Abstract
Although ceramic-on-ceramic bearings for total hip arthroplasty (THA) show promising results in terms of bearing-surface wear, fracture of the bearing, insertional chips, and squeaking remain a concern. Our primary objective of this report was to determine overall survivorship of a titanium-encased ceramic-on-ceramic bearing couple. Our secondary objectives were to evaluate for ceramic fracture, insertional chips, osteolysis, and device squeaking. Six surgeons at six institutions implanted 194 patients (209 hips) with an average age of 52 years with cementless hips and alumina ceramic bearings. One hundred thirty-seven patients (146 hips) have 10-year followup (70%). We determined Kaplan-Meier survivorship of the bearing surface and implant system and collected radiographic and clinical data to evaluate for osteolysis and squeaking. Survivorship using revision for any reason as the end point was 97% at 10 years and survivorship end point bearing surface failure or aseptic loosening of 99%. There was one ceramic insert fracture (0.5%), there were no insertional chips, there was no visible osteolysis on AP and lateral radiographs, and there was a 1% patient-self-reported incidence of squeaking at the last clinical followup. Six hips underwent revision (3.7%). Ceramic bearings for THA with a titanium-encased insert have high survivorship at 10 years followup and a fracture risk of 0.5%. We found at last followup on routine radiographs no evidence of osteolysis, and no patient has been revised for squeaking or has reported dissatisfaction with the clinical result because of noise. IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Highlights
The major advantages of alumina ceramic bearings for total hip arthroplasty (THA) include their hardness and scratch resistance, low coefficient of friction, hydrophilic nature and superior lubrication, less reactive particulate debris, and superior wear resistance [2, 5, 7].612 D’Antonio et al.Clinical Orthopaedics and Related Research1Early experiences dating back to the 1970s had failures primarily related to aseptic loosening and ceramic fractures [1, 6, 16]
There was one ceramic insert fracture (0.5%), there were no insertional chips, there was no visible osteolysis on AP and lateral radiographs, and there was a 1% patientself-reported incidence of squeaking at the last clinical followup
We found at last followup on routine radiographs no evidence of osteolysis, and no patient has been revised for squeaking or has reported dissatisfaction with the clinical result because of noise
Summary
The major advantages of alumina ceramic bearings for THA include their hardness and scratch resistance, low coefficient of friction, hydrophilic nature and superior lubrication, less reactive particulate debris, and superior wear resistance [2, 5, 7].612 D’Antonio et al.Clinical Orthopaedics and Related Research1Early experiences dating back to the 1970s had failures primarily related to aseptic loosening and ceramic fractures [1, 6, 16]. In the mid-1990s a new generation of alumina ceramic bearings was developed (Biolox Forte; Ceram Tec, Plochingen, Germany) [7]. This new ceramic material is of higher quality, has greater burst strength, and currently is mated with implants that have excellent fixation records and high taper tolerances [4, 7, 13, 16]. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. This work was performed at Sewickley Valley Hospital Sewickley, PA, USA; Indiana University School of Medicine, Indianapolis, IN, USA; and Stryker Orthopaedics, Mahwah, NJ, USA
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