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

Abstract

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.

Design Considerations for the Next Generation Hip Resurfacing Implant

“…An early attempt at a ceramic-on-ceramic resurfacing implant resulted in fracture in all cases [25] and was abandoned. However, the newest generation of delta ceramics are more fracture resistant [4,16] and could potentially be used for a resurfacing head and acetabulum.…”

Metal-on-metal total hip arthroplasty: is there still a role in 2016?

“…CoC bearings have had mixed results throughout the literature, with early generations experiencing issues with ceramic fracture and squeaking [1]. The newest generation of ceramics exhibit an exceedingly low fracture risk [2,3], yet the squeaking hip continues to be an issue [4]. Ranawat et al reported 10.7 % of patients with CoC hips complained of audible squeaking [5].…”

Do the Reasons for Ceramic-on-ceramic Revisions Differ From Other Bearings in Total Hip Arthroplasty?

“…The rate of ceramic breakage has diminished with the introduction of better components and is currently estimated to be below one in 5000 [1,20,28]. However, with more frequent use of ceramics, other concerns such as squeaking have emerged with a frequency of 0.5% to 20% [2,5,6,18,27]. All these limitations expose CoC THAs to reoperation with the 10-year survival rate ranging from 62% to 97% [12][13][14][15][16][17].…”