Early Diagnosis of Ceramic Liner Fracture

Toni, Aldo; Traina, Francesco; Stea, Susanna; Sudanese, A; Visentin, M.; Bordini, Barbara; Squarzoni, Stefano

doi:10.2106/jbjs.f.00587

Cited by 99 publications

(93 citation statements)

References 16 publications

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“…Synovial fluid samples were obtained either intra-operatively, after the joint was exposed during revision surgery (carefully avoiding dilution with blood from the surgical dissection), or by using an ultrasound-guided hip needle aspiration according to a published guideline [19] and then stored at −80°C until the analysis was performed.…”

Section: Detection Of Particles In Synovial Fluidmentioning

confidence: 99%

Metal-on-metal hip prostheses: Correlation between debris in the synovial fluid and levels of cobalt and chromium ions in the bloodstream

Pasquale

Stea

Squarzoni

et al. 2013

International Orthopaedics (SICOT)

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Purpose Hip prostheses with metal-on-metal (MoM) coupling can release cobalt-chromium particles and ions. The aim of this work is to verify the correlation between particles in the synovial fluid and circulating ions. Methods Forty patients were enrolled; particles from synovial fluid were analysed by SEM-EDX (Scanning Electron Microscopy-Energy Dispersion X-rays analysis) and levels of circulating Co and Cr were assayed by ICP-MS (inductively-coupled plasma mass spectrometry). Results In 16 cases we did not find any particles in the synovial fluid and the Co level in whole blood was 0.05-4.42 ppb; in seven with few particles the blood level was 2.2-15.6 ppb; in six cases with several particles the level was 5.0-54.3 ppb; finally, in 11 cases we isolated not only Co-Cr particles, but also Cr particles with low or absent Co and in these patients the circulating level of Co was 23.8-109.6 ppb. Co in serum and Cr level both whole blood and serum have shown a similar trend to Co; the correlation between all these values and the corresponding particles is statistically significant in all cases. Conclusion Co and Cr both in serum and whole blood represents a systemic representation of the particle release at local level and can therefore be used to confirm a diagnosis and monitor the wear process of MoM articular prostheses.

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Section: Detection Of Particles In Synovial Fluidmentioning

confidence: 99%

Metal-on-metal hip prostheses: Correlation between debris in the synovial fluid and levels of cobalt and chromium ions in the bloodstream

Pasquale

Stea

Squarzoni

et al. 2013

International Orthopaedics (SICOT)

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“…Although mechanistic information regarding fracture of ceramic liners is currently minimal, component impingement is believed to be a/the principal risk factor [14,17,23,28,36]. Component malpositioning [13], microseparation leading to edge loading [33], incomplete seating of modular liners [22], and obesity [30] have also been suggested.…”

Section: Introductionmentioning

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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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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“…This, together with late manifestation on radiographs, led to delayed diagnosis. Toni et al 14 found a positive correlation between ceramic liner fracture and a noisy hip on clinical examination. They recommended computed tomography (CT) and joint aspiration in any snapping hip after ceramic THA to rule out early failure.…”

Section: Discussionmentioning

confidence: 98%

Early Fracture of a Plasma Cup Ceramic Liner: A Case Report and Surface Analysis

Gallo¹,

Stewart²,

Novotný³

et al. 2007

BIOMED PAP

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Early Diagnosis of Ceramic Liner Fracture

Abstract: Preparative steps for synovial fluid analysis. Tlie filter is placed on the holder, synovial fluid is added (a), digestion is performed with sodium hypochlorite (b), water is flushed through the filter, and the filter is dried (c).

Cited by 99 publications

References 16 publications

Metal-on-metal hip prostheses: Correlation between debris in the synovial fluid and levels of cobalt and chromium ions in the bloodstream

Metal-on-metal hip prostheses: Correlation between debris in the synovial fluid and levels of cobalt and chromium ions in the bloodstream

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

Early Fracture of a Plasma Cup Ceramic Liner: A Case Report and Surface Analysis

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