Alumina Inlay Failure in Cemented Polyethylene-backed Total Hip Arthroplasty

Iwakiri, Kentaro; Iwaki, Hiroaki; Minoda, Yukihide; Ohashi, Hirotsugu; Takaoka, Kunio

doi:10.1007/s11999-008-0168-9

Cited by 23 publications

(14 citation statements)

References 30 publications

(51 reference statements)

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“…During the past decade, various studies have reported outcomes and survival of alternative bearing surfaces in THA [6,7,9,12,14,15,19,20,[23][24][25]. Complications associated with the use of hard-on-hard bearings include squeaking, fracture, liner disassociation, metallosis, and hypersensitivity reactions occurring in some patients [14].…”

Section: Discussionmentioning

confidence: 99%

Causes of Failure of Ceramic-on-Ceramic and Metal-on-Metal Hip Arthroplasties

Porat

Parvızı

Sharkey

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Few large series of hard bearing surfaces have reported on reasons for early failure. A number of unique mechanisms of failure, including fracture, squeaking, and adverse tissue reactions, have been reported with these hard bearing surfaces. However, the incidence varies among the published studies. Questions/purposes To confirm the incidences, we identified the etiologies of early failures of hard-on-hard bearing surfaces for ceramic-on-ceramic and metal-onmetal THAs. Methods We retrospectively reviewed records of 2907 THAs with hard-on-hard bearing surfaces implanted between 1996 and 2009; 1697 (58%) had ceramic-onceramic and 1210 (42%) had metal-on-metal bearing surfaces. We recorded bearing-related complications and compared them to nonspecific reasons for revision THA. The minimum followup of the ceramic-on-ceramic and metal-on-metal cohorts was 6 months (mean, 48 months; range, 6-97 months) and 24 months (mean, 60 months; range, 24-178 months), respectively. Results The overall revision rate for ceramic-on-ceramic THA was 2.2% (38 of 1697), with aseptic loosening accounting for 55% of revisions (femur or acetabulum). The bearing accounted for 13% of the revisions in the ceramic-on-ceramic THA cohort. The overall metal-onmetal revision rate was 5.4% (65 of 1210), 17 involving adverse tissue reactions related to the metal-on-metal bearing surface (17 of 1210, 1.4% of cases; 17 of 65, 26% of revisions). Conclusions Twenty-six percent of the revisions from metal-on-metal and 13% of ceramic-on ceramic were bearing related. The overall short-to medium-term revision rate was 2.2% and 5.4% for ceramic-on-ceramic and metalon-metal, respectively. The most common etiology of failure was loosening of the femoral or acetabular components.

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Section: Discussionmentioning

confidence: 99%

Causes of Failure of Ceramic-on-Ceramic and Metal-on-Metal Hip Arthroplasties

Porat

Parvızı

Sharkey

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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“…Hasegawa et al [11] reviewed 35 consecutive hips with a layered component at six years and reported two liner fractures (5.7%). Iwakiri et al [27] reported a fracture rate of 5.6% (4/82) at eight years associated with periacetabular radiolucent lines (cemented cup) and could determine three causes: small ceramic thickness (four mm), small alumina clearance (five to 35 μm) and small oscillation angle (<120°). Park et al [15] reported a 1.1% (4/357) fracture rate of the sandwich liner at three year follow-up in a multicentre study.…”

Section: Discussionmentioning

confidence: 99%

Fractures of a sandwich ceramic liner at ten year follow-up

Viste

Chouteau

Desmarchelier

et al. 2011

International Orthopaedics (SICOT)

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Purpose The aim of this study was to understand the causes of sandwich liner fractures implanted at our institution by evaluating the long-term results of this device. Methods We retrospectively assessed 143 patients (151 hips) consecutively operated upon in our department by the same senior surgeon between 1999 and 2001 and with a mean follow-up period of 9.9 years (range 8.5-11.5). The components used were Cerasul® sandwich ceramic liners within a cementless cup. Patient assessment was based on demographic factors (age, gender, body mass index), the clinical scores according to Devane (activity), the potential complications and a radiographic analysis from an anteroposterior pelvic radiograph (cup inclination). Revision cases and their cause were classified (implant fracture, loosening, dislocation, periprosthetic fracture). Results Five cases of liner fracture (3.7%) were observed at a mean seven year (4.5-8.5) follow-up. The risk factor for implant failure was found to be patient activity: the mean preoperative Devane score was 3.5 in the fracture group vs 2.6 in the control group (p=0.008). Mean cup inclination was 52°. The survivorship analysis at ten years was 85% with revision as the endpoint. Prosthetic complications accounted for 8.6% of all 151 hips (fractures included): one case of aseptic loosening (0.7%), two cases of sepsis (1.4%), four cases of isolated dislocation (2.8%) and one case of recurrent dislocation (0.7%). Conclusions Alumina sandwich liners remain a subject of concern since the increasing clinical follow-up period may predispose them to fatigue failure. This system has been abandoned in our department since 2005

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“…However, in a recent retrospective study, Petsatodis et al reported a survivorship of 84.4% of cementless alumina COC prostheses at 20 years follow-up 23 . Others have reported significant differences in survivorship of COC bearings depending on the type of prosthesis and its fixation, especially with respect to cementless and cemented cups [24][25] . Therefore, the survivorship and rate of complications of ceramic bearing surfaces depend not only on the period of implantation (and therefore the generation of ceramic material), but also on other important factors e.g.…”

Section: Clinical Evidence For Ceramic-on-ceramic Thamentioning

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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Alumina Inlay Failure in Cemented Polyethylene-backed Total Hip Arthroplasty

Cited by 23 publications

References 30 publications

Causes of Failure of Ceramic-on-Ceramic and Metal-on-Metal Hip Arthroplasties

Causes of Failure of Ceramic-on-Ceramic and Metal-on-Metal Hip Arthroplasties

Fractures of a sandwich ceramic liner at ten year follow-up

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

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