Ceramic-on-ceramic articulation in press-fit total hip arthroplasty as a potential reason for early failure, what about the survivors: a ten\xa0year follow-up

J Van Loon,I N Sierevelt,D C Baas,D Haverkamp,G M M J Kerkhoffs,H M Van Der Vis,A M J S Vervest,K T M Opdam

doi:10.1007/s00264-020-04895-1

J Van Loon, I N Sierevelt + Show 6 more

Open Access

https://doi.org/10.1007/s00264-020-04895-1

Copy DOI

Abstract

PurposeIn press-fit total hip arthroplasty (THA), primary stability is needed to avoid micromotion and hereby aseptic loosening, the main reason for early revision. High aseptic loosening revision rates of the seleXys TH+ cup (Mathys Medical) with Ceramys ceramic-on-ceramic (CoC) bearing are seen in literature. Since CoC is presumed to overcome long-term wear-related revisions, the reason for early failure of this cup is important to clarify. The aim is to investigate its ten year outcomes and differentiate between potential causes and identify risk factors for aseptic loosening.MethodsRetrospective screening of a prospectively documented series of 315 THAs was performed. Primary outcome was cumulative incidence of cup revision due to aseptic loosening. Secondary outcomes were component revision and reoperation. Additionally, potential predictive factors for aseptic loosening were evaluated.ResultsAt the median follow-up of 9.7 years [IQR 4.4; 10.3], 48 TH+ (15.2%) were revised due to aseptic loosening. Competing risk analysis showed a ten year cumulative incidence of cup revision due to aseptic loosening of 15.6% (95% CI 12.0–20.2). Stabilization of early revision rates was observed, following a high rate of respectively 81.3% (n = 39) and 95.8% (n = 46) within the first two and three years. No significant predictive factors for aseptic loosening were found.ConclusionThe ten year results of seleXys TH+ cup with Ceramys CoC bearing showed an unacceptable high aseptic loosening rate, which stabilized over time after a high early failure incidence. This could be attributed to a problem with osseointegration during the transition of primary to definitive stability.

Highlights

Materials and methodsDuring press-fit total hip arthroplasty (THA), the initial primary stability of the uncemented acetabular cup during implantation is the most important factor for survival of the implant [1, 2]
The 10-year results of seleXys TH+ cup with Ceramys CoC bearing showed an unacceptable high aseptic loosening rate, which stabilized over time after a high early failure incidence
Writing of the study protocol was performed by J. van Loon, D.C

Summary

Introduction

Materials and methodsDuring press-fit total hip arthroplasty (THA), the initial primary stability of the uncemented acetabular cup during implantation is the most important factor for survival of the implant [1, 2]. Micromotion jeopardizes osseointegration and definitive secondary stability, which can cause aseptic loosening of the implant, one of the main reasons for early revision in THA [4,5,6]. Focusing on the long term, aseptic loosening caused by wear-induced osteolysis is regarded as the main limitation of prosthesis survival [7, 8]. To overcome both of these problems, the search for the perfect implant still continues. Ceramic-on-ceramic (CoC) is one of the options to overcome wear and late revisions. This hard-on-hard bearing shows wear rates of 5 μm/year compared with 50 μm/year in ceramic-on-polyethylene (CoPE) bearing during 20 years [9]

Objectives

Results

Discussion

Conclusion