Five Year Outcomes of Ceramic-Оn-Ceramic and Ceramic-Оn-Polyethylene Bearings in Hip Joint Replacement

Abstract

In view of the increasing number of hip joint replacement volume there remains the key issue of improving prosthesis survivorship which directly depends on the friction couple. Material and methods. The authors have analyzed five year outcomes of two bearing types (head and insert) used in hip replacement: ceramic-on-ceramic (CoC) in 324 patients and ceramic-on-polyethylene (CoP) in 300 patients. Totally 550 patients were operated in the period starting 2010 till 2014, including 74 patients underwent bilateral hip replacement. The authors divided patients based on gender and also into three age groups: 20-40, 41-60 and 61-80 years old. The largest group comprised 156 women aged 41-60 years (28.4%). Additional grouping of patients was made based on gender, age and bearing diameter.36 mm diameter bearing was characterized of the most frequent use. Functional outcomes were assessed by Harris Hip Score. Statistical analysis was made with Statistica 10 software. Statistical significant was observed at p0.05.Results.28 mm diameter bearing were rarely (19.5%) applied and mainly in women which is related to need for use of smaller acetabulum components and inability to implant a larger insert.36 mm diameter bearing were used most frequently, CoC articulation of36 mm was used in men in 34% of cases and in women – in 18.12% of cases.40 mm articulations were implanted in women two times less than in men which is related to a smaller diameter of acetabulum in women. Generally, CoC bearings were implanted more often in men which can be explained by a bigger social demand as well as a higher anti-luxation stability of large diameter bearings. Dislocations of implants occurred in 5 (0.91%) patients: in 4 patients with CoP bearingand in one patient with CoC articulation. Four revision procedures (0.64%) were made due to deep periprosthetic infection: two surgeries in each group. Harris Hip Score evaluation in CoC group demonstrated excellent and good outcomes in 99.2% of cases, and in CoP group – in 97.5% of cases.Conclusion. The authors observed no ceramic fractures or acoustic effects during 60 months follow up. It’s reasonable to increase CoC bearing diameter to achieve a better anti-luxation effect. CoC bearing selection should depend on patient’s activity and social demands but not only on the age. Based on study observations the authors forecast a higher survivorship of CoC couple within 15-20 years and expect to prove this conclusion in further studies.

Mid-Term Results of Large-Diameter Ceramic-Bearing Monoblock Acetabular Components in THA.

“…These authors also did not observe formidable complications such as luxation [35] . The work and experience of 30 years of practice in our arthroplasty centre show that to achieve the best anti-luxation effect, it is advisable to increase the diameter of the CoC friction pair [25] . To minimize the risk of luxation, we sought to install CoC pairs with a large diameter.…”

“…et al predicted that the introduction of Biolox delta ceramics would reduce the risk of ceramic destruction close to zero and provide long-term wear of the friction components [16], [24] . To achieve a better anti-luxation effect, it has been recommended to increase the diameter of the CoC friction pair [25], [26] . In China, at Xianqua Hospital, a randomized controlled trial was conducted to assess whether the use of large ceramic friction pairs provided any bene ts in young, active patients.…”

Cementless Hip Implants: History and Current Status of the Issue

“…Чтобы избежать этих проблем, были разработаны новые системы фиксации и модели, нацеленные на повышение первоначальной стабильности при установке, на уменьшение шунтирования нагрузки и потери костной ткани проксимального отдела бедра, а также на улучшение биомеханики тазобед ренного сустава [6,7]. Несмотря на постоянную разработку новых улучшенных имплантатов, расшатывание компонентов эндопротеза на фоне остеолиза остается серьезной проблемой и основной причиной ревизий по данным регистров 1 [8,9,10]. Поскольку первым этапом развития остеолиза является износ ПЭ, истирание узла трения все еще является главной угрозой для нормального функционирования эндопротеза [11].…”