Large head ceramic-on-ceramic bearing in primary total hip arthroplasty: average 3-year follow-up of a multicentre study

Lavigne, Martin; Vendittoli, Pascal‐André; Virolainen, Petri; Corten, Kristoff; Martínez, Mariano; Zicat, B.; Peter, Viju; Bloem, Rolf M.; Miazzolo, N; Remes, Ville

doi:10.1177/1120700019863376

Cited by 9 publications

(14 citation statements)

References 19 publications

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“…The 5 non-comparative studies encompassed >100 hips; the largest case series was described by Blakeney et al [12] and 264 implants were assessed [10, 11, 14, 15] (Tables 1, 2). The study by Goldhofer et al [14] was an update of Tai et al [11].…”

Section: Resultsmentioning

confidence: 99%

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Ceramic-on-Ceramic Total Hip Arthroplasty with Large Diameter Heads: A Systematic Review

et al. 2020

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Ceramic-on-ceramic (COC) total hip arthroplasties (THAs) with large heads (>36 mm) were introduced to reduce dislocation rates and restore the hip anatomy as closely as possible to the native one. To date, the literature is scarce and fragmented; a review is desirable to point out the outcomes and the possible specific complications (noise, groin pain, and taperosis). A systematic review about large-diameter COC THAs was conducted according to the PRISMA guidelines. The PubMed and Cochrane databases were searched using the terms “large”, “big”, “head”, “hip”, and “ceramic.” The methodological quality of the papers was assessed using the MINORS (Methodological Index for Nonrandomized Studies) score. Seven papers (level of evidence: 5 case series and 2 case-control studies) met the inclusion criteria. Clinical outcomes were excellent in >90% of the patients. Groin pain was reported in only 1 article (7%). Radiological outcomes were positive. Minimal revision rates (<2%) were reported at short- to mid-term follow-ups. Dislocation rates were usually <1%. No bearing surfaces failed. No case of trunnionitis was reported. Noise occurred in up to 30% of the patients, mostly squeaking. The noise did not influence clinical outcomes or patients’ satisfaction. Noise was inconstantly associated with component positioning, younger age, high articular excursions, and larger sizes. Large-diameter heads in COC THAs (≥40 mm) showed promising clinical and radiological outcomes with minimal revision rates. Noise is a cause of concern and should be carefully evaluated at longer follow-ups and in larger, prospective, and specifically designed case series.

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Section: Resultsmentioning

confidence: 99%

“…Two types of implants were adopted, the Maxera LDH (Zimmer, Warsaw, IN, USA) and the DeltaMotion Hip System (DePuy Synthes, Warsaw, IN, USA) (Table 1) [10-16]. The minimum rate of large heads (≥40 mm) was 88% [15]. All the papers reported short- to mid-term follow-ups ranging from 21 to 78.8 months (Table 2) [10-16].…”

Section: Resultsmentioning

confidence: 99%

Ceramic-on-Ceramic Total Hip Arthroplasty with Large Diameter Heads: A Systematic Review

et al. 2020

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“…Although originally an issue in large head MoM THA and surface replacements, 102 groin pain has also been reported in 36-mm MoXLPE THA, 103 as well as in 7% of larger head (38–44-mm) CoC THA. 104 It is speculated that large heads overstuff the anterior joint capsule and impinge the iliopsoas tendon. 105 Noise generation such as squeaking has also been associated with increasing head size in CoC THA from 7% with 36-mm up to 44% with 48-mm heads, although reportedly without influence on patient satisfaction.…”

Section: Femoral Head Sizementioning

confidence: 99%

Global diversity in bearings in primary THA

et al. 2020

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Choice of articulating materials, head size and the design of the articulation will become decisive for the long-term performance of a total hip arthroplasty (THA) and especially in terms of risk for dislocation and wear-related problems. Here we account for common alternatives based on available studies and the evidence that can be derived from them. Metal or ceramic femoral heads articulating against a liner or cup made of highly cross-linked polyethylene and ceramic-on-ceramic articulations have about similar risk for complications leading to revision, whereas the performance of metal-on-metal articulations, especially with use of big heads, is inferior. The clinical significance of problems related to ceramic-on-ceramic articulations such as squeaking remains unclear. With use of current technology ceramic fractures are rare. Large femoral heads have the potential to increase the range of hip movement before impingement occurs and are therefore expected to reduce dislocation rates. On the other hand, issues related to bearing wear, corrosion at the taper-trunnion junction and groin pain may arise with larger heads and jeopardize the longevity of THA. Based on current knowledge, 32-mm heads seem to be optimal for metal-on-polyethylene bearings. Patients with ceramic-on-ceramic bearings may benefit from even larger heads such as 36 or 40 mm, but so far there are no long-term reports that confirm the safety of bearings larger than 36 mm. Assessment of lipped liners is difficult because randomized studies are lacking, but retrospective clinical studies and registry data seem to indicate that this liner modification will reduce the rate of dislocation or revision due to dislocation without clear evidence of clinically obvious problems due to neck-liner impingement. The majority of studies support the view that constrained liners and dual mobility cups (DMC) will reduce the risk of revision due to dislocation both in primary and revision THA, the latter gaining increasing popularity in some countries. Both these devices suffer from implant-specific problems, which seem to be more common for the constrained liner designs. The majority of studies of these implants suffer from various methodological problems, not least selection bias, which calls for randomized studies preferably in a multi-centre setting to obtain sufficient power. In the 2020s, the orthopaedic profession should place more effort on such studies, as has already been achieved within other medical specialties, to improve the level of evidence in the choice of articulation when performing one of the most common in-hospital surgical procedures in Europe. Cite this article: EFORT Open Rev 2020;5:763-775. DOI: 10.1302/2058-5241.5.200002

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“…To cope with a limited ROM after a THA, prosthesis designs with larger diameter head bearings have been introduced to provide stability, a larger ROM, a smaller risk of dislocation, and to possibly prevent StL impingement. These claims have been supported in the literature [8][9][10][11][12], although concerns are still reported [13][14][15].…”

Section: Introductionmentioning

confidence: 91%

Cup-To-Neck Contact and Range of Motion after Total Hip Arthroplasty with Large Head Diameters: An Original Three-Dimensional Combined Gait and Videofluoroscopy Analysis

et al. 2020

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After a total hip arthroplasty, a limited range of motion and lower-limb disability continue to be observed, with these being mainly associated with the implant design and the head-to-neck ratio. Larger diameters of the head bearings were assumed to provide better stability, a larger range of motion, and smaller risks of dislocation and stem-to-liner impingement. However, these claims have never been demonstrated in real patients. The specific aim of this study was to assess, via multi-instrumental analysis, whether the range of motion of a replaced hip is limited by the stem-to-liner contact in patients with large femoral head diameters. Twenty-three patients with a total hip arthroplasty were evaluated at their one-year follow-ups using clinical and instrumental examinations. A combined three-dimensional gait analysis of the full body and videofluoroscopy analysis of the replaced hip were performed during the execution of standard, i.e., daily living, and more demanding motor tasks. The latter were meant to reach the extreme range of motion at the replaced hip site, thus revealing possible stem-to-liner contact. An original technique based on imaging and computer-aided design (CAD) models of the prosthesis components was developed to calculate the stem-to-liner distance. Excellent clinical scores were observed in the study. The gait analysis showed that the range of motion of the replaced hip in the sagittal plane, averaged over all patients, ranged from 28° to 78° in standard activities. In more demanding tasks, single peaks were as high as 110°, 39°, and 60° in the sagittal, frontal, and transverse anatomical planes, respectively. In all motor tasks, the stem-to-liner distances ranged from 8.7 to 13.0 mm on average, with one outlier minimum distance being 2.2 mm. This study shows that, even in demanding motor tasks and with an extreme range of motion, the hip joint replaced with large femoral head diameters did not experience impingement between the prosthesis components.

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Large head ceramic-on-ceramic bearing in primary total hip arthroplasty: average 3-year follow-up of a multicentre study

Cited by 9 publications

References 19 publications

Ceramic-on-Ceramic Total Hip Arthroplasty with Large Diameter Heads: A Systematic Review

Ceramic-on-Ceramic Total Hip Arthroplasty with Large Diameter Heads: A Systematic Review

Global diversity in bearings in primary THA

Cup-To-Neck Contact and Range of Motion after Total Hip Arthroplasty with Large Head Diameters: An Original Three-Dimensional Combined Gait and Videofluoroscopy Analysis

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