Al2O3 against Al2O3 combination in hip endoprostheses. Histologic investigations with semiquantitative grading of revision and autopsy cases and abrasion measures

Abstract

For comparison of hip endoprostheses with AI203 combinations of the gliding surfaces with other material combinations, pseudocapsules and soft tissue membranes around hip endoprostheses retrieved at revision surgery or at autopsy were histologically investigated. In all tissue specimens around loosened prostheses, ceramic wear particles were found, in 50% of cases high-grade ceramic wear was seen. In contrast, only half of the autopsy cases revealed ceramic wear. Cases with AI203-AI203 combinations showed less villdus transformation of the synovial tissue, a thinner synovial layer and reduced necroses in comparison to AI203-polyethylene and metal-polyethylene combinations. These differences appeared more pronounced in the autopsy cases. The result of this study confirm the hypothesis, that a high ceramic wear rate in loosened prostheses develops mainly as a consequence of loosening. For that reason, biologically fixation of implants with spongious structured surfaces and without bone cement fixation seems a logical consequence. Modular systems are necessary not only for stem and ball, but also for the acetabular component of the hip endoprostheses.

Advanced biomaterials in hip joint arthroplasty. A review on polymer and ceramics composites as alternative bearings

“…ago; they were introduced in orthopaedics for hip implants to solve the critical problems of polyethylene wear [14,15]. The most used ceramic in the orthopaedic field are alumina and zirconia.…”

Comparison of Diamond‐Like‐Carbon and Alumina‐Oxide articulating with Polyethylene in Total Hip Arthroplasty

“…Another attempt is the use of so called hard/hard bearings, such as all metal-(Cobalt-Chromium based alloy) or alumina-oxide-(Al 2 O 3 ) joint bearings [7,8]. A third attempt is based on improvement of existing bearing surfaces.…”

New polymer materials in total hip arthroplasty

“…Light microscopy have revealed the presence of particles with a size between 0.4 and 7 μm around ceramic-on-ceramic total hip replacements (Henssge et al 1994, Lerouge et al 1997). The tissues with these particles have been reported to display a mixed pathology with granulomatous necrotic and necrobiotic tissue (Hatton et al 2002).…”