Strategies for head and inlay exchange in revision hip arthroplasty

Pospischill, M.; Knahr, K.

doi:10.1007/s00264-010-1164-8

Cited by 14 publications

(7 citation statements)

References 29 publications

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“…Furthermore, all the stems and Morse taper were made of titanium in this series, and the authors have not experienced use of a new ceramic head on a used Morse taper with cobalt-chromium or stainless steel stems. For these stems, a titanium sleeve [16] has been proposed for use with an alumina head on the old Morse taper. Another solution to change the femoral head could be to use the cement-within-cement technique [13] in isolated cup revision presenting with a stable stem.…”

Section: Discussionmentioning

confidence: 99%

Alumina Heads Minimize Wear and Femoral Osteolysis Progression After Isolated Simple Acetabular Revision

Hernigou

Dupuy

Pidet

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Patients with THA requiring cup revision for acetabular osteolysis may have a stable stem component without loosening. However, it is unclear whether isolated cup revision halts femoral osteolysis progression. Question/purposes We asked (1) whether and to what degree osteolysis progresses after isolated acetabular revision with a change of the femoral head and (2) whether an alumina or metal bearing better reduces osteolysis progression and wear with a polyethylene (PE) cup. Methods We retrospectively evaluated 150 patients who underwent 165 acetabular revisions but no treatment for proximal femoral osteolysis in hips with stable femoral components. Mean age at revision was 63 years (range, 48-74 years). All hips received a new PE cup; 83 hips received new alumina heads and 82 new metal heads. Radiographs (mean followup, 15 years; range, 10-25 years) were assessed to measure osteolysis, loosening, and PE wear. Revisions of the femoral stem were recorded.

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Section: Discussionmentioning

confidence: 99%

Alumina Heads Minimize Wear and Femoral Osteolysis Progression After Isolated Simple Acetabular Revision

Hernigou

Dupuy

Pidet

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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“…In this situation, the ceramic para b ticles, which are harder than metal, might damage a metal head in a short time. This is why some specialists advise against the use of a metal head in the scenario of revision due to a fractured ceramic head/liner 46 . Accordingly, only revision to COC or ceramic-on-polyethylene is recommended in this case.…”

Section: Damage Of the Ceramic Rimmentioning

confidence: 99%

Advantages and disadvantages of ceramic on ceramic total hip arthroplasty: A review

Gallo¹,

Goodman²,

Lošťák³

et al. 2012

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background. Ceramic on ceramic (COC) total hip arthroplasty (THA) was developed to reduce wear debris and accordingly, the occurrence of osteolysis and aseptic loosening especially in younger patients. Based on the excellent tribological behavior of current COC bearings and the relatively low biological activity of ceramic particles, significant improvement in survivorship of these implants is expected. Methods. We used manual search to identify all relevant studies reporting clinical data on COC THAs in PubMed. The objective was to determine whether current COC THA offers a better clinical outcome and survivorship than non-COC THA. Results. Studies with early generation ceramic bearings yielded 68% to 84% mean survivorship at 20 years follow-up which is comparable with the survivorship of non-COC THAs. Studies on current ceramic bearings report a 10-year revision-free interval of 92% to 99%. These outcomes are comparable to the survivorship of the best non-COC THAs. However, there are still concerns regarding fracture of sandwich ceramic liners, squeaking, and impingement of the femoral neck on the rim of the ceramic liner leading to chipping, especially in younger and physically active patients. Conclusion. Current COC THA leads to equivalent but not improved survivorship at 10 years follow-up in comparison to the best non-COC THA. Based on this review, we recommend that surgeons weigh the potential advantages and disadvantages of current COC THA in comparison to other bearing surfaces when considering young very active patients who are candidates for THA.

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“…It is well known that a precise match of the taper and the femoral head is crucial to avoid stress in localized areas of the ceramic head [ 4 – 8 ]. It is generally not recommended to use a ceramic head on an existing taper during revision surgery, because undetected damage in the taper may increase the risk of ceramic fracture [ 4 , 9 – 11 ]. Additionally, a component mismatch may lead to accelerated wear and earlier revision [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, the revision of a fractured head with a metal-on-polyethylene pairing is not feasible. Severe damage of the metal head and the polyethylene inlay may occur due to third-particle wear, because ceramic particles are much harder than the metal or polyethylene [ 11 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

Two-year follow-up of revision total hip arthroplasty using a ceramic revision head with a retained well-fixed femoral component: a case series

2014

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IntroductionIt is known that a well-fixed stem can be left in situ when only the acetabular component and femoral head have to be changed. However, in a revision case, the use of a ceramic head on an existing taper is not recommended. Slight damages of the taper may increase the risk of a ceramic fracture. Until now in a revision case a primary ceramic-on-ceramic or ceramic-on-polyethylene pairing was changed to a metal-on-polyethylene pairing or the well-fixed stem was removed as well. During the past several years, a ceramic head with a metallic sleeve has been introduced as an option for revisions with a stem left in situ. We report short-term results of a ceramic revision head in this clinical setting.MethodsEight patients with a ceramic revision head were clinically and radiologically followed up two years after revision surgery. Their Harris Hip Score and visual analogue scale scores for pain and satisfaction were recorded, and their radiographs were checked for osteolysis and heterotopic ossifications.ResultsThe mean Harris Hip Score increased from 46.5 points before surgery to 88.3 points 2 years after surgery. The mean visual analogue scale score for pain improved from 6.7 to 1.1, and the mean visual analogue scale for satisfaction rose from 5.1 to 8.3. The radiological results did not show osteolysis in any of the patients. Grade I heterotopic ossification according to the Brooker classification system was seen in one patient.ConclusionsThe early clinical and radiological results in this case series are in agreement with previously published studies. Ceramic revision heads with a metallic sleeve are a promising approach in the revision of a ceramic head with a well-fixed stem which can be left in situ. This solution avoids an unnecessary exchange of a well-fixed stem and thereby shortens the surgical time of the revision and may reduce the peri-operative complications.

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Strategies for head and inlay exchange in revision hip arthroplasty

Cited by 14 publications

References 29 publications

Alumina Heads Minimize Wear and Femoral Osteolysis Progression After Isolated Simple Acetabular Revision

Alumina Heads Minimize Wear and Femoral Osteolysis Progression After Isolated Simple Acetabular Revision

Advantages and disadvantages of ceramic on ceramic total hip arthroplasty: A review

Two-year follow-up of revision total hip arthroplasty using a ceramic revision head with a retained well-fixed femoral component: a case series

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