Alternative bearing surfaces in total hip arthroplasty

Tuli, Richard; Parvızı, Javad

doi:10.1586/17434440.2.4.445

Cited by 7 publications

(6 citation statements)

References 93 publications

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“…Recessing the bearing reduces ROM and causes metal-on-metal impingement and wear, 13 whereas as metal-on-ceramic impingement may be better tolerated. 39 We found alumina ceramic-on-ceramic bearings reliable and safe in a diverse patient population, with an average patient age younger than 50 years and with more than 75% of the patients aged 60 years or younger at the time of surgery. The absence of osteolysis was very promising, and implant-related problems were infrequent.…”

Section: Figmentioning

confidence: 82%

“…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.…”

mentioning

confidence: 99%

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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: Figmentioning

confidence: 82%

mentioning

confidence: 99%

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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“…In recent years, an increasing number of alternative bearing surfaces have been used in THA [21,22]. These surfaces include ceramic on highly crosslinked polyethylene, metal on metal (MOM), and ceramic on ceramic (COC).…”

Section: Introductionmentioning

confidence: 99%

Natural History of Squeaking after Total Hip Arthroplasty

Restrepo

Matar

Parvızı

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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“…Some authors have suggested that limitations in manufacturing technology may have resulted in inconsistent and suboptimal dimensions of these early-generation metal-on-metal prostheses [23][24][25], leading to excessive friction, seizing and implant loosening. While the importance of consistent component sphericity and avoidance of equatorial articulation (a condition where the acetabular inner diameter is smaller than the outer diameter of the femoral head, leading to loading of the rim-head interface, see Figure 1) have been demonstrated in in vitro studies, neither of these phenomena have been consistently demonstrated in an ana lysis of explanted failed implants [26].…”

Section: Origins Development and Resultsmentioning

confidence: 99%

“…The importance of consistent and accurate head-cup clearance has been recognized as an important contributor to wear in large-diameter metal-on-metal bearings. While low bearing clearance is beneficial in terms of reducing wear rates, and increasing clearance from 100 µm by as little [15] Second-generation stemmed total hip arthroplasty Berton et al (2010) 100 (92) High-tolerance CoCrMo 43 Uncemented Uncemented 92 [34] Long et al (2010) 207 (181) High-tolerance CoCrMo 19 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) Uncemented Uncemented 85 [35] Neumann et al…”

Section: Search Strategymentioning

confidence: 99%

State of the art in hard-on-hard bearings: how did we get here and what have we achieved?

Zywiel

Sayeed

Johnson

et al. 2011

Expert Review of Medical Devices

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Total hip arthroplasty has shown excellent results in decreasing pain and improving function in patients with degenerative disease of the hip. Improvements in prosthetic materials, designs and implant fixation have now resulted in wear of the bearing surface being the limitation of this technology, and a number of hard-on-hard couples have been introduced to address this concern. The purpose of this article is to review the origins, development, survival rates and potential advantages and disadvantages of the following hard-on-hard bearings for total hip arthroplasty: metal-on-metal standard total hip arthroplasty; metal-on-metal hip resurfacing arthroplasty, ceramic-on-ceramic total hip arthroplasty; and ceramic-on-metal bearings. Improvements in the manufacturing of metal-on-metal bearings over the past 50 years have resulted in implants that provide low wear rates and allow for the use of large femoral heads. However, concerns remain regarding elevated serum metal ion levels, potential teratogenic effects and potentially devastating adverse local tissue reactions, whose incidence and pathogenesis remains unclear. Modern total hip resurfacing has shown excellent outcomes over 10 years in the hands of experienced surgeons. Current ceramic-on-ceramic bearings have demonstrated excellent survival with exceptionally low wear rates and virtually no local adverse effects. Concerns remain for insertional chipping, in vivo fracture and the variable incidence of squeaking. Contemporary ceramic-on-metal interfaces are in the early stages of clinical use, with little data reported to date. Hard-on-hard bearings for total hip arthroplasty have improved dramatically over the past 50 years. As bearing designs continue to improve with new and modified materials and improved manufacturing techniques, it is likely that the use of hard-on-hard bearings will continue to increase, especially in young and active patients.

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Alternative bearing surfaces in total hip arthroplasty

Cited by 7 publications

References 93 publications

Two- to 9-Year Clinical Results of Alumina Ceramic-on-Ceramic THA

Two- to 9-Year Clinical Results of Alumina Ceramic-on-Ceramic THA

Natural History of Squeaking after Total Hip Arthroplasty

State of the art in hard-on-hard bearings: how did we get here and what have we achieved?

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