Comparison of Preoperative Radiographs and Intraoperative Findings of Fixation of Hemispheric Porous-Coated Sockets

Background Ceramic-on-ceramic bearing couples are theoretically attractive in total hip arthroplasty (THA) because of low wear, but concerns regarding ceramic fracture and squeaking have arisen. Improved material properties of newer alumina matrix composite (AMC) materials, known as Delta ceramics, may reduce these risks. In addition, the use of thinner liners and larger femoral heads may be helpful clinically to lower the rate of dislocation. However, limited short-term clinical results are available and intermediate-term effects are unclear. Questions/purposes (1) What is the frequency of bearingrelated complications (dissociation, fracture, and noise) with ceramic-on-ceramic AMC bearings in cementless THA? (2) What other complications arose in patients treated with these bearings? (3) What are the Harris hip scores (HHS) and survivorship free from reoperation and revision at a minimum of 5 years after cementless THA performed with AMC bearings? Methods Over a 9-month period in 2009, one surgeon performed 125 THAs, of which 100 (80% of the total) were performed with cementless, AMC bearings. During the period in question, the exclusion criteria for this implant were primary THAs with severe acetabular or femoral bone defect and revision THAs. Of these, 94 hips (95%) in 91 patients were available for analysis at a minimum of 5 years (range, 5-6 years), because five patients (six hips) had died. Mean age at the time of arthroplasty was 55 ± 14 years. Prostheses with an identical design and Biolox 1 Delta ceramics were used in all patients. Noise was classified into squeaking, clicking, grinding, and popping. Ceramic fracture, dislocation, and any other complications associated with the use of AMC ceramics were also investigated. Clinical evaluation included the modified HHS preoperatively and at each followup. Survivorship free from reoperation and revision was calculated using the Kaplan-Meier method. Results Of 91 patients, four developed bearing-related complications, including one with liner dissociation despite initial square seating and three with clicking. No patients had ceramic fractures. A single event of perioperative dislocation occurred in one patient and postoperative periprosthetic fracture occurred in two hips. Mean HHS improved from 56 to 93 points at the final followup (p \ 0.001). Survivorship at 5 years free from reoperation and revision was 96.8% and 97.9%, respectively.

Section: Methodsmentioning

confidence: 99%

Do Alumina Matrix Composite Bearings Decrease Hip Noises and Bearing Fractures at a Minimum of 5 Years After THA?

Baek

Kim

et al. 2015

“…Fixation and osteolysis of the cup were measured by the zones of DeLee and Charnley [7]. Cup loosening was diagnosed when any of the following were present: (1) any evidence of a circumferential radiolucent line of 1 mm or wider; (2) appearance of a completely new radiolucent line in any zone; (3) progressive radiolucent line into a new zone; or (4) migration of the cup by more than 2 mm of vertical or horizontal shift or change in inclination of more than 5° [2,25]. Impending failure was radiographic evidence of loosening without revision.…”

Section: Methodsmentioning

confidence: 99%

Failure of the Durom Metasul® Acetabular Component

Long

Dastane

Harris

et al. 2010

Self Cite

Large-diameter metal-on-metal articulations reportedly provide better stability and range of motion than smaller diameter bearings. We therefore asked whether a large-diameter (44-to 50-mm) metal-on-metal articulation (Durom1) would eliminate dislocation and provide similar functional scores and clinical and radiographic failure rates as those with 28-mm articulation. We prospectively followed 181 patients (207 hips) who had a large-diameter articulation implanted between May 2006 and November 2007. We compared these patients with a historical control of 54 patients who had a small-diameter (28-mm Metasul1) articulation. All patients had a Harris hip score and a self-assessment of outcome and radiographic followup. The minimum followup was 1 year (mean, 1.6 years; range, 1-2 years). During the followup period, we performed revisions on 29 patients (30 hips [15%]) with 21 of 29 (72%) having radiographic criteria of loosening. Thirteen retrieved cups and acetabular tissue were examined histologically. Twenty-eight of 151 unrevised patients had radiographic impending failure; 12 without revision had clinical failure. Eight patients (nine hips) had both clinical failure and impending radiographic failure. Cup inclination was 41.3°± 5.4°and anteversion was 20.2°± 7°. The revision rate and quality of clinical results were unacceptable as compared with our historical controls. We do not recommend use of the Durom1 implant.

“…Fixation and osteolysis of the cup were measured by the zones of DeLee and Charnley [8]. Cup loosening was diagnosed when there was: (1) a circumferential radiolucent line of 1 mm or wider; (2) appearance of a new radiolucent line in any zone; (3) progression of a radiolucent line; or (4) migration of the cup by more than 2 mm of vertical or horizontal shift or a change in inclination of more than 5° [33].…”

Section: Methodsmentioning

confidence: 99%

Metal-on-Metal Hip Arthroplasty Does Equally Well in Osteonecrosis and Osteoarthritis

Dastane

Long

Wan

et al. 2008

Self Cite

Many previous reports suggest total hip arthroplasty performs suboptimally in young patients with osteonecrosis. We retrospectively compared the performance of metal-on-metal articulation in a select group of 107 patients with 112 hips (98 uncemented and 14 cemented stems) 60 years of age or younger with either osteonecrosis (27 patients, 30 hips) or primary osteoarthritis (80 patients, 82 hips). We evaluated all patients with patient-generated Harris hip score forms and serial radiographs. Five mechanical complications were caused by impingement, two with pain, two dislocations, and one liner dissociation. At a minimum followup of 2.2 years (mean, 5.5 years; range, 2.2-11.7 years), we observed no osteolysis or aseptic loosening in the osteonecrosis group, whereas one osteoarthritic hip had cup revision for loosening (none showed evidence of osteolysis). None of the stems were loose. Patients with osteonecrosis or primary osteoarthritis were similar in clinical and radiographic performance. The patients with metal-on-metal hip arthroplasty for osteonecrosis had no revisions for aseptic loosening, but did have one liner change in a cup for painful impingement.