Excellent results with cementless total hip arthroplasty and alumina-on-alumina pairing: minimum ten-year follow-up

International Orthopaedics (SICOT)

Park

Kulkarni

et al. 2013

Purpose Very few studies have compared alumina-onalumina ceramic and alumina-on-highly cross-linked polyethylene bearings in the same patient. The purpose of this prospective randomised study was to compare the clinical and radiographic results and the prevalence of osteolysis in cementless total hip arthroplasty using an alumina-on-alumina and alumina-on-highly cross-linked polyethylene bearings in young active patients. Methods We prospectively compared the results of 100 patients (200 hips) who had undergone a cementless total hip arthroplasty with an alumina-on-alumina ceramic bearing in one hip and an alumina-on-highly cross-linked polyethylene in the other. There were 66 men and 34 women with a mean age of 45.3 years (range, 21-49 years) at the time of surgery. The mean follow-up was 12.4 years (range, 11-13 years). The patients were assessed clinically and radiographically at three months, one year, and annually thereafter. Results Harris hip, Western Ontario and McMaster Universities Osteoarthritis Index, and University of California, Los Angeles activity scores did not show statistically significant differences between the two groups of bearings preoperatively or at the time of final follow-up. Radiographic findings of the component were not significantly different between the two groups. The mean polyethylene linear penetration was 0.031±0.004 mm per year. No hips in either group displayed osteolysis. The Kaplan-Meier survivorship with revision as the end point at 12.4 years was 100 % (95 % confidence interval [CI], 94-100 %) for the femoral component in both groups and 99 % (95 %CI, 93-100 %) for the acetabular component. Conclusion The clinical and radiographic results of using an alumina-on-alumina ceramic and alumina-on-highly crosslinked polyethylene bearings were similar.

Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

A randomised prospective evaluation of ceramic-on-ceramic and ceramic-on-highly cross-linked polyethylene bearings in the same patients with primary cementless total hip arthroplasty

International Orthopaedics (SICOT)

Park

Kulkarni

et al. 2013

Clinical Orthopaedics &Amp; Related Research

“…We found the survivorship of implants with alumina-onalumina bearings was 98.9% in the best-case scenario and 83.1 % in the worst-case scenario, at 10 years, which are similar to the survival rates reported for older patients [23,28,31]. Numerous reports have been published on alumina-on-alumina bearings in THAs in young patients ( Table 3).…”

Section: Discussionsupporting

confidence: 80%

Alumina-on-alumina THA Performed in Patients Younger Than 30 Years: A 10-year Minimum Followup Study

Yoon

Yoo

Yoon

et al. 2012

Background THA in patients younger than 30 years presents challenges because of uncertainties regarding the long-term survivorship of prostheses. Alumina-on-alumina bearings, which exhibit little long-term wear, may be a reasonable option but the long-term survivorship is unknown. Questions/Purposes We determined (1) the survival rate of alumina-on-alumina bearings in patients younger than 30 years after a 10-year followup, (2) the incidence of audible hip clicking and squeaking, (3) radiographic evidence of osteolysis, and (4) the effects on pregnancy, childbirth, and career choice. Methods We retrospectively reviewed 62 patients who had 75 THAs with alumina-on-alumina bearings followed more than 10 years (average, 11.5; range, 10-13.5 years). Mean patient age at the time of surgery was 24 years (range, 18-30 years). All operations were performed using the same cementless implant at a single center. We determined survival, presence of osteolysis, and function (Harris hip score, WOMAC).

“…Although the results of modern cemented or cementless total hip arthroplasty (THA) are generally good [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15], thigh pain, stress shielding and periprosthetic fracture are still potential problems [2,[6][7][8][9]. In an effort to reduce the periprosthetic fracture, thigh pain, and stress shielding, an ultra-short, anatomic metaphyseal-fitting cementless femoral component was developed.…”

Section: Introductionmentioning

confidence: 99%

Behaviour of the ultra-short anatomic cementless femoral stem in young and elderly patients

Park

International Orthopaedics (SICOT)

2013

Purpose The question arises as to whether it is possible to obtain rigid fixation of the ultra-short metaphyseal-fitting anatomic cementless stem without diaphyseal fixation in the elderly as well as younger patients. We investigated whether ultra-short, metaphyseal-fitting anatomic cementless femoral stem would provide similar functional improvements in the younger and elderly patients, radiographically secure implant fixation would be achieved in both groups, the bone content would be preserved in both groups, and complication rates would be similar in both groups. Methods A total of 100 patients (114 hips) in the younger patient group and 100 patients (112 hips) in the elderly patient group were included in the study. Their mean age was 43.9± 6.11 years (range, 31-65 years) in the younger patient group and 78.9±12.1 years (range, 66-91 years) in the elderly patient group. The mean duration of follow-up was 7.5 years (range, six to nine years) in the younger patient group and 7.6 years (range, six to nine years) in the elderly patient group. Results The mean postoperative Harris hip scores (95 points versus 91 points), WOMAC scores (11 points versus 15 points), thigh pain (none in either group), UCLA activity scores (6.5 points versus 4.5 points), and radiographic results were not significantly different between the two groups. No hip in either group had an aseptic loosening. No hip in either group had clicking or squeaking sounds or ceramic fractures. Conclusion The cementless ultra-short, metaphyseal-fitting anatomic cementless femoral component provides stable fixation without any need of diaphyseal fixation in both younger and elderly patients. Despite the concern, the poor bone quality in elderly patients did not compromise the stability, and osseointegration of this ultra-short, anatomic cementless femoral stem was achieved in all elderly patients.