Third-generation pure alumina and alumina matrix composites in total hip arthroplasty

Hannouche, Didier; Zingg, Matthieu; Miozzari, Hermès Howard; Nizard, Rémy; Lübbeke, Anne

doi:10.1302/2058-5241.3.170034

Cited by 26 publications

(15 citation statements)

References 80 publications

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“… 34 At this early stage a more widespread use, however, did not occur, probably because of risk of fracture, problems in achieving durable fixation between ceramic implants and bone, and increased costs. 35 – 37 Progress in the manufacturing process and introduction of alumina matrix composite ceramic heads 38 have substantially decreased the risk of fracture in contemporary studies 35 , 39 and use of ceramic liners in a metallic shell designed for bony ingrowth has made fixation more reliable. Several studies 40 – 42 report good long-term results with high survival rate, low rate of complications related to the material and no osteolysis even in young patients.…”

Section: Articulating Materialsmentioning

confidence: 99%

Global diversity in bearings in primary THA

et al. 2020

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Choice of articulating materials, head size and the design of the articulation will become decisive for the long-term performance of a total hip arthroplasty (THA) and especially in terms of risk for dislocation and wear-related problems. Here we account for common alternatives based on available studies and the evidence that can be derived from them. Metal or ceramic femoral heads articulating against a liner or cup made of highly cross-linked polyethylene and ceramic-on-ceramic articulations have about similar risk for complications leading to revision, whereas the performance of metal-on-metal articulations, especially with use of big heads, is inferior. The clinical significance of problems related to ceramic-on-ceramic articulations such as squeaking remains unclear. With use of current technology ceramic fractures are rare. Large femoral heads have the potential to increase the range of hip movement before impingement occurs and are therefore expected to reduce dislocation rates. On the other hand, issues related to bearing wear, corrosion at the taper-trunnion junction and groin pain may arise with larger heads and jeopardize the longevity of THA. Based on current knowledge, 32-mm heads seem to be optimal for metal-on-polyethylene bearings. Patients with ceramic-on-ceramic bearings may benefit from even larger heads such as 36 or 40 mm, but so far there are no long-term reports that confirm the safety of bearings larger than 36 mm. Assessment of lipped liners is difficult because randomized studies are lacking, but retrospective clinical studies and registry data seem to indicate that this liner modification will reduce the rate of dislocation or revision due to dislocation without clear evidence of clinically obvious problems due to neck-liner impingement. The majority of studies support the view that constrained liners and dual mobility cups (DMC) will reduce the risk of revision due to dislocation both in primary and revision THA, the latter gaining increasing popularity in some countries. Both these devices suffer from implant-specific problems, which seem to be more common for the constrained liner designs. The majority of studies of these implants suffer from various methodological problems, not least selection bias, which calls for randomized studies preferably in a multi-centre setting to obtain sufficient power. In the 2020s, the orthopaedic profession should place more effort on such studies, as has already been achieved within other medical specialties, to improve the level of evidence in the choice of articulation when performing one of the most common in-hospital surgical procedures in Europe. Cite this article: EFORT Open Rev 2020;5:763-775. DOI: 10.1302/2058-5241.5.200002

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Section: Articulating Materialsmentioning

confidence: 99%

Global diversity in bearings in primary THA

et al. 2020

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“…The ceramic materials used in hip arthroplasty are classified as either alumina (Al 2 O 3 ), third-generation alumina or alumina matrix composite19). In this case, the fractured femoral head was manufactured with a third-generation alumina ceramic material.…”

Section: Discussionmentioning

confidence: 99%

Non-traumatic Ceramic Head Fracture in Total Hip Arthroplasty with Ceramic-on-Ceramic Articulation at Postoperative 16th Years

et al. 2019

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Ceramic articulation has gained popularity in total hip arthroplasty (THA); however, one of the most important concerns about the use of ceramic materials is the potential for breakage. Importantly, almost all ceramic fractures occur within the first six years after surgery. Here, we present a case report of a 52-year-old female patient who experienced an atraumatic ceramic head fracture at the 16th year after surgery. Key parameters that may be associated with ceramic head fracture are considered to be the use of a 28-mm head and high body mass index (BMI); the patient described here had a BMI of 34.3 kg/m 2 . Surgical treatment of the case included removal of the broken ceramic head and replacement with an alumina matrix composite ceramic head. At the 12th month follow-up visit, the patient was mobilized independently and could perform her daily activities. Ceramic head fracture after THA may occur even in late periods after surgery. For the treatment of fractures of ceramic material, the fractured component must be removed together with extensive soft tissue excision to ensure that no residual fragments are left behind.

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“…Because internal fixation has a significantly greater failure probability, resulting in more pain for these patients, primary arthroplasty stands out as the best option for displaced Garden 3 and 4 femoral neck fractures (FFN). When a THA is performed, the surgeon must consider implant dislocation as a possible complication, which is said to be more common after a hip fracture, with the posterior surgical approach, in elderly patients with soft-tissue laxity due to sarcopenia and thus poor muscular strength, and the attempt to regain the full range of motion before the injury [41,42]. Even with heads bigger than 28 and 22.2 mm, the ceramic-on-ceramic connection delivers little friction and wear.…”

Section: Alumina-on-alumina Total Hip Replacement For Femoral Neck Fr...mentioning

confidence: 99%

Outcomes of Ceramic Composite in Total Hip Replacement Bearings: A Single-Center Series

et al. 2021

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Despite the fact that total hip replacement is one of the most successful surgical procedures for treatment of a variety of end-stage hip diseases, the process of osteolysis and implant loosening remains a significant problem, especially in young and high-demand patients. More than 40 years ago, ceramic bearings were introduced due to their mechanical advantage in order to obtain a reduction in wear debris, and due to the conviction that it was possible to minimize friction and wear owing to their mechanical hardness, high chemical stability, surface lubrication by fluids and low friction coefficient. Together with excellent mechanical properties, ceramics have a biological inertness: eventual ceramic debris will lead to a reactive response with a high predominance of fibrocystic cells, rather than macrophagic cells, and absence of giant cells, which is ideal from a biological perspective. As a consequence, they will not trigger the granulomatous reaction necessary to induce periprosthetic osteolysis, and this clearly appears to be of great clinical relevance. In recent years, tribology in manufacturing ceramic components has progressed with significant improvements, owing to the development of the latest generation of ceramic composites that allow for an increased material density and reduced grain size. Currently, ceramic-on-ceramic bearings are considered the attractive counterparts of ceramic- or metal-on-polyethylene ones for patients with a long life expectancy. The aim of this paper is to report the results of total hip replacements performed with a ceramic-on-ceramic articulation made from a ceramic composite in a single center, focusing on its usefulness in specific preoperative diagnosis.

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Third-generation pure alumina and alumina matrix composites in total hip arthroplasty

Cited by 26 publications

References 80 publications

Global diversity in bearings in primary THA

Global diversity in bearings in primary THA

Non-traumatic Ceramic Head Fracture in Total Hip Arthroplasty with Ceramic-on-Ceramic Articulation at Postoperative 16th Years

Outcomes of Ceramic Composite in Total Hip Replacement Bearings: A Single-Center Series

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