No Increased Migration in Cups with Ceramic-on-Ceramic Bearing

Zhou, Kai; Li, Ming G.; Börlin, Niclas; Wood, David; Nivbrant, Bo

doi:10.1097/01.blo.0000223999.10389.c9

Cited by 38 publications

(28 citation statements)

References 35 publications

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“…This is 10 times less wear than in the control group with conventional PE, γ-irradiated in air. Also, another of our studies involving 50 patients with highly cross-linked UHMWPE has shown almost negligible annual wear (0.009 µm) after the so-called wear-in period (Zhou et al 2006). These values correspond well with the results of laboratory studies, but they are less than was reported for of course is promising, but whether it is absolutely safe in the long term is unknown.…”

Section: Discussionsupporting

confidence: 75%

“…In addition, we have seen similar "early creep" behavior in other RSA results with highly cross-linked PE (Zhou et al 2006), and using in vitro tests Deng et al (1998) found that creep occurs in the early time period following the application of load. Creep and true wear might in fact be different for the new highly cross-linked PEs manufactured by different methods.…”

Section: Discussionsupporting

confidence: 50%

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Very low wear of non-remelted highly cross-linked polyethylene cups: An RSA study lasting up to 6 years

Röhrl

Nilsson

et al. 2007

Acta Orthopaedica

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Background and purpose Highly cross-linked polyethylenes (PEs) all appear to reduce wear dramatically in laboratory studies, although there is substantial variation in this respect between manufacturers. Nonremelted cross-linked PE is almost as tough as unirradiated PE, but is not completely stable and can oxidize in vivo, as has been shown in recent retrievals studies.We had reported low wear and good clinical performance after 2 years for 10 non-remelted highly crosslinked PE cups compared to 16 conventional PE cups sterilized by gamma-in-air.Method Because of possible degradation by free radicals, we followed up both cohorts for 5 years (conventional PE) and 6 years (highly cross-linked PE).Result Mean (CI) proximal head penetration over the observation time was linear and measured 0.08 (0.02-0.13) mm for cross-linked PE and 0.42 (0.23-0.62) mm for conventional PE, and total penetration was 0.23 (0.1-0.35) mm and 0.75 (0.05-1.4) mm respectively. After subtracting creep, the annual wear for non-remelted highly cross-linked PE was below 6 µm. The cups had equally low migration and few radiolucencies.Interpretation The theoretical possibility of oxidation in non-remelted highly cross-linked PE may not show clinically. However, it may be that cemented cups with their thicker PE are more forgiving than metal-backed cups with thin PE moving in the locking mechanism. So far, we can conclude that the Crossfire highly crosslinked polyethylene cups performed very well clinically, with extremely low wear even after almost 6 years. This is reassuring, but care should be taken in extrapolating

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Section: Discussionsupporting

confidence: 75%

Section: Discussionsupporting

confidence: 50%

Very low wear of non-remelted highly cross-linked polyethylene cups: An RSA study lasting up to 6 years

Röhrl

Nilsson

et al. 2007

Acta Orthopaedica

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“…Zhou et al [12] investigated the phenomenon of stiff implants and early loosening by randomizing patients to ceramic-ceramic or PE-ceramic bearing and followed migration of the cup in the first 2 years showing no difference between the ceramic-ceramic or PE-ceramic bearing. Although there is a lack of clinical evidence of this potential cause of loosening, stiffness of the implant may be at least theoretically a factor in preventing osseointegration and early loosening [13][14][15][16].…”

Section: Discussionmentioning

confidence: 99%

Early loosening of a press-fit cup with ceramic-on-ceramic articulation: our early results

Haverkamp

Westerbos

Campo

et al. 2013

Arch Orthop Trauma Surg

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“…23,25,40 More recent clinical studies have had the benefit of improved ceramic strength and quality control, and improved fixation of the acetabulum, which has resulted in dramatic improvement in intermediate and long-term results. 7,29,30,41 Further, the absence osteolysis in uncemented alumina ceramic-on-ceramic THA at minimum 18.5-year followup in a study by Hamadouche et al 14 raises the possibility periprosthetic osteolysis may be greatly reduced by the use of these bearings.…”

mentioning

confidence: 99%

Two- to 9-Year Clinical Results of Alumina Ceramic-on-Ceramic THA

Murphy

Ecker

Tannast

2006

Clinical Orthopaedics &Amp; Related Research

111

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we performed 194 total hip arthroplasties on 173 patients using alumina ceramic-onceramic bearings as part of a prospective United States Food and Drug Administration/Investigational Device Exemption study. The average patient age at surgery was 49.9 years. Minimum followup time was 2 years (mean 4.3 years, range 2−9 years). We evaluated survival rate, implant-and nonimplant-related complications. Clinical outcomes included the Merle d'Aubigné score. We assessed radiographs for signs of osteolysis, component loosening, and implant wear. No patients had osteolysis and there were no hip dislocations. Implant survivorship for all hips with aseptic revision of any component was 96% (CI, 91-100) at 9 year; survivorship for hips without prior surgery was 99.3%, (CI, 98-100). There was a 1.7% incidence of implant-related complications. Our data help confirm two United States FDA/IDE studies on alumina ceramic-on-ceramic total hip arthroplasty that reported low aseptic revision rates and low revision rates for instability. Total hip arthroplasty using alumina ceramic-onceramic implants is a safe and reliable procedure in the comparably young and active patient.Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.Traditional total hip arthroplasty (THA) using metal-onpolyethylene bearings has been established as a reliable procedure. 6 However, wear and wear debris-associated osteolysis are still among the most common complications affecting these devices. Several alternative bearings have been used clinically to reduce wear and osteolysis.39 The alternatives include cross-linked polyethylene acetabular liners, metal-on-metal bearings, and alumina ceramic-onceramic bearings. Although metal-on-cross-linked polyethylene is most commonly used, these bearings have the shortest clinical experience of the available alternative bearings. 10Generally, good results with these improved polyethylene implants have been reported by several authors, 10,27,33 especially compared to the older-generation conventional polyethylene bearings. However, theoretical concerns include a relatively poor resistance to scratching and thirdbody wear compared with hard bearings. Cross-linked polyethylene bearings may be more susceptible to fracture and dissociation as compared to conventional polyethylene because of their low resistance to crack propogation. 16Whether these material factors will substantially affect long-term clinical outcomes remains to be seen.Metal-on-metal bearings have demonstrated substantially improved wear characteristics as compared to metalon-conventional polyethylene bearings. Long-term clinical studies also suggest these bearings represent a promising alternative method of achieving improved THA longevity. 3,8 Yet, theoretical concerns about wear from these bearings remain because wear debris produces an inflammatory response of the surrounding tissue.38 Some authors have suggested this response may lead to component loosening or implant-induced osteol...

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No Increased Migration in Cups with Ceramic-on-Ceramic Bearing

Abstract: Therapeutic Level I. See the Guidelines for Authors for a complete description of levels of evidence.

Cited by 38 publications

References 35 publications

Very low wear of non-remelted highly cross-linked polyethylene cups: An RSA study lasting up to 6 years

Very low wear of non-remelted highly cross-linked polyethylene cups: An RSA study lasting up to 6 years

Early loosening of a press-fit cup with ceramic-on-ceramic articulation: our early results

Two- to 9-Year Clinical Results of Alumina Ceramic-on-Ceramic THA

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