Cementless alumina-on-alumina total hip arthroplasty in patients younger than 50 years: a 5-year minimum follow-up study

Sixty-seven patients (78 hips) who were younger than 50 years underwent cementless total hip arthroplasty using a porous-coated acetabular cup, an alumina liner, a 28-mm alumina head, and a proximally porous-coated femoral stem. One patient (1 hip) died and 2 patients (3 hips) were lost to follow-up. The remaining 64 patients (74 hips) were followed for 5 to 6 years. Their mean age at the index operation was 37 years. The mean Harris hip score was 94 points at the time of final follow-up. Four patients (4 hips) had mild thigh pain. All acetabular and femoral components were bone-ingrown, and neither pelvic nor femoral osteolysis was identified. No fracture of the ceramic liner or head was identified. Wear of the ceramic components was undetectable in 27 hips in which measurement was possible.     

Long-Term Outcome on the Mal-Seating of Ceramic-on-Ceramic Articulation in Total Hip Arthroplasty

BackgroundTotal hip arthroplasty with ceramic-on-ceramic articulation aims to decrease wear, osteolysis, and aseptic loosening. A metal-backed ceramic liner was developed to reduce the risk of liner fracture. However, a significant number of cases of mal-seating of the metal-backed ceramic liner were observed in the 2000s, and there were concerns about their outcome. This review aims to investigate the long-term performance of the mal-seated ceramic liner.MethodsFrom July 2003 to March 2007, 35 ceramic-on-ceramic total hip arthroplasties were performed with the Trident acetabular system. Clinical assessment, radiological analysis, and outcome assessment were performed. The prevalence of liner mal-seating and its long-term outcomes were investigated.ResultsThere was liner mal-seating in 8 hips (22.9%). One liner was exchanged in the early postoperative period. No revision surgery was required for the remaining 7 hips at a mean follow-up of 14 years. All patients were free of hip pain with a mean Harris Hip Score of 94.7 at the most recent follow-up. No adverse event was observed.ConclusionThe long-term outcomes of the mal-seated liner were favorable. However, surgeons should exercise meticulous surgical technique to achieve a properly aligned liner within the acetabular shell to minimize this potentially correctable error.     

Isolated Acetabular Revision With Ceramic-on-Ceramic Bearings Using a Ceramic Head With a Metal Sleeve

The purpose of this study is to evaluate results of isolated acetabular revision with ceramic-on-ceramic bearings using a ceramic head with a metal sleeve. A retrospective review of fifty-three hips was performed. The mean patient age was 49.9 years and the mean follow-up period was 5.7 years. The mean modified Harris hip score improved from 47.5, pre-operatively, to 84.7 at the time of last follow-up (P < 0.001). Two patients reported squeaking of the hip. Three patients experienced loosening cup, necessitating re-revision surgery. There was a significant difference of acetabular bone defect between loose cup group and stable cup group (P = 0.018). There were no ceramic fractures and no osteolysis. The survival rate of the acetabular cup at the mid-term follow-up was 94.3%. In conclusion, ceramic head with a metal sleeve can be a reliable option for isolated acetabular revision.     

The Result of Revision Total Hip Arthroplasty in Patients with Metallosis Following a Catastrophic Failure of a Polyethylene Liner

BackgroundWear cannot be completely prevented after total hip arthroplasty. If severe polyethylene (PE) liner wear develops, the so-called catastrophic failure occurs and metallosis develops. We postulated that longevity of the new implant may be affected after revision surgery for metallosis following a catastrophic failure of a PE liner due to the substantial amount of PE wear particles and infiltration of the metal particles in this catastrophic condition.MethodsTwenty-three hips of 23 patients were identified because they showed metallosis during revision total hip arthroplasties performed in Seoul National University Hospital between January 1996 and August 2004. They were followed for at least 6.5 years after the index revision total hip arthroplasty. The clinical and radiological results of revision total hip arthroplasties in these patients were evaluated.ResultsThe median Harris hip score increased from 60 points before revision total hip arthroplasties to 90 points at the final follow-up. Osteolysis was detected at an average of 9.3 years after revision total hip arthroplasties in 13 hips and acetabular cup loosening at average 9.8 years after revision total hip arthroplasties in 9 hips. With radiographic evidence of osteolysis and loosening as the end points, the 15-year survival rates were 28.2% and 56.0%, respectively.ConclusionsThe survival rate of revision total hip arthroplasty in patients with metallosis following a catastrophic failure of a PE liner was low.     

Midterm Results of a Contemporary,Porous-Coated Acetabular System in Patients Undergoing Primary Total Hip Replacement for Degenerative Hip Disease: A Prospective,Multicenter Study

BackgroundA contemporary, porous-coated acetabular implant designed for uncemented insertion was introduced in Europe and Australia in 2007. A similar previous acetabular system was found in several studies at 10 to 15-year follow-up to demonstrate accelerated polyethylene wear, osteolysis, and early failure. The current study was conducted to determine the midterm safety and effectiveness of this contemporary acetabular system using highly crosslinked polyethylene and ceramic liners at 5-year follow-up.MethodsA prospective, nonrandomized study was conducted at 8 sites in Canada and the United States. All 148 study participants received a contemporary acetabular shell with proprietary porous coating. The primary outcome was the requirement for revision surgery at 5 years postoperatively. Secondary outcomes included a survival analysis, patient-reported outcome measures, radiographic failure, and postoperative adverse events.ResultsAt 5-year follow-up there was 1 cup revised for deep infection. No cups were revised for loosening and none were found to be radiographically loose. The overall survival rate with reoperation for any reason was 97.1%. The success rate was 96.8% for polyethylene and 100% for ceramic with no difference in the success rate between either bearing surface (P = 1.0). The mean patient-reported outcome measures all improved significantly between preoperative and 5-year postoperative scores (P < .001).ConclusionResults from this 5-year, multicenter, prospective study indicate excellent survivorship for this acetabular system when used with crosslinked polyethylene or ceramic bearing surfaces.     

Ceramic on ceramic hip arthroplasty in fused hips

Background:Most literature in the field of total hip arthroplasty (THA) for fused hips, until date has reported the results of using metal on polyethylene and ceramic on polyethylene bearings. Results of THA using ceramic on ceramic (CoC) bearings in fused hips have not been published in literature. This study reports the results of cementless THA using CoC articulation perfomed in fused hips.Results:Mean Harris hip score improved from 42.4 to 84.2 and mean leg lengthening of 36.6 mm was achieved. In the average 5.4 years (range 2.8-9.1 years) followup there were no cases with osteolysis around acetabular cup and femoral stem. In this study, there was no case of ceramic fracture. There was one case of squeaking.Conclusion:This study suggests that cementless THA performed for fused hips with CoC bearings can provide good early clinical results.     

Ten- to Sixteen-Year Follow-Up of Highly Cross-Linked Polyethylene in Total Hip Arthroplasty: What Factors Affect Wear?

BackgroundIncrease in acetabular cup abduction in total hip arthroplasty (THA) using conventional polyethylene is associated with greater linear wear. Whether this relationship holds true for highly crosslinked liners, particularly with long-term follow-up, is still controversial. The effect of liner thickness on wear of highly cross-linked liners also remains to be clarified.This study sought to determine (1) the long-term clinical and radiological performance of highly cross-linked polyethylene in THA and (2) the effect of acetabular component positioning, polyethylene thickness, and patient demographics on wear.MethodsNinety-three THAs using a 28-mm hip ball, single brand of highly cross-linked polyethylene liner, and cementless cup were performed in 87 patients. Clinical outcomes were evaluated using the Harris Hip Score and need for revision surgery. Linear and volumetric wear, presence of osteolysis, and cup abduction angle were assessed.ResultsThe mean age at operation was 51.4 years. The mean duration of follow-up was 12.7 years (10-16 years). Patients aged >50 years had higher rates of linear wear than those aged <50 years (P = .015). Positive correlation was found between cup abduction angle (P = .014) and cup version (P = .035) with a linear wear rate. Thinner liners (≤7 mm) had similar rates of linear and volumetric wear as thicker liners (≥8 mm) (P = .447).ConclusionThis is the only study to demonstrate a positive significant relationship between cup abduction angle and version with linear wear rate in THA with at least 10 years of follow-up. Liner thickness was not found to affect wear rates.     

Computed Tomographic Osteolytic Analysis of a First-Generation Remelted Highly Cross-Linked Polyethylene in Total Hip Arthroplasty—At a Minimum of 15-Year Follow-Up

BackgroundLow polyethylene wear rate and low incidence of osteolysis have been reported after total hip arthroplasty (THA) using first-generation remelted highly cross-linked polyethylene (HXLPE). However, osteolysis has not been evaluated in long-term studies of these patients (15 years or more). The present study assessed computed tomography (CT) images to determine the incidence of osteolysis associated with HXLPE in THA during at least 15 years of follow-up.MethodsWe evaluated 105 primary THAs in 84 patients (77 women and 7 men). Mean follow-up was 15.9 years (range, 15-18 years). All THAs used a Longevity HXLPE liner and a 26-mm zirconia femoral head. Areas of osteolysis were identified from CT images using 3D and multiplanar reconstruction views.ResultsCT 3D multiplanar reconstruction images at 15-year follow-up showed no obvious osteolysis in the acetabulum or femur of any patient. No patients developed cup loosening or liner breakage.ConclusionOur study indicates that first-generation remelted HXLPE liners do not increase the risk of osteolysis during 15-year follow-up and suggests that the wear particles from first-generation remelted HXLPE are less biologically active than those generated by conventional polyethylene devices.     

Ceramic-on-Ceramic Total Hip Arthroplasty: Minimum of Six-Year Follow-up Study

Background

This study examines the clinical and radiologic results of ceramic-on-ceramic total hip arthroplasties with regard to wear, osteolysis, and fracture of the ceramic after a minimum follow-up of six years.

Methods

We evaluated the results of a consecutive series of 148 primary ceramic-on-ceramic total hip arthroplasties that had been performed between May 2001 and October 2005 in 142 patients. The mean age was 57.2 years (range, 23 to 81 years). The mean follow-up period was 7.8 years (range, 6.1 to 10.1 years). Preoperative diagnosis was avascular necrosis in 77 hips (52%), degenerative arthritis in 36 hips (24.3%), femur neck fracture in 18 hips (12.2%), rheumatoid arthritis in 15 hips (10.1%), and septic hip sequelae in 2 hips (1.4%). Clinical results were evaluated with the Harris hip score, and the presence of postoperative groin or thigh pain. Radiologic analysis was done with special attention in terms of wear, periprosthetic osteolysis, and ceramic failures.

Results

The mean Harris hip score improved from 58.3 (range, 10 to 73) to 92.5 (range, 79 to 100) on the latest follow-up evaluation. At final follow-up, groin pain was found in 4 hips (2.7%), and thigh pain was found in 6 hips (4.1%). Radiologically, all femoral stems demonstrated stable fixations without loosening. Radiolucent lines were observed around the stem in 25 hips (16.9%), and around the cup in 4 hips (2.7%). Endosteal new bone formation was observed around the stem in 95 hips (64.2%) and around the cup in 88 hips (59.5%). No osteolysis was observed around the stem and cup. There were 2 hips (1.4%) of inclination changes of acetabular cup, 2 hips (1.4%) of hip dislocation, 1 hip (0.7%) of ceramic head fracture, and 1 hip (0.7%) of squeaking. The Kaplan-Meier survival rate of the prostheses was 98.1% at postoperative 7.8 years.

Conclusions

The ceramic-on-ceramic total hip arthroplasty produced excellent clinical results and implant survival rates with no detectable osteolysis on a minimum six-year follow-up study. The ceramic-on-ceramic couplings could be a reasonable option of primary total hip arthroplasty for variable indications.     

Comparison of Surgical Outcomes Between Standard and Elevated-Rim Highly Cross-Linked Polyethylene Acetabular Liners in Primary Total Hip Arthroplasty With Minimum 15-Year Follow-Up: Single-Center,Retrospective Cohort Study

BackgroundThe aims of the present study are to (1) conduct the longest-to-date follow-up wear analysis of the highly cross-linked polyethylene acetabular liners, (2) assess the incidence of femoral and acetabular osteolysis, and (3) compare the surgical outcomes between standard and elevated-rim acetabular liners in primary total hip arthroplasty (THA).MethodsIn this retrospective cohort study, we evaluated 112 primary THAs performed by a single experienced arthroplasty surgeon at our institution between March 2000 and December 2003. Patients were classified based on the type of acetabular liner used: standard or elevated-rim liner. For evaluation of surgical outcomes, the following data were collected: acetabular cup position (anteversion and inclination), wear rate (linear and volumetric), presence of osteolysis, history of reoperation (all-cause and wear-related), complications (deep joint infection, dislocation, and periprosthetic fracture), and Harris hip score at last follow-up.ResultsLinear and volumetric wear rates were 0.028 mm/y (0.000-0.145 mm/y) and 11.641 mm³/y (0.000-70.000 mm³/y) in the standard group and 0.026 mm/y (0.000-0.094mm/y) and 9.706 mm³/y (0.000-33.000 mm³/y) in the elevated-rim group, respectively. These rates were not significantly different between groups. One case of osteolysis was confirmed in the standard group, whereas no osteolysis was observed in the elevated-rim group.ConclusionWe suggest that elevated-rim highly cross-linked polyethylene acetabular liners might be a good implant option that can be used safely.     

Migration and Wear of a Dual Mobility Acetabular Construct at 3 Years Measured by Radiostereometric Analysis

BackgroundThe anatomic dual mobility (ADM) acetabular component was introduced because of previously described low dislocation rates for this type of construct. The shape of the anatomic cup and the motion of polyethylene liner may have implications for acetabular cup fixation and polyethylene liner wear; therefore, the purpose of this study was to assess the migration patterns and wear rates of the ADM component using radiostereometric analysis.MethodsUncemented ADM acetabular components were implanted in 27 patients. Radiostereometric analysis exams were taken at 6 follow-up visits over 3 years. Proximal translation and sagittal rotation of the cup and polyethylene total wear and wear rates were calculated. Oxford 12 Hip scores and satisfaction were recorded.ResultsMean proximal translation was below the 0.2 mm threshold at 2 years associated with acceptable long-term survivorship (0.16 mm [standard deviation {SD} 0.31] at 3 years). Mean sagittal rotation was 0.29 degrees (SD 1.03) and was greater in female subjects (P < .001). Following bedding-in, the annual wear rate was 0.02 mm/y, below the 0.1 mm/y threshold. There was no association between cup migration and polyethylene wear. Patient satisfaction at 3 years was 96%. Mean Oxford 12 Hip scores improved from 21 (SD 7) preoperatively to 43 (SD 7) 3 years postoperatively.ConclusionsThe ADM cup demonstrated stable migration at 3 years indicating low risk for aseptic loosening. Bedding-in in the first year was followed by low annual wear rates. These finding suggest no increased risk of the dual mobility and anatomic design on fixation or wear.     

Mid-term results of large diameter heads on cross-linked polyethylene liners in total hip replacement

BackgroundHighly cross-linked polyethylene liners in total hip replacement (THR) have allowed the use of larger diameter femoral heads. Larger heads allow for increased range of motion, decreased implant impingement, and protection against dislocation. The purpose of this study is to assess the clinical and radiographic outcomes of patients with large femoral heads THR at 4 years postop.Materials and methodsStudy includes 28 patients who had a primary THR with a 36 mm larger femoral head were retrospectively for minimum 4 years follow-up. All patients received a cementless acetabular shell and a highly cross-linked polyethylene liner with an inner diameter of 36 mm. The median radiographic follow-up was 4 years (range 2.0–6.0), and patients were assessed clinically by Harris hip score.ResultsThe mean follow-up is minimum 4 years (range 2–6 years) results in all operated patients showed marked improvement in Harris hip score from preoperative mean 49.1 to 89.9 at 4 years or more follow-up. The complications include superficial infection (n = 2). No dislocation, or no osteolysis was seen in the pelvis or proximal femur, and no components failed due to aseptic loosening. There was no evidence of cup migration, screw breakage, or eccentric wear on the liner.ConclusionThe mid-term results in this series of patients with LDH using 36 mm femoral head articulating with highly cross linked polyethylene showed excellent clinical, and radiological results, in terms of, joint restoration that replicates the natural anatomy, optimized range of motion without impingement & reduced opportunity for postoperative dislocation.     

Primary Total Hip Arthroplasty With Duraloc Cup in Patients Younger Than 50 Years : A 5- to 7-Year Follow-Up Study

We evaluated the clinical and radiographic results of 67 (64 patients) cementless Duraloc-300 cups for young active patients after a mean follow-up period of 6.2 years. The preoperative mean Harris hip score improved from 46.24 to 96.5 points at 5 years. The survivorship of the cup, using radiographically confirmed aseptic loosening as the end point, was 100% at 5 years. The mean rate of liner wear was 0.125 mm/y (00-0.39 mm/y). Acetabular osteolysis was found in 14% (9 hips) of the 67 hips, and the osteolysis is related to polyethylene wear (P = .0024) and sex (P = .001). Although there was no aseptic loosening of the components, there was a high rate of liner wear of the polyethylene liner and acetabular osteolysis.     

Primary total hip arthroplasty with a flattened press-fit acetabular component in osteoarthritis and inflammatory arthritis: a prospective study on 416 hips with 6–10 years follow-up

Introduction

A flattened cup was designed to create a more physiological load transfer to the pelvic bone compared to hemispherical cups, and to allow more bone contact compared to low-profile’ spherical cups. To investigate these theoretical advantages and the potential influence of the quality of the acetabular bone, a clinical study was performed in patients with osteoarthritis (OA) and inflammatory arthritis (IA). The aims of the study were (1) to evaluate the fixation of the cup, postoperatively and later when osseous integration should have taken place, (2) to assess perioperative complications such as acetabular fractures and (3) to monitor the polar gap, a potential risk factor for osteolysis.

Patients and methods

A prospective study was performed on all consecutive OA and IA patients with an indication for primary total hip arthroplasty (THA). Three hundred and nine OA patients (340 hips) and 65 IA patients (76 hips) were included. The acetabular component was the flattened press-fit EPF-PLUS^® cup, the femoral component the tapered cementless Zweymueller SL-PLUS^® stem. All revisions and complications were recorded. Clinical and radiographical evaluation was performed on regular basis during 6–10 years.

Results

The incidence of early loosening of the cup was 0 out of 340 in the OA group and 1 out of 76 in the IA group. The incidence of acetabular fractures was 7 out of 340 in the OA group and 3 out of 76 in the IA group. Failure rate for the acetabular component due to aseptic loosening or osteolysis after 6–10 years was 0% in the OA group and 4.8% in the IA group. In all cases available for follow-up the polar gap had disappeared and full osseous integration had taken place in both the groups.

Interpretation

This study shows that the flattened press-fit acetabular component creates adequate initial mechanical stability to allow osseous integration and that the cup can be safely used in both OA and IA patients. However, after 6–10 years, in the IA group failure of the cup due to aseptic loosening occurred once and failure due to osteolysis occurred three times, while these type of failures did not occur in the OA group.     

Mid-term Results of Revision Total Hip Arthroplasty Using Delta Ceramic-on-Ceramic Bearing

BackgroundDelta ceramic-on-ceramic (CoC) articulation affords excellent outcomes in primary total hip arthroplasty (THA). However, the safety and reliability of this bearing in revision THA need more evidence. This study aimed to report complications, radiological changes, clinical results, and survivorship of revision THA using Delta CoC articulation at minimum 5-year follow-up.MethodsWe reviewed 118 revision THAs (113 patients: 68 men and 45 women) performed with use of Delta CoC bearing. Their mean age was 58.7 years (range, 30–90 years) and their mean body mass index was 24.6 kg/m² (range, 15.2–32.5 kg/m²). These patients were followed up for 5–12 years (mean, 7.2 years). We evaluated squeak, grinding sensation, ceramic fracture, dislocation, periprosthetic joint infection (PJI), periprosthetic fracture, prosthetic loosening, ceramic wear, osteolysis, modified Harris hip score (mHHS), and survivorship with any reoperation after the revision as the endpoint.ResultsTwo patients (1.7%) had grinding sensation, but no patient had ceramic fracture. Reoperations were necessary in 9 hips (7.6%) due to PJIs in 2, stem loosening in 2, cup loosening in 2, recurrent dislocation in 2, and periprosthetic fracture in 1. No hip had measurable wear or osteolysis. The average mHHS improved from 53.3 points before the revision to 82.3 points at the final follow-up. Survivorship was 91.6% (95% confidence interval, 86.3%–96.9%) at 12 years.ConclusionsThe Delta ceramic bearing appeared a reliable option for revision THA, showing encouraging mid-term results with acceptable survivorship and a low complication rate.     

Fracture of a ceramic liner in a total hip arthroplasty with a sandwich cup

Alumina ceramic-on-ceramic total hip arthroplasty (THA) has been widely used due to its advantages such as low wear, scratch resistance, wettable surface and relatively low biological reactivity of the wear particles. Nevertheless, this material in THA still persists to be one of the major concerns about the risk of fracture, due to its brittleness. Many authors have reported a fracture of the ceramic head but few reported a fracture of the ceramic acetabular insert. In order to reduce the rigidity of the ceramic-on-ceramic coupling and prevent an impingement between the rim of the ceramic liner and the metal neck of the femoral stem, a modular acetabular component with a sandwich insertion (alumina/polyethylene/titanium) was proposed. We report the fracture of the ceramic acetabular liner of such a ceramic sandwich cup due to a slightly retroverted position of the cup that causes an impingement between the femoral stem and the rim of the insert. The fracture occurred 3 years after the operation without trauma. At revision the entire cup was replaced using a polyethylene liner without inner ceramic liner.     

A Minimum Ten Years of Follow-Up of Alumina Head on Delta Liner Total Hip Arthroplasty

Background

In the early days when delta ceramics were developed, there was a period of using delta ceramic liner and alumina ceramic head. Therefore, the purpose of this study is to investigate the clinical and radiological outcomes of total hip arthroplasty using delta ceramic liner on alumina ceramic head after a minimum of 10 years of follow-up and to evaluate problems of early delta ceramic liner.

大直径陶瓷-陶瓷股骨头在保留股骨假体全髋关节翻修术中的应用

目的评价大直径陶瓷-陶瓷股骨头在保留股骨假体全髋关节翻修术中应用的临床疗效。方法回顾性分析自2006-01—2012-12在保留股骨假体全髋关节翻修术中应用直径36 mm陶瓷-陶瓷股骨头假体的32例（32髋）的临床资料。手术前后评估髋关节功能Harris评分,术后6周、6个月、1年及随后每隔半年随访中临床及X线片评价是否出现假体脱位、松动、下沉、骨溶解、陶瓷碎裂。结果 32例均获得随访平均26.2（11.0-38.0）个月。末次随访时髋关节功能Harris评分从术前平均68.9（9.0-87.0）分提高到85.0（39.0-98.0）分,差异有统计学意义（t=17.36,P=0.013）。均未出现假体脱位、松动、下沉、骨溶解、陶瓷破碎。结论大直径陶瓷-陶瓷股骨头在保留股骨假体的全髋关节翻修术中可以显著降低术后假体脱位率,不增加股骨侧假体周围骨溶解,可以获得较好的近、中期疗效。     

Mid term results of total hip arthroplasty using polyethylene-ceramic composite (Sandwich) liner

Background:

Ceramic-on-ceramic (COC) couplings are an attractive alternative bearing surfaces that have been reported to eliminate or reduce problems related to polyethylene wear debris. However, the material in total hip arthroplasty (THA) remains one of the major concern regarding the risk of fracture. The present study aims at reporting the fracture rate of bearings in a series of COC THAs with the use of a sandwich liner and attempt to detect the relative risk factors, the possible cause and assess the clinical results.

Materials and Methods:

We retrospectively evaluated 153 patients (163 hips) using the sandwich liner COC THA between 2001 and 2009. Patient assessment was based on demographic factors, including age, weight, gender and body-mass index (BMI). All patients were evaluated clinically and radiographically or using computed tomography viz-a-viz dislocation, osteolysis, periprosthetic fracture, infection, loosening and implant fracture.

Results:

Three ceramic sandwich liners fracture (1.84%) were observed at an average of 7.3 years’ followup. The factors which were found to be non-significant to the ceramic liner fracture, included age (P = 0.205), weight (P = 0.241), gender (P = 0.553), BMI (P = 0.736), inclination (P = 0.199) and anteversion (P = 0.223). The overall survival was 91.4% at 12-year with revision as the endpoint. Other complications included osteolysis in 4 (2.45%), dislocation in one and periprosthetic fracture in one. In no hip aseptic loosening of the implants was seen.

Conclusions:

Our experience with the ceramic-polyethylene sandwich liner acetabular component has been disappointing because of the high rate of fracture and osteolyis. We have discontinued the use of this device and recommend the same.