Hybrid alumina total hip arthroplasty using a press-fit metal-backed socket in patients younger than 55 years

Abstract

Between 1990 and 1992, we implanted 71 hybrid alumina-on-alumina hip arthroplasties in 62 consecutive patients under the age of 55 years, with a mean age of 46 years at surgery. There were 56 primary and 15 secondary procedures. The prostheses involved a cemented titanium alloy stem, a 32 mm alumina head, and a press-fit metal-backed socket with an alumina insert. Three patients (four hips) died from unrelated causes. Four hips had revision surgery for either deep infection, unexplained persistent pain, fracture of the alumina head, or aseptic loosening of the socket. The nine-year survival rate was 93.7% with revision for any cause as the end-point and 98.4% with revision for aseptic loosening as the end-point. The outcome in the surviving patients (50 patients, 57 hips) with a minimum five-year follow-up (mean eight years) was excellent in 47 hips (82.5%), very good in eight (14%), good in one and fair in one. A thin, partial, lucent line, mainly in zone III was present in 38% of the sockets and one socket had a complete lucency less than 1 mm thick. One stem had isolated femoral osteolysis. There was no detectable component migration nor acetabular osteolysis. This hybrid arthroplasty gave satisfactory medium-term results in active patients. The press-fit metal-backed socket appeared to have reliable fixation in alumina-on-alumina hip arthroplasty. The excellent results using cemented fixation of the stem may be related to the low production of wear debris.

Behaviour of the ultra-short anatomic cementless femoral stem in young and elderly patients

“…Alumina ceramic head or liner fracture is reported in the literature [40,41]. In the present study, the absence of a ceramic head or liner fracture contrasts with the results of other studies on the use of modern designs with alumina-onalumina ceramic bearings [1,[40][41][42][43]. The absence of a ceramic head or liner fracture in the present series is attributed to improved quality of ceramic material, optimal cup orientation, optimal interlocking of the alumina head and taper of the stem as well as alumina liner and metallic cup shell.…”

“…Although the results of modern cemented or cementless total hip arthroplasty (THA) are generally good [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15], thigh pain, stress shielding and periprosthetic fracture are still potential problems [2,[6][7][8][9]. In an effort to reduce the periprosthetic fracture, thigh pain, and stress shielding, an ultra-short, anatomic metaphyseal-fitting cementless femoral component was developed.…”

Ceramic-on-ceramic THA Implants in Patients Younger Than 20 Years

“…The results of ceramic-on-ceramic bearings in patients who were older than 40 years have been reported [2,3,16,29,30], but few [6,15,23] have focused on the long-term results of ceramic-on-ceramic implants in patients younger than 20 years. In this series, we found the survivorship of ceramic-on-ceramic implants in adolescent patients was encouraging, averaging 90.3% at 10 years.…”

“…Ceramic-on-ceramic bearing couples have become an alternative to standard surface bearing couples (such as metal-on-polyethylene) because of decreased wear production and lower rates of osteolytic lesions compared with metal-on-conventional polyethylene [21]. The results of modern ceramic-on-ceramic bearings are available in patients younger than 60 years who have degenerative diseases [2,3,16,29,30], but few reports [6,15,23] have focused on patients younger than 20 years, who may be more likely to have high activity levels, perform sports activities, or engage in higher-demand workplace tasks.…”

Does Acetabular Inclination Angle Affect Survivorship of Alumina-ceramic Articulations?

“…Survival rates in the reported literature of medium-term followup for ceramicon-ceramic THA range from 94% to 97% [2,6,8,20,27]. Aldrian et al [2], reporting on a series of 107 ceramic-onceramic THAs, found at a mean followup of 7.6 years (range, 7.1-8.3 years) three failures, resulting in a 97% survival rate.…”