Fractures of a sandwich ceramic liner at ten year follow-up

Abstract

Purpose The aim of this study was to understand the causes of sandwich liner fractures implanted at our institution by evaluating the long-term results of this device. Methods We retrospectively assessed 143 patients (151 hips) consecutively operated upon in our department by the same senior surgeon between 1999 and 2001 and with a mean follow-up period of 9.9 years (range 8.5-11.5). The components used were Cerasul® sandwich ceramic liners within a cementless cup. Patient assessment was based on demographic factors (age, gender, body mass index), the clinical scores according to Devane (activity), the potential complications and a radiographic analysis from an anteroposterior pelvic radiograph (cup inclination). Revision cases and their cause were classified (implant fracture, loosening, dislocation, periprosthetic fracture). Results Five cases of liner fracture (3.7%) were observed at a mean seven year (4.5-8.5) follow-up. The risk factor for implant failure was found to be patient activity: the mean preoperative Devane score was 3.5 in the fracture group vs 2.6 in the control group (p=0.008). Mean cup inclination was 52°. The survivorship analysis at ten years was 85% with revision as the endpoint. Prosthetic complications accounted for 8.6% of all 151 hips (fractures included): one case of aseptic loosening (0.7%), two cases of sepsis (1.4%), four cases of isolated dislocation (2.8%) and one case of recurrent dislocation (0.7%). Conclusions Alumina sandwich liners remain a subject of concern since the increasing clinical follow-up period may predispose them to fatigue failure. This system has been abandoned in our department since 2005

A late dissociation of the ceramic component of a sandwich liner cup in a total hip arthroplasty<br>—Case report and review of the literature

“…Ravasi and Sansone reported good-toexcellent outcomes with this liner at 5 years follow up [2]. However, recently reports are published with high fracture rates of the liner component [5][6][7][8]. To the best of our knowledge, this is the first report of a late dissociation of the ceramic-polyethylene interface of a sandwich cup resulting in instability of the hip.…”

“…No trauma or abnormal physical activity was observed; neither were there dislocations preceding liner fracture. Viste and coworkers published their results of 124 consecutive THA with a sandwich liner [8]. They reported five cases (3.7%) of liner fracture at a mean follow-up of 9.9 years.…”

“…Although some reports showed good results [2,11], case reports and recent retrospective analyses have demonstrated a high risk of fracture of the ceramic liner [5][6][7][8]10,12,13]. Several authors are expecting an increase of fracture rate over time [7,8,10]. In order to avoid this complication the use of a sandwich cup should be abandoned and that a ceramicon-ceramic or ceramic-on-polyethylene configuration is preferable.…”

“…They state that next to cup design, intraoperative range of motion testing and impeccable surgical technique are keystones for good results in ceramic-ceramic bearings. Other risk factors contributing to ceramic component fracture risk include hyperflexion position, high BMI, malposition of the cup and activity [5,7,8,10,11,12].…”

There Are No Differences in Short- to Mid-term Survivorship Among Total Hip-bearing Surface Options: A Network Meta-analysis

“…Squeaking has been well documented in CoC components; however, specific risk factors remain in debate [27,42,48]. Ceramic liners can also fracture during surgical implantation, which leads to a wasted expensive implant [50]. Postoperative fracture of ceramics, although rare with recent material advancements, has been reported with CoC being at greatest risk [1].…”