Ceramic-on-ceramic bearings in hip arthroplasty

Jeffers, Jonathan R.T.; Walter, William K.

doi:10.1302/0301-620x.94b6.28801

Cited by 115 publications

(84 citation statements)

References 84 publications

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“…As a result, instead of using a taper angle less than 10°, which generates a smaller window for engagement like in earlier designs, most manufacturers have adopted a taper of approximately 18°. Although increasing taper angle facilitates correct liner insertion into the shell, this change can complicate liner-cup engagement and lead to problems of secondary micromotion of the ceramic insert [18,25]. Concerning the brittle nature of ceramics, we applied manual pressure with a plastic pusher on all ceramic liners and did not impact them after confirming square seating by tactile feeling with a finger [26].…”

Section: Discussionmentioning

confidence: 99%

“…A suction force acting at the instant of separation of the 28-mm-diameter head and liner was reported up to 30 N [10]. This force acts against the static friction between them and failure to impact the liner with sufficient force during assembly may contribute to liner dissociation [18]. Moreover, suction force between the head and liner and micromotion between the liner and cup secondary to joint torque force may increase as head size increases.…”

Section: Discussionmentioning

confidence: 99%

“…Although the third-generation alumina ceramics have been shown to be superior to those with previous generations in terms of material properties and reducing risk of fractures [18], there still remains a number of concerns such as potential for ceramic fracture [13,21], noise issues [20], fewer intraoperative options and impingement [3], and decreased positional range of error during liner insertion [22]. These limitations of pure alumina characteristics required the development of improved ceramic materials.…”

Section: Introductionmentioning

confidence: 99%

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

Baek

Kim

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Baek

Kim

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…Current implants and surgical techniques must respond to growing demands from patients who want to resume their normal sports activities. Among active and athletic patients, hard-hard bearing (metal-on-metal or ceramicon-ceramic) can help to reduce the risk of wear and loosening [14,21], while polyethylene wears more quickly, reducing implant survival rate [33]. In addition, the recent development of large-diameter prosthetic heads (equivalent to femoral head diameter) has significantly curtailed dislocation rates and allowed unrestricted movements necessary for participation in sports activities [9,12].…”

Section: Discussionmentioning

confidence: 99%

Can patients return to high-impact physical activities after hip resurfacing? A prospective study

Girard

Miletic

Deny

et al. 2013

International Orthopaedics (SICOT)

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Purpose Although the resumption of low-impact sports activities is compatible with total hip arthroplasty (THA), participation in high-impact sports seems problematic, and there is no consensus as to whether it is advisable. The purpose of this article is to evaluate the quality and possibility of resuming high-impact physical activities after hip resurfacing. Materials The study was performed in an on-going, singlesurgeon, prospective series of 215 resurfacing arthroplasties (RSA). Mean follow-up was 44.1 months (range, 39.1-54.5). Clinical evaluation included the Postel-Merle d'Aubigné (PMA) score, the Oxford hip score, the Harris hip score (HHS), Devane score, and UCLA activity score. A specific questionnaire analysing sports activities was administered to each patient to assess the number and level of physical activities performed (both before the operation and at final follow-up). Results In the series of 202 consecutive patients (215 RSA), 50 patients (55 RSA) engaged regularly in at least one highimpact activity before their operation and the onset of pain, 102 patients practised at least one intermediate-impact activity, and the 50 remaining patients undertook only low-impact activities. Harris hip score increased from 44.8 (range, 23-68) before the operation to 97.8 (range, 85-100) at the last followup. Mean time to sports resumption after surgery was 14.6 weeks (range, 7-29). The resumption rate was 98 % for sports of any impact level and 82 % for high-impact activities. No osteolysis or implant loosening was observed at follow-up. No revision was performed. Conclusion In 2012, no consensus recommendations yet exist for the resumption of sports activities after RSA. Existing recommendations concern only conventional THA. We believe that RSA allows younger and more active patients to resume physical and sports activities without restriction. The rate of return to sports after RSA appears to be excellent and unequalled by conventional hip prostheses. High-impact sports seem to be compatible with hip resurfacing, although no longterm studies have analysed the impact of these activities on wear and/or aseptic loosening.

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“…design of the prosthesis, surgical technique and the method of femoral and acetabular fixation 2 . The new generations of ceramic implants suggest more promising outcomes (Table 2), especially in young and active patients, with survivorship rates (free of revision) between 92% and 99% at ten years of follow-up [26][27][28][29][30] . However, these data are comparable but not better than the best outcomes for both metal-on-metal and metal/ceramic-onpolyethylene articulations (Table 2).…”

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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Ceramic-on-ceramic bearings in hip arthroplasty

Cited by 115 publications

References 84 publications

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

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

Can patients return to high-impact physical activities after hip resurfacing? A prospective study

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

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