Early Results of Our International, Multicenter, Multisurgeon, Double-Blinded, Prospective, Randomized, Controlled Trial Comparing Metal-on-Metal With Ceramic-on-Metal in Total Hip Arthroplasty

Higgins, J.; Conn, Kevin S.; Britton, J.; Pesola, Maija; Manninen, Mikko; Stranks, G

doi:10.1016/j.arth.2019.08.002

Cited by 10 publications

(9 citation statements)

References 10 publications

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“…When compared to the other studies of the effect of hip arthroplasty on Cr and Co ion levels, Cr results were not significantly different from the overall mean of the other studies, while Co results were significantly lower (p < 0.001). 4,8,25,[29][30][31][32][33][34] Figure 3 depicts Cr and Co levels in our sample in comparison to the general Italian population and to the estimated overall mean of published studies.…”

Section: Resultsmentioning

confidence: 99%

Ceramic-on-metal bearing in short stem total hip arthroplasty: ions, functional and radiographic evaluation at mid-term follow-up

et al. 2020

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Introduction: The aim of this study is to evaluate clinical, radiographic and laboratory results of ceramic-on-metal (CoM) (hybrid hard bearing) in total hip arthroplasty (THA), associated with a short stem implant. Methods: From a cohort of 37 patients suffering from primary or secondary hip osteoarthritis who underwent THA using CoM bearing, 19 were suitable for this study. All procedures were performed by the same surgeon using a posterior-lateral approach. All patients were compared clinically using the Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analogue scale (VAS), 12-item Short Form Health Survey (SF12F/M), and radiographically (offset, CD angle, limb length discrepancy, cup inclination and anteversion, subsidence, osseointegration, heterotopic ossification). Blood samples were collected in order to evaluate chromium (Cr) and cobalt (Co) ions level. Radiographic evaluations were carried out by 3 different blinded surgeons. A statistical analysis was performed. Results: At a mean follow-up of 97 (73–125) months all implanted stems were well-positioned and osseointegrated. Clear improvements were observed for clinical scores comparing preoperative and postoperative values. Radiographic evaluation showed a good ability to restore proper articular geometry. Cr ion analysis revealed values below the safety threshold except for 1 case. Serum levels of Co were below the threshold in all patients. There was a statistically significant correlation only between Cr metal ions and length of follow-up. Conclusions: CoM bearing has proven to be reliable and safe at a mean 8-year follow-up for patients in whom the components were correctly implanted. The rise of blood metal ions was minimal and involved neither systemic or local toxicity nor influenced clinical results.

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Section: Resultsmentioning

confidence: 99%

Ceramic-on-metal bearing in short stem total hip arthroplasty: ions, functional and radiographic evaluation at mid-term follow-up

et al. 2020

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“…In a randomized study, Higgins et al observed less metallic wear with use of this articulation, but a tendency to increased chromium levels after three years. 56 In the National Joint Registry the revision rate of CoM articulations is higher than observed for MoXLPE and CoXLPE articulations. 57 This type of coupling, which gained some popularity based on in vitro studies in the early 2000s, has been rapidly withdrawn from the market.…”

Section: Articulating Materialsmentioning

confidence: 94%

Global diversity in bearings in primary THA

et al. 2020

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Choice of articulating materials, head size and the design of the articulation will become decisive for the long-term performance of a total hip arthroplasty (THA) and especially in terms of risk for dislocation and wear-related problems. Here we account for common alternatives based on available studies and the evidence that can be derived from them. Metal or ceramic femoral heads articulating against a liner or cup made of highly cross-linked polyethylene and ceramic-on-ceramic articulations have about similar risk for complications leading to revision, whereas the performance of metal-on-metal articulations, especially with use of big heads, is inferior. The clinical significance of problems related to ceramic-on-ceramic articulations such as squeaking remains unclear. With use of current technology ceramic fractures are rare. Large femoral heads have the potential to increase the range of hip movement before impingement occurs and are therefore expected to reduce dislocation rates. On the other hand, issues related to bearing wear, corrosion at the taper-trunnion junction and groin pain may arise with larger heads and jeopardize the longevity of THA. Based on current knowledge, 32-mm heads seem to be optimal for metal-on-polyethylene bearings. Patients with ceramic-on-ceramic bearings may benefit from even larger heads such as 36 or 40 mm, but so far there are no long-term reports that confirm the safety of bearings larger than 36 mm. Assessment of lipped liners is difficult because randomized studies are lacking, but retrospective clinical studies and registry data seem to indicate that this liner modification will reduce the rate of dislocation or revision due to dislocation without clear evidence of clinically obvious problems due to neck-liner impingement. The majority of studies support the view that constrained liners and dual mobility cups (DMC) will reduce the risk of revision due to dislocation both in primary and revision THA, the latter gaining increasing popularity in some countries. Both these devices suffer from implant-specific problems, which seem to be more common for the constrained liner designs. The majority of studies of these implants suffer from various methodological problems, not least selection bias, which calls for randomized studies preferably in a multi-centre setting to obtain sufficient power. In the 2020s, the orthopaedic profession should place more effort on such studies, as has already been achieved within other medical specialties, to improve the level of evidence in the choice of articulation when performing one of the most common in-hospital surgical procedures in Europe. Cite this article: EFORT Open Rev 2020;5:763-775. DOI: 10.1302/2058-5241.5.200002

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“…They tended to be used for physically-active young patients. Nonetheless, it soon showed catastrophic failures due to metal sensitivity problem and the aseptic lymphocytedominated vasculitis associated lesions (ALVAL) [9]. 2 Ceramic-on-ceramic (COC):…”

Section: Hard-on-soft Bearingsmentioning

confidence: 99%

“…The authors reported some revisions in the COM attributed to metal debris. They concluded that the COM produced metal ions, suggesting there existed a wear pattern different from MOM, and further investigation on its safety and efficacy was needed [9]. To simplify the discussion of advances in the biomaterials of bearing surfaces, we divide these materials into three categories: polymers, metals, and ceramics.…”

Section: Hard-on-soft Bearingsmentioning

confidence: 99%

“…They tended to be used for physically-active young patients. Nonetheless, it soon showed catastrophic failures due to metal sensitivity problem and the aseptic lymphocyte-dominated vasculitis associated lesions (ALVAL) [ 9 ]. Ceramic-on-ceramic (COC): COC was introduced as a hard-on-hard bearing alternative to MOM, to avoid MOM’s major drawbacks as ceramics provided better wear resistance, without metal ion production but with wear particle generation.…”

Section: Introductionmentioning

confidence: 99%

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Updates in biomaterials of bearing surfaces in total hip arthroplasty

Khalifa

Bakr

2021

Arthroplasty

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Total hip arthroplasty (THA) is one of the most successful surgical procedures. It entails replacement of the damaged or diseased joint surface with artificial materials. Various materials had been developed and used to achieve optimal outcomes, including longer survivorship and minimal complications. The primary materials used in the manufacture of THA implants are polymers, metal alloys, and ceramics. The failures of THA mainly result from aseptic loosening due to the production of wear particles and the development of periprosthetic joint injection. A lot of advancement and introduction of new biomaterials in THA implants’ armamentarium are designed to avoid the common failure mechanisms and improve the longevity of the implants. In this review, we discussed various aspects of commonly used biomaterials in THA implants, to provide some updated information.

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Early Results of Our International, Multicenter, Multisurgeon, Double-Blinded, Prospective, Randomized, Controlled Trial Comparing Metal-on-Metal With Ceramic-on-Metal in Total Hip Arthroplasty

Cited by 10 publications

References 10 publications

Ceramic-on-metal bearing in short stem total hip arthroplasty: ions, functional and radiographic evaluation at mid-term follow-up

Ceramic-on-metal bearing in short stem total hip arthroplasty: ions, functional and radiographic evaluation at mid-term follow-up

Global diversity in bearings in primary THA

Updates in biomaterials of bearing surfaces in total hip arthroplasty

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