Abstract
BackgroundHip prosthetic replacement surgery is the gold standard for patients affected by symptomatic osteoarthritis. The ceramic-on-metal hybrid hard-on-hard bearing was initially launched on the market with the purpose of reducing adhesive and corrosion wear, loss of metal debris and ions and risk of fracture and squeaking. However, this bearing was withdrawn from the market, in the apprehension of local and systemic toxicity. The aim of this study is to evaluate the reliability and safety of ceramic-on-metal bearing at long term follow-up.MethodsFrom 2 cohorts of patients suffering of hip osteoarthritis who underwent total hip arthroplasty using ceramic-on-metal bearing with two different short stems, 19 of the GROUP A and 25 of the GROUP B were suitable for this study. All patients were compared clinically using the Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analogue scale (VAS), 12-item Short Form Health Survey (SF12P/M), and radiographically. Blood samples were collected in order to evaluate chromium and cobalt ions level. The two groups were compared in terms of metal ions blood levels, and finally all the implanted prostheses were compared with a healthy control group.ResultsAll the implanted stems were well-positioned and osseointegrated at a mean follow-up of 114 months. Improvements were observed for all clinical scores comparing preoperative and postoperative values in both groups. Radiographic evaluation showed a good ability to restore proper articular geometry. Chromium and cobalt ion analysis revealed values below the safety threshold except for 1 case in GROUP A (cup malposition) and 2 cases in GROUP B (6.1%). No revision occurred.ConclusionsCeramic-on-metal bearing is safe and reliable at long term follow-up in association to short stems arthroplasty, if the implant is correctly positioned. Chromium and cobalt metal ions blood levels evaluation should be performed annually.
Highlights
Hip prosthetic replacement surgery is the gold standard for patients affected by symptomatic osteoarthritis
There was a marked improvement in all the parameters compared to the preoperative conditions
Pain was significantly reduced in both groups, (VAS of GROUP A vs. GROUP B) from 66 to 4.5 and from 72.4 to 5.5 (t: 17.23; p < 0.001 for GROUP A; t: 19.32; p < 0.001 for GROUP B)
Summary
Hip prosthetic replacement surgery is the gold standard for patients affected by symptomatic osteoarthritis. The ceramic-on-metal hybrid hard-on-hard bearing was initially launched on the market with the purpose of reducing adhesive and corrosion wear, loss of metal debris and ions and risk of fracture and squeaking. This bearing was withdrawn from the market, in the apprehension of local and systemic toxicity. Prosthetic replacement surgery is nowadays the gold standard for those patients in whom conservative treatment have lost its effectiveness This technique, introduced in the seventies of the twentieth century, Logroscino et al BMC Musculoskeletal Disorders (2021) 22:1065 guarantees high standards of safety and reliability. Ceramic-onCeramic (CoC) coupling is certainly the most reliable and long-lasting one, thanks to the development of Alumina and Zirconia-based composites [1]
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