Comparing the cup deformation following implantation of a novel ceramic-on-ceramic hip resurfacing bearing to a metal standard in a cadaveric model

Abstract

Hip resurfacing is an attractive alternative to total hip replacement preserving bone and reducing dislocation risk. Recent metal-on-metal designs have caused failure due to metal wear debris. Ceramic implants may mitigate this risk. Deformation of the acetabular cup can affect the lubrication, producing high friction torques between the femoral head and the cup that would increase wear and/or lead to cup loosening due to femoral head clamping. Our objective was to quantify the deformation of a novel monobloc ceramic hip resurfacing cup component compared to a metal standard, in a fresh frozen cadaveric model using a press-fit technique representative of standard surgical conditions. For this study eight acetabula were prepared from four fresh frozen cadavers. One surgeon with extensive experience in hip resurfacing surgery (J.H.) prepared the acetabulum by sequential reaming. The implants were then impacted into the acetabulum. Four ceramic and four metal implants were used of equal and varying size. Deformation was measured peri-implantation, and at 30 min, using an optical high-precision deformation sensor (GOM GmbH, Braunschweig, Germany). The maximum inscribed circle and the measurement of radial segment techniques were used. Deformation was greater in the metal implants (mean: 34–22mm) immediately after implantation. At 30 min after implantation, the deformation increased to 36mm in the metal and 26mm in the ceramic cup. Greater diameter changes were observed in larger cups. Metal and ceramic implants did not return to the initial diameter. We conclude the ceramic resurfacing acetabular implants undergo similar deformation to existing metal-on-metal implants. The deformation observed was significantly less in the ceramic component at 30 min on one measure. Less deformation may result in better surface conditions and wear characteristics. Deformation change did not resolve after 30 min for both implants.

Trends and developments in hip and knee arthroplasty technology

“…32,33 While Early cementless knee replacement designs with high failure rates left many younger patients with significant lysis and bone loss. 7 Overall the initial results of the newer class of cementless knee replacement are encouraging, though further long-term studies Figure 3. Dual Mobility Total hip arthroplasty.…”

“…While early clinical data are not yet available for either implant, cadaveric studies have evaluated the mechanical properties of the ReCerf TM arthroplasty which have reassuringly demonstrated comparable deformation between a standard metal component and the novel ceramic acetabular component. 7 Although ceramic on ceramic articulations do have favourable wear characteristics, there is concern regarding the potential for squeaking and the brittleness of ceramic bearings. Furthermore, there is the potential for unwanted reduction in bone density around the implanted ceramic implants, a phenomenon known as stress shielding.…”

“…While early clinical data are not yet available for either implant, cadaveric studies have evaluated the mechanical properties of the ReCerf™ arthroplasty which have reassuringly demonstrated comparable deformation between a standard metal component and the novel ceramic acetabular component. 7…”

Modern Trends in the Developments of Hip and Knee Arthroplasty

“…Метою цього десятирічного контрольованого дослідження є аналіз безпеки й ефективності протезування. Пара «кераміка -кераміка» ReCerfTM, розроблена MatOrtho (Летерхед, Суррей, Великобританія) насьогодні очікує сертифікації у Великобританії, хоча перший виріб був імплантований 24 вересня 2018 р. Ранніх клінічних даних ще немає для жодного з цих матеріалів, але біомеханічні дослідження на тілах померлих продемонстрували співставні деформації в разі встановлення стандартного металевого та новітнього керамічного ReCerfTM ацетабулярного компонента ендопротеза [5].…”

“…Безцементна часткова заміна колінного суглоба OxfordVR ® від Zimmer Biomet продемонструвала відмінну виживаність [26]. Проте після встановлення безцементних конструкцій під час ендопротезування колінного суглоба в багатьох молодих пацієнтів отримали незадовільні результати через значний лізис і втрату кісткової тканини [5]. Загалом первинні результати використання нового класу імплантатів для безцементної заміни колінного суглоба обнадійливі, хоча й необхідні подальші тривалі дослідження перед тим, як ця технологія замінить методику з використанням цементу.…”