Alumina ceramic bearings for total hip arthroplasty

This article presents an experience with alumina ceramic bearings involving the use of improved ceramic materials as well as new design considerations. The alumina-alumina ceramic hard bearing is a safe option for the younger, more active patient.     

New experience with alumina-on-alumina ceramic bearings for total hip arthroplasty

A major challenge for total hip arthroplasty is to minimize wear and osteolysis in young, active patients. Alumina ceramic bearings have shown superior wear resistance and lubrication and do not carry the risk of ion release. In a prospective randomized study, 514 hips were implanted. All patients (average age, 53 years) received the same press-fit hydroxyapatite coated femoral stem; two thirds (345 hips) received alumina ceramic bearings, and one third (169 hips) received a cobalt-chrome-on-polyethylene bearing. At a mean follow-up of 35.2 months (range, 24-48 months), there was no significant difference in clinical performance between the patient cohorts. No ceramic fracture or alumina ceramic bearing failure occurred. This new experience involves the use of improved ceramic materials and new design considerations that eliminate the risks and complications of past experiences with ceramic implants and provides a safe bearing option for young patients.     

Ceramic-on-ceramic bearings in total hip arthroplasty

The ideal bearing surface for total hip arthroplasty still is being sought. This bearing would be durable, cost-effective, easy to implant, inert, and produce minimal wear debris. Ceramic-on-ceramic bearings have continued to evolve and have enjoyed success in many European centers throughout the past 3 decades. A limited number of early reports from the United States discouraged widespread acceptance and use of ceramic-on-ceramic total hip arthroplasty. Once critically analyzed most of the failures from the early reports are attributable to design and material specific flaws. Vast improvements have been made in ceramic manufacturing leading to even more superior wear characteristics and higher burst strengths. The case for alumina-on-alumina ceramic bearings is becoming stronger as data accumulate clinically and in vitro. In a multicenter, prospective and randomized study, an alumina-on-alumina ceramic bearing is compared with a cobalt chrome-on-polyethylene bearing. After as many as 48 months there has been no significant difference in clinical performance between the two study groups. No ceramic head fracture or ceramic bearing failure has occurred. Therefore, this new alumina-on-alumina ceramic bearing is a safe option for total hip arthroplasty and may provide a more durable prosthesis especially in young and active patients.     

Ceramic/ceramic total hip arthroplasty

Alumina-on-alumina total hip arthroplasty has been used for 30 years, mainly in Europe. The theoretical advantages of this combination are represented by its remarkable sliding characteristics, its very low wear debris generation, and its sufficient fracture toughness. These advantages are achieved if the material is properly controlled with high density, high purity, and small grains. The authors summarize the results obtained with ceramic/ceramic total hip arthroplasty. Information is provided about in vivo behavior regarding wear debris characterization and quantification, and histological tissue examinations for inflammatory reactions, which were not encountered except when alumina debris was mixed with metal or cement. Modification of socket fixation resulted in improved clinical outcomes. With a press-fit metal shell and an alumina liner utilized for 10 years, the results are excellent especially in a young and active population. Alumina-on-alumina seems at the moment to be one of the best choices when a total hip arthroplasty has to be performed in young and active patients. Received: March 22, 2000     

Alumina-on-alumina ceramic versus metal-on-highly cross-linked polyethylene bearings in total hip arthroplasty: a comparative study

The aim of the study was to evaluate the reliability and durability of alumina-on-alumina ceramic in comparison to metal-on-highly cross-linked polyethylene (CoCr/HXLPE) bearing couples. This prospective randomised study involved 150 patients (157 hips). All patients (mean age: 54.7 years) obtained an identical fibre metal midcoat femoral stem and fibre metal-coated acetabular shell. In 78 patients (82 hips) we used alumina, while in 72 patients (75 hips) metal-polyethylene bearing couples were used. During a mean 50.4-month follow-up period (51 ± 8 alumina and 50 ± 8.9 metal-polyethylene) no statistically significant changes in clinical and radiographic parameters were noted between the two groups. There was no ceramic breakage and no need for revision surgery due to the ceramic liner. The alumina bearing couples proved to be as reliable as CoCr/HXLPE.     

Mid-term results in total hip arthroplasty with the basic noncemented hip prosthesis.

The Basic (IQL-Biomet, Valencia, Spain) hip prosthesis was used in 430 implant procedures, of which 417 had mean follow-up of 6 years. Radiographic follow-up was performed at 1, 3, 6, and 12 months postoperatively, and annually thereafter. The average Harris hip score improved from 35.7 preoperatively to 90.9 postoperatively. Clinical results after 2 years of follow-up showed 6% thigh pain, which decreased to 2% at 6 years. Radiographic evaluation demonstrated 22 cases of calcar resorption, 14% of which had distal pedestal formation. Heterotopic ossification was noted radiographically in 36%. These mid-term results obtained with the Basic prosthesis are similar to the findings of other series and warrant its use.     

现代氧化铝陶瓷应用于全髋关节置换术的可靠性

全髋关节置换术中,陶瓷部件失效是一种十分罕见而严重的并发症.随着陶瓷材料质量、制作工艺及假体设计方面的改进,陶瓷部件失效的发生率正稳定地下降.自2000年1月至2006年5月,Ceram Tec公司生产的BIOLOX品牌陶瓷部件失效的发生率约为0.02%,即一万例中有2例发生.目前全髋关节置换术中陶瓷部件发生失效的风险估计为万分之二,其中大多发生于陶瓷球头.因此,氧化铝陶瓷在现代全髋关节置换术中的应用安全可靠,且具有极低的失效风险.     

A rare complication of ceramic-on-ceramic bearings in total hip arthroplasty

Each year, approximately 217000 primary total hip arthroplasties (THAs) are performed in the United States (National Center for Health Statistics, 2003). This number is expected to increase as our population ages, and the indication for THA expands to younger and more active patients. Efforts are continually being made to improve implant design and, ultimately, patient outcomes. One area in particular that has undergone tremendous change is bearing surface technology. Ceramic-on-ceramic technology has gained widespread popularity in young patients because of its improved wear characteristics and durability. Bearing surface advancement must be tempered with analysis of implant-specific complications. We report a case of an audible hip complication after the use of ceramic components in THA.     

28 mm Metasul™ bearings in primary total hip arthroplasty

Assessment of possible low-wear with some former metal-on-metal (MoM) total hip arthroplasties (THA) led to the reintroduction of metallic bearings in the late 80’s. The author reports on two studies of Metasul-28 mm cementless THA. In the first one in a general population, impingement has been the main cause of osteolysis and Co level survey has been a good indicator of Metasul bearing behaviour. In the second study, in a group of 83 less than 50-year-old and active patients, Metasul bearings showed good wear resistance at 7.2 years mean follow-up. In both studies, no general toxic effect could have been detected thus far. According to the current knowledge, it is always reasonable to expect low-wear and better THA longevity with use of MoM bearings under the following conditions: 1) use of a CoCr alloy with high carbide concentration; 2) reduce impingement risk (head without sleeve, slimmer as possible neck, perfectly adapted Morse cone from the same manufacturer, well — oriented components); and 3) prefer cementless acetabular fixation.     

Fracture of ceramic femoral heads in total hip arthroplasty

Five cases of fractured ceramic heads occurring 1–2 years after primary hip arthroplasty are reported. All fractures occurred without significant trauma. As the mechanism of these failures has not been clarified, the authors have stopped using ceramic heads.     

Thirty years of experience with alumina-on-alumina bearings in total hip arthroplasty

Alumina-on-alumina bearings in total hip arthroplasty have been developed in an attempt to minimise debris and the occurrence of osteolytic lesions. The outstanding tribological properties of this bearing system are explained by low surface roughness, high hardness for major scratch resistance, and high wettability. Since the 1970s, technological improvements in the manufacturing process of alumina components together with a better understanding of Morse taper technology have provided a surgical grade material with high density, high purity and small grains. Published studies on the outcome of total hip arthroplasty performed with this new generation of implants showed high survivorship especially in young and active patients, with survival rates free of revision of 90.8% to 97.4% at ten years. However, concern remains over ceramic liner fracture and squeaking, which has been noted recently with increasing prevalence. This review will discuss the current knowledge on the use of alumina-on-alumina bearings.     

Anatomic cementless total hip arthroplasty with ceramic bearings and modular necks: 3 to 5 years follow-up

Reported here are the results obtained for 216 prosthetic implants in which cementless arthroplasty and a modular neck were used. The advantages to using this method are related to the fact that it may be adapted to a variety of anatomical conditions.     

Fracture of an alumina ceramic head in total hip arthroplasty

The authors have experienced a fracture in the ceramic head in a total hip arthroplasty in three cases. Two of these were comminuted and the other was a hair-line fissure. A foreign body, perhaps from the operation, existed between the neck of the stem and the head in two cases (one in a comminuted fracture and the other in the fissure fracture). The other case had no foreign body, and, judging from the serial radiographs, the fracture was probably caused by weight-bearing stress. Care must be taken during operation to avoid interposing any foreign body in the modular ceramic head total hip arthroplasty, and the weight-bearing stress factor must be considered as an indication for a ceramic head fracture in young active patients     

One-stage versus two-stage bilateral autophor ceramic total hip arthroplasty

Noncemented autophor ceramic total hip arthroplasty (ACTHA) has been developed in recent years for treatment of advanced hip diseases. Bilateral ACTHAs were routinely performed in two operations at a four- to six-month interval. There have been no reported series of one-stage bilateral ACTHAs. In this retrospective study, the authors compared 20 patients who had bilateral one-stage ACTHAs with 15 patients who had similar bilateral arthroplasties in two stages. The study revealed no significant differences in estimated intraoperative blood loss, postoperative hemovac drainage, total amount of blood transfusion, intra- or postoperative complications, or postoperative functional results in the two groups. There was no difference in achieving prosthesis stability by interface bone growth, in spite of a significant difference in weight-bearing status during the immediate postoperative period. The one-stage bilateral procedure, however, offered advantages over two-stage bilateral procedures, including shorter length of hospital stay (18 days versus 27 days), shorter operative time (148 minutes versus 245 minutes), shorter period of disability (86 days versus 202 days), and reduced economic costs (about 10% less). There was no increase in the risk of morbidity or mortality in the one-stage bilateral group. In selected cases, one-stage bilateral ACTHA would be preferable.     

混合型全髋关节置换术治疗股骨头缺血性坏死中期评估

目的回顾性研究混合型全髋关节置换术（total hip arthroplasty，THA）治疗股骨头缺血性坏死的疗效及其影响因素。方法1998年1月至2001年6月，对采用同一类型混合假体行THA的股骨头缺血性坏死患者57例（61髋）进行至少6．5年的影像及临床随访。观察髋臼、股骨假体的位置及其周围的骨质改变，并测量臼杯内衬的磨损速度与磨损方向。假体的生存率采用Kaplan—Meier分析，分别以髋臼、股骨假体的无菌性松动和任何原因所致的翻修为终点。结果患者Harris评分从术前平均（39．0±6．0）分（25～56分），提高到末次随访时平均（90．4±4．6）分（80-100分）。截至末次随访时，1髋（2％）出现骨盆局灶性骨溶解，拟行植骨治疗；7髋（11％）出现股骨局灶性骨溶解。聚乙烯内衬平均线性磨损率为（0．14±0．05）mm／年（0．02-0．45mm／年）。Kaplan-Meier生存分析表明，以任何原因导致的翻修或再手术为终点，髋臼与股骨假体的生存率分别为98％（95％置信区间，0．96-1．00）和100％（95％置信区间，0．95-1．00），以假体无菌性影像学松动为终点，髋臼与股骨假体的生存率均为100％（95％置信区间，0．95-1．00）。结论应用混合型假体行THA可以为晚期股骨头缺血性坏死患者提供完好的中期固定及临床效果。然而，由于聚乙烯磨损、骨溶解等潜在危险因素的存在，长期效果仍须进一步随访。     

Differential hardness bearings in hip arthroplasty

Second-generation metal-on-metal (MOM) bearing couples produce less wear debris than first-generation implants due to a better understanding of design parameters coupled with improved manufacturing processes. Wear debris generated by MOM bearings is extremely small compared with that from conventional metal-on-polyethylene bearings and can potentially be larger in number. Reductions in metal wear debris may be achieved by the use of differential hardness (DH) bearings for use with surface or total hip replacement implants. Laboratory testing has demonstrated that DH bearings exhibited less abrasive, adhesive, and surface fatigue damage than previous-generation MOM bearing couples. In addition, recent clinical trials have demonstrated a reduction in metal ion levels in patients who were implanted with a differential hardness bearing system. DH bearings may represent a third generation of hard bearing implants for use in hip replacement surgery that may potentially result in less complications and better success rates.