Third-Generation Alumina-on-Alumina Ceramic Bearings in Cementless Total Hip Arthroplasty

Background Ceramic-on-ceramic bearing couples are theoretically attractive in total hip arthroplasty (THA) because of low wear, but concerns regarding ceramic fracture and squeaking have arisen. Improved material properties of newer alumina matrix composite (AMC) materials, known as Delta ceramics, may reduce these risks. In addition, the use of thinner liners and larger femoral heads may be helpful clinically to lower the rate of dislocation. However, limited short-term clinical results are available and intermediate-term effects are unclear. Questions/purposes (1) What is the frequency of bearingrelated complications (dissociation, fracture, and noise) with ceramic-on-ceramic AMC bearings in cementless THA? (2) What other complications arose in patients treated with these bearings? (3) What are the Harris hip scores (HHS) and survivorship free from reoperation and revision at a minimum of 5 years after cementless THA performed with AMC bearings? Methods Over a 9-month period in 2009, one surgeon performed 125 THAs, of which 100 (80% of the total) were performed with cementless, AMC bearings. During the period in question, the exclusion criteria for this implant were primary THAs with severe acetabular or femoral bone defect and revision THAs. Of these, 94 hips (95%) in 91 patients were available for analysis at a minimum of 5 years (range, 5-6 years), because five patients (six hips) had died. Mean age at the time of arthroplasty was 55 ± 14 years. Prostheses with an identical design and Biolox 1 Delta ceramics were used in all patients. Noise was classified into squeaking, clicking, grinding, and popping. Ceramic fracture, dislocation, and any other complications associated with the use of AMC ceramics were also investigated. Clinical evaluation included the modified HHS preoperatively and at each followup. Survivorship free from reoperation and revision was calculated using the Kaplan-Meier method. Results Of 91 patients, four developed bearing-related complications, including one with liner dissociation despite initial square seating and three with clicking. No patients had ceramic fractures. A single event of perioperative dislocation occurred in one patient and postoperative periprosthetic fracture occurred in two hips. Mean HHS improved from 56 to 93 points at the final followup (p \ 0.001). Survivorship at 5 years free from reoperation and revision was 96.8% and 97.9%, respectively.

Section: Discussionsupporting

confidence: 57%

Do Alumina Matrix Composite Bearings Decrease Hip Noises and Bearing Fractures at a Minimum of 5 Years After THA?

Baek

Kim

et al. 2015

“…The results of ceramic-on-ceramic bearings in patients who were older than 40 years have been reported [2,3,16,29,30], but few [6,15,23] have focused on the long-term results of ceramic-on-ceramic implants in patients younger than 20 years. In this series, we found the survivorship of ceramic-on-ceramic implants in adolescent patients was encouraging, averaging 90.3% at 10 years.…”

Section: Discussionmentioning

confidence: 99%

“…Ceramic-on-ceramic bearing couples have become an alternative to standard surface bearing couples (such as metal-on-polyethylene) because of decreased wear production and lower rates of osteolytic lesions compared with metal-on-conventional polyethylene [21]. The results of modern ceramic-on-ceramic bearings are available in patients younger than 60 years who have degenerative diseases [2,3,16,29,30], but few reports [6,15,23] have focused on patients younger than 20 years, who may be more likely to have high activity levels, perform sports activities, or engage in higher-demand workplace tasks.…”

Section: Introductionmentioning

confidence: 99%

Ceramic-on-ceramic THA Implants in Patients Younger Than 20 Years

Hannouche

Devriese

Delambre

et al. 2016

“…Early to intermediate clinical followup studies of 1-5 years with these newer ceramic bearings have reported low revision rates and few reports of wear, periprosthetic bone loss, or lysis [14,15,18,19,31]. Reported dislocation rates with ceramic bearings have been low (ie, 1.1% to 3%) [4,7].…”

Section: Introductionmentioning

confidence: 99%

Ceramic-on-Ceramic Total Hip Arthroplasty: Incidence of Instability and Noise

Schroder

Bornstein

Bostrom

et al. 2011

Background Alternative bearing materials in THA have been developed to reduce the incidence of osteolysis. Alumina-on-alumina bearings exhibit extremely low wear rates in vitro, but concerns exist regarding component impingement with the potential for dislocation and the occurrence of noise. Questions/purposes We determined generation of squeaking and the relationship between squeaking and component position. Methods We prospectively entered 436 alumina-on-alumina, cementless, primary THAs in 364 patients into our institutional database. All procedures were performed with the same surgical technique and the same implant. We obtained Harris Hip scores and a noise questionnaire and assessed radiographic component position and loosening. We determined the difference in abduction angle between squeakers and nonsqueakers. Minimum followup was 2 years (average, 3.5 years; range, 2.0-6.2 years).