THA With Delta Ceramic on Ceramic: Results of a Multicenter Investigational Device Exemption Trial

Hamilton, William G.; McAuley, James P.; Dennis, Douglas A.; Murphy, Jeffrey A.; Blumenfeld, Thomas J.; Politi, Joel

doi:10.1007/s11999-009-1091-4

Cited by 199 publications

(170 citation statements)

References 39 publications

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“…Although manufacturers reported a stable fracture rate of third-and fourth-generation ceramic liners going from 0.032% to 0.028% [25], this very low rate has not been supported by previous studies, which reported a higher rate of AMC ceramic liners ranging from 1.9% to 2% [7,15] (Table 2). Most of those liner fractures were intraoperative insertional chipping [15] or postoperative fracture resulting from improper initial seating of the modular liner within the metal cup [7,15]. Thus, liner fractures in vivo reported in earlier studies can be explained by technical errors rather than mechanical properties of the AMC ceramics.…”

Section: Discussionmentioning

confidence: 63%

“…Although these material improvements would be expected to decrease clinical concerns associated with previous-generation alumina bearings such as ceramic fracture and squeaking, little is known about this new bearing material and intermediateterm effects are unclear [7,15,27]. Therefore, we evaluated complications associated with the use of ceramic-on- ceramic AMC bearings and clinical outcomes including HHS and survivorship.…”

Section: Discussionmentioning

confidence: 99%

“…The rate of incorrect liner positioning has been reported as high as 16% in some studies and is thought to be the result of difficulty in seating along the axis of the Morse taper interior to the metal cups [15,22]. 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°.…”

Section: Discussionmentioning

confidence: 99%

“…Theoretically, these material improvements would be expected to decrease mentioned concerns associated with previousgeneration alumina bearings. However, few short-term clinical results have been published [7,15,27] and several questions remain regarding longer term clinical outcomes after THAs using Delta ceramic bearings.…”

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: 63%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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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“…A potential alternative to conventional metalon-PE bearing surfaces is alumina-ceramic-on-ceramic. Historically, these bearing surfaces were associated with catastrophic failures of the ceramic head or liner, such as component fracture and chipping [17,18]. Recently, improvements in manufacturing processes have produced ceramics with smaller grain sizes, lower porosity, and higher density, leading to stronger and more fractureresistant materials [29].…”

Section: Introductionmentioning

confidence: 99%

Does Acetabular Inclination Angle Affect Survivorship of Alumina-ceramic Articulations?

Johansson

Johnson

Zywiel

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Reports in the literature have linked high acetabular inclination angles to increased wear of ceramicon-ceramic bearings. However, many of these studies were only conducted in vitro and did not address the clinical relevance of such findings. Questions/purposes We therefore determined: (1) whether the cup inclination angle influences survival or function in patients with ceramic-on-ceramic implants; (2) the incidence of radiolucencies, osteolysis, and subsidence of ceramic-on-ceramic implants; and (3) whether the survival rate higher for ceramic-on-ceramic THAs than for conventional metal-on-polyethylene THAs.Methods We retrospectively reviewed 537 THAs performed in 512 prospectively followed patients having THA between October 1996 and October 2000. Eleven patients (12 hips) were lost to followup before 2 years, leaving 501 patients (525 THAs); of these, 421 were alumina ceramic-on-ceramic articulations and 104 cobaltchromium-on-polyethylene. The mean age was 54 years. We determined acetabular cup inclination angles, Harris hip scores, Health-Status-Questionnaire-12 scores, and presence and location of any radiolucencies, osteolysis, or radiographic subsidence. We compared survival using the Kaplan-Meier method. The minimum followup was 24 months (mean, 59 months; range, 24-120 months). Results Twenty-two of the 424 THAs (4.2%) were revised. We observed no difference in clinical or radiographic outcomes with respect to cup inclination angles. Radiographically, two loose acetabular components and two femoral components had subsided. The 5-year survival rate was slightly higher for ceramic-on-ceramic bearings (98%) than for metal-on-polyethylene (92%).

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Ceramic in Total Hip Arthroplasty

Lewis

Waddell

2021

Evidence‐Based Orthopedics

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THA With Delta Ceramic on Ceramic: Results of a Multicenter Investigational Device Exemption Trial

Abstract: Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Cited by 199 publications

References 39 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?

Does Acetabular Inclination Angle Affect Survivorship of Alumina-ceramic Articulations?

Ceramic in Total Hip Arthroplasty

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