Late dissociation of an alumina-on-alumina bearing modular acetabular component

Akagi, Masao; Nonaka, Tohgo; Nishisaka, Fumiaki; Mori, Satoshi; Fukuda, Kanji; Hamanishi, Chiaki

doi:10.1016/j.arth.2004.02.027

Cited by 18 publications

(15 citation statements)

References 17 publications

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“…Ravasi and Sansone [34] reported satisfactory 5-year followup of a ceramic cup sandwich and noted the benefit of reduced stiffness by adding a layer of polyethylene, reducing the dynamic stresses transmitted to the acetabular bone/component interface. However, another ceramic polyethylene sandwich device was withdrawn from the Japanese market after reports of up to 3% alumina liner fractures and 6% alumina/polyethylene liner dissociation with 3933 sandwich cups implanted [1,15,17,51]. We observed no cases of fracture or dissociation of the ceramic liner from within the polyethylene insert.…”

Section: Discussionmentioning

confidence: 75%

Delta Ceramic-on-Alumina Ceramic Articulation in Primary THA: Prospective, Randomized FDA-IDE Study and Retrieval Analysis

Lombardi

Berend²,

Seng³

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Wear and osteolysis continue to be major reasons for revision surgery in THA. Ceramic-on-ceramic bearings eliminate polyethylene wear debris. The newest generation of these bearings incorporate nanosized, yttriastabilized tetragonal zirconia particles producing an alumina matrix composite. We asked whether this new material would perform as well as a conventional bearing in terms of functional hip scores, radiographic migration and osteolysis, complications and survival. As part of a US FDA investigational device exemption study (G000075), we conducted an initial prospective safety study of 21 alumina matrix composite femoral heads articulating on alumina liners followed by a prospective, randomized study with 44 more of these articulations and 45 zirconia femoral heads on polyethylene liners. The minimum followup for all patients was 26 months (mean, 73 months; range, 26-108 months). Harris hip scores and radiographic findings were similar in the two groups as was survivorship (trial 95% versus control 93%). There were three reoperations in the trial group and three in the control group. A fractured head retrieval showed a 33% monoclinic transformation with an increase in surface roughness from 3 to 5 nm at the main wear zone. While our numbers were insufficient to compare device-related complications, the trial device performed as well as the control device in terms of reoperation, and clinical and radiographic outcome. The alumina matrix composite femoral head on an alumina liner provided high survivorship.

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Section: Discussionmentioning

confidence: 75%

Delta Ceramic-on-Alumina Ceramic Articulation in Primary THA: Prospective, Randomized FDA-IDE Study and Retrieval Analysis

Lombardi

Berend²,

Seng³

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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“…One case of complete liner dissociation with no associated fracture of the ceramic component has been described [1]. Ha et al [7] reviewed 122 patients with a mean four year follow-up period.…”

Section: Discussionmentioning

confidence: 99%

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

Viste

Chouteau

Desmarchelier

et al. 2011

International Orthopaedics (SICOT)

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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

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“…In addition, this prosthesis had a poor acetabular component design that was responsible for a rate of failure as much as 27% by the 26-month followup [21]. Meanwhile, fracture of the alumina component is one of the disadvantages, and it remains despite the advance in technology [1,12,14,18,22,24,25,28,30,31].…”

Section: Discussionmentioning

confidence: 99%

“…There have been some reports of failures of the polyethylene-alumina composite liner within a cementless titanium alloy shell [1,12,14,22,24,30] in which alumina inlay dissociation and fracture were caused by impingement, microseparation, and squeeze force [14,22,30]. We thus speculated the following three disadvantageous features in this study led to alumina inlay failure in the unique acetabular component design modification: (1) use of a much thinner, 4-mm alumina inlay despite improved quality of material; (2) the narrow clearance of the alumina inlay and alumina head (5-35 lm), which generated strong squeeze force leading to separation of the alumina inlay from the polyethylene shell; and (3) a relatively narrow oscillation angle, 120°, which readily produced contact force leading to dissociation of the alumina inlay insert from its polyethylene shell or increased the chance of peripheral chip fracture and subsequent crack propagation resulting from the brittle alumina material under conditions of impingement.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, there have been reports regarding problems with the alumina inlay in this design [1,12,14,18,22,24,25,28,30,31], but what factors might relate to the socket or insert failure are unclear as there have been no reports regarding the clinical Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Alumina Inlay Failure in Cemented Polyethylene-backed Total Hip Arthroplasty

Iwakiri

Iwaki

Minoda

et al. 2008

Clinical Orthopaedics &Amp; Related Research

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Alumina-on-alumina bearings for THA have markedly improved in mechanical properties through advances in technology; however, alumina fracture is still a concern. We retrospectively reviewed 77 patients (82 hips) with cemented alumina-on-alumina THAs to identify factors relating to alumina failure. The mean age of the patients at surgery was 63 years. The prostheses had a cemented polyethylene-backed acetabular component with an alumina inlay and a 28-mm alumina head. Revision surgery was performed because of alumina inlay failure in four hips (three fractures and one dissociation; 5.6%), deep infection in two, and recurrent dislocation in one. The 8-year survival rate was 90.7% with revision for any reason and 94.4% with revision for alumina failure as the end point. There were no differences in age, body mass index, gender, mobility, function, abduction angle, or size of component among the four hips with alumina failure and the remaining 68 hips without it; however, radiolucent lines in the sockets were more apparent in four cases with alumina inlay failure. This alumina-on-alumina THA thus yielded unsatisfactory medium-term results because we observed a high rate of catastrophic alumina inlay failure.

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Late dissociation of an alumina-on-alumina bearing modular acetabular component

Cited by 18 publications

References 17 publications

Delta Ceramic-on-Alumina Ceramic Articulation in Primary THA: Prospective, Randomized FDA-IDE Study and Retrieval Analysis

Delta Ceramic-on-Alumina Ceramic Articulation in Primary THA: Prospective, Randomized FDA-IDE Study and Retrieval Analysis

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

Alumina Inlay Failure in Cemented Polyethylene-backed Total Hip Arthroplasty

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