Mismatched wear couple zirconium oxide and aluminum oxide in total hip arthroplasty

Morlock, Michael M.; Nassutt, R.; Janßen, Rolf; Willmann, G.; Honl, M.

doi:10.1054/arth.2001.27233

Cited by 91 publications

(39 citation statements)

References 7 publications

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“…Microseparation is a known risk factor for stripe wear and both are reported as potential causes of squeaking [31,35,39,43]. Others found the mismatch of zirconia on alumina as a cause of squeaking [30]. Of note, we did have a mismatch of ceramics and still did not observe any cases of squeaking.…”

Section: Discussionmentioning

confidence: 46%

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: 46%

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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show abstract

“…We believe this is important and a potentially worrisome phenomenon that possibly is underreported [14,21,22]. We then asked whether squeaking was related to neck-socket impingement owing to suboptimal inclination and anteversion of the cup, to various demographic factors or component features.…”

Section: Discussionmentioning

confidence: 99%

High Incidence of Squeaking in THAs with Alumina Ceramic-on-ceramic Bearings

Keurentjes

Kuipers

Wever

et al. 2008

Clinical Orthopaedics &Amp; Related Research

203

147

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Ceramic-on-ceramic bearings in THA are a popular alternative to overcome wear concerns in traditional metal-polyethylene bearings. However, squeaking is a potentially worrisome phenomenon in ceramic-onceramic THAs which we observed in some of our patients. We reviewed all 42 patients who underwent 43 ceramicon-ceramic noncemented THAs during the time of the study. Squeaking, defined as a reproducible sound of squeaking, clicking, or grating, occurred in nine of 43 implants (20.9%). Standard radiographs were normal. We used CT imaging to determine cup anteversion and inclination angles, comparing the squeaking hips with those of a randomly selected control group, but found no differences. We then hypothesized specific design features (stem size, cup size, head size, and neck length of the head) would be risk factors for squeaking. We found a difference in neck length between squeaking and nonsqueaking implants. A neck length of -4 mm or shorter resulted in a relative risk of 5.56 (95% confidence interval, 1.14-27.01) for squeaking. We found a high incidence of squeaking in our population, and we believe this phenomenon is an underreported side effect of these types of bearings. A short neck length of the femoral implant was a risk factor for squeaking in ceramic-on-ceramic THA. Level of Evidence: Level III, therapeutic study.

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“…The recent poor clinical wear performance of zirconia heads against alumina inserts is an example of a wear couple that performed well in conventional simulator studies but badly in vivo. 16,17 This stresses the importance of using clinically relevant test methods, as this poor wear performance of zirconia on alumina has recently been reproduced with the use of in vitro microseparation. 9 The results of the current microseparation study support the use of AMC femoral heads against HIPed alumina acetabular inserts and AMC femoral heads against AMC acetabular inserts, and these wear couples should provide equivalent or lower wear than HIPed alumina/alumina in vivo.…”

Section: Discussionmentioning

confidence: 99%

Long‐term wear of ceramic matrix composite materials for hip prostheses under severe swing phase microseparation

Stewart¹,

Tipper²,

Insley³

et al. 2003

J Biomed Mater Res

121

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The purpose of this study was to evaluate the long-term wear performance of alumina matrix composite (AMC) heads against alumina matrix composite inserts and alumina matrix composite heads against alumina (Al) inserts with the use of a hip-joint simulator incorporating severe swing phase joint microseparation. The wear of AMC on Al produced an average wear rate of 0.61 mm3/million cycles over the 5-million-cycle test duration. The wear of AMC on AMC produced an average wear rate of 0.16 mm3/million cycles over the 5-million-cycle test duration. Both the AMC on alumina and AMC on AMC produced significantly lower wear than previously tested HIPed alumina, where an average wear rate of 1.84 mm3/million cycles was reported over 5 million cycles. The wear mechanisms and wear debris of AMC on AMC and AMC on Al were similar to those observed in previous alumina retrieval studies with stripe wear caused by intragranular fracture and wear debris consisting of predominantly uniform 10-20-nm-sized particles and a few irregular particles up to 3 microm in size.

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Mismatched wear couple zirconium oxide and aluminum oxide in total hip arthroplasty

Cited by 91 publications

References 7 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

High Incidence of Squeaking in THAs with Alumina Ceramic-on-ceramic Bearings

Long‐term wear of ceramic matrix composite materials for hip prostheses under severe swing phase microseparation

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