edge loading-associated) scraping wear. Fracture risk was greatest for cups with lower inclination (average 42°for fractured cases versus 48°for nonfractured cases) and lower anteversion (9°versus 20°). Conclusions Fracture propensity for 36-mm liners was elevated for cups with decreased anteversion and/or inclination and under conditions of patient obesity. Clinical Relevance Factors causing stripe wear, including obesity and cup malpositioning, also involve increased risk of ceramic liner fracture and merit heightened concern.

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Section: Discussionmentioning

confidence: 88%

Section: Methodsmentioning

confidence: 99%

Do Obesity and/or Stripe Wear Increase Ceramic Liner Fracture Risk? An XFEM Analysis

Elkins

Pedersen

Callaghan

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…Ceramic-on-ceramic (COC) has been an excellent alternative bearing surface for THA in young, high-demand patients with end-stage arthritis of the hip [7,13]. 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].…”

Section: Introductionmentioning

confidence: 99%

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

Mai¹,

Verioti

Ezzet

et al. 2010

Clinical Orthopaedics &Amp; Related Research

125

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The incidence of hip ''squeak'' associated with ceramic-on-ceramic bearings has been variably reported, ranging from 0.7% to 20.9%. We determined the patients' perception of squeaking in 306 patients (336 hips) in whom ceramic-on-ceramic total hip arthroplasties (THAs) were performed between 1997 and 2005. A questionnaire regarding hip noise was obtained by telephone. With a minimum followup of 2 years (mean, 3.9 years; range, 2-10 years), 290 patients (320 or 95% of the THAs) completed the questionnaire. Patients reported hip noise in 55 of the 320 THAs (17%); noise was perceived as squeak in 32 of the 320 (10%). Most squeaking hips (29 of 32) were pain-free and symptom-free. One patient was unhappy with his squeaking hip without pain. Our data suggest a much higher incidence of squeak as perceived by patients than previously reported.

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“…Numerous advantages have been reported with the use of ceramic THA designs, including extremely low wear resulting from the very low surface roughness (Ra = 0.02 lm) and increased wettability of the ceramic material [8].…”

Section: Introductionmentioning

confidence: 99%