Prosthetic component failures in hip arthroplasty surgery

Heck, David A.; Partridge, Cynthia M.; Reuben, Jeffrey D.; Lanzer, William L.; Lewis, Courtland G.; Keating, E. Michael

doi:10.1016/s0883-5403(05)80199-8

Cited by 143 publications

(56 citation statements)

References 10 publications

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“…Comparing this incidence to that of metal-on-polyethylene, Heck et al 21 reported fracture or dissociation of polyethylene occurred at a combined rate of [45/10,000 in a 5-year period. Similarly, 18 cases of fracture or dislodgement of polyethylene liners has also been reported.…”

Section: Discussionmentioning

confidence: 97%

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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Section: Discussionmentioning

confidence: 97%

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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“…After its introduction in the 1970s alumina has been used widely for the head to articulate with a polyethylene cup. It has maintained its position despite reports of fractures of the head 42 and has proved successful in reducing the amount of polyethylene wear. 43 The introduction of ceramic-onceramic articulating surfaces did not achieve the same success.…”

Section: Discussionmentioning

confidence: 99%

Analysis of 118 second-generation metal-on-metal retrieved hip implants

Sieber

Rieker

Köttig

1999

The Journal of Bone and Joint Surgery. British volume

182

134

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O steolysis is due to particulate wear debris and is responsible for the long-term failure of total hip replacements. It has stimulated the development of alternative joint surfaces such as metal-on-metal or ceramic-on-ceramic implants.Since 1988 the second-generation metal-on-metal implant Metasul has been used in over 60 000 hips. Analysis of 118 retrieved specimens of the head or cup showed rates of wear of approximately 25 µm for the whole articulation per year in the first year, decreasing to about 5 µm per year after the third. Metal surfaces have a 'self-polishing' capacity. Scratches are worn out by further joint movement. Volumetric wear was decreased some 60-fold compared with that of metal-on-polyethylene implants, suggesting that second-generation metal-on-metal prostheses may considerably reduce osteolysis. [Br] 1998;80-B:46-50. Received 20 April 1998; Accepted after revision 8 July 1998 Osteolysis is due to particulate wear debris 1,2 and is mainly responsible for the long-term failure of total hip replacement (THR). The Charnley THR has been shown to give satisfactory clinical results with a survival rate of 85% at 20 years. When radiological evidence of loosening was added to that seen at revision operations, 22% of the acetabular and 7% of the femoral components were considered to be unstable. Polyethylene wear was shown to be significantly related to acetabular loosening and resorption of the femoral neck in nearly two-thirds of cemented THRs in patients younger than 20 years at the time of operation. 4 About half a million polyethylene wear particles are produced at each step due mainly to abrasive wear. 5,6 Contact of particle-laden articular fluid with the surrounding bone could be a key factor in the development of osteolysis. Joint fluid under pressure invades soft tissues and bone and expands the effective joint pace. J Bone Joint Surg7 As a result, activated macrophages may be found in cysts around the prostheses. 8It is not only the concentration of accumulated polyethylene particles which affects the amount of osteolysis, but also their capacity for phagocytosis.9,10 Particles with a critical size of between 0.5 and 10 µm are needed to induce the secretion of interleukin-6 by macrophages in vitro. It is still unclear as to whether polyethylene or cement debris induces more osteolysis. Severe lysis around a stable uncemented press-fit titanium shell is a clear indication of polyethylene wear.11 Polymethylmethacrylate (PMMA) cement alone is less harmful if it does not contain radiopaque additives. In vitro, monocytes and macrophages responding to particles of bone cement are capable of differentiation into osteoclastic cells. Their capacity for bone resorption is activated only when radiopaque additives are introduced with the cement particles, with a doubling of the rate for Ba 2 SO 4 compared with ZrO 2 . 12Osteolysis therefore has a multifactorial pattern and the biological activity of all possible wear particles has to be considered when introducing new implants. 13There have bee...

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“…Fracture of the femoral prosthesis at the head-neck junction has been reported although infrequently [1,2,9], and some authors have attributed such instances to increased mechanical stresses, higher levels of activity, and cyclic loading [4,5,7,19]. Although the mechanisms of such fractures are likely to be multifactorial, the clinical presentation of these events often has less variation.…”

Section: Introductionmentioning

confidence: 99%