Alumina-Debris-Induced Osteolysis in Contemporary Alumina-on-Alumina Total Hip Arthroplasty

Abstract

Aceramic-on-ceramic bearing coupling, because of its qualities of reduced friction and wear, is an attractive alternative bearing surface in total hip arthroplasty. The use of such bearing couplings is likely to reduce problems related to polyethylene wear debris1-6. Osteolysis has only rarely been reported in association with ceramic-on-ceramic bearing couplings, and reports are generally limited to cases involving early generation ceramic bearings or loosened prostheses7,8. Recently, several cases of osteolysis have been reported after total hip arthroplasty with use of a contemporary alumina bearing, but these reports only described the femoral scalloping seen on radiographs and did not present any histological evidence that ceramic particles were the causative factor9. We present the case of a patient who had formation of a large amount of osteolysis about both the acetabulum and the proximal part of the femur, induced by ceramic wear particles from a well-functioning contemporary alumina-on-alumina total hip prosthesis. The patient was informed that data concerning the case would be submitted for publication, and she consented. A sixty-three-year-old woman underwent bilateral total hip arthroplasty in June 1998 for the treatment of corticosteroid-induced osteonecrosis. The arthroplasties included the use of cementless implants (PLASMACUP SC-BiCONTACT; Aesculap, Tuttlingen, Germany) that incorporated 28-mm alumina femoral heads and alumina acetabular inserts (BIOLOX forte; CeramTec, Plochingen, Germany). The PLASMACUP had a roughened titanium plasma-sprayed exterior and a machined interior that accepted an alumina insert with a self-locking press-fit taper. The BiCONTACT stem was a tapered, rectangular, titanium-alloy implant, the proximal one-third of which was surface-treated with titanium plasma spray. The alumina head was secured to the stem by means of a tapered cone. After surgery, the patient did not present for regular follow-up visits and did not revisit our clinic until June 2006. At the time …