Outcomes of Ceramic Composite in Total Hip Replacement Bearings: A Single-Center Series

Giuseppe Solarino,Antonio Virgilio,Marco Baglioni,Antonio Spinarelli,Biagio Moretti,Filippo Simone

doi:10.3390/jcs5120320

Abstract

Despite the fact that total hip replacement is one of the most successful surgical procedures for treatment of a variety of end-stage hip diseases, the process of osteolysis and implant loosening remains a significant problem, especially in young and high-demand patients. More than 40 years ago, ceramic bearings were introduced due to their mechanical advantage in order to obtain a reduction in wear debris, and due to the conviction that it was possible to minimize friction and wear owing to their mechanical hardness, high chemical stability, surface lubrication by fluids and low friction coefficient. Together with excellent mechanical properties, ceramics have a biological inertness: eventual ceramic debris will lead to a reactive response with a high predominance of fibrocystic cells, rather than macrophagic cells, and absence of giant cells, which is ideal from a biological perspective. As a consequence, they will not trigger the granulomatous reaction necessary to induce periprosthetic osteolysis, and this clearly appears to be of great clinical relevance. In recent years, tribology in manufacturing ceramic components has progressed with significant improvements, owing to the development of the latest generation of ceramic composites that allow for an increased material density and reduced grain size. Currently, ceramic-on-ceramic bearings are considered the attractive counterparts of ceramic- or metal-on-polyethylene ones for patients with a long life expectancy. The aim of this paper is to report the results of total hip replacements performed with a ceramic-on-ceramic articulation made from a ceramic composite in a single center, focusing on its usefulness in specific preoperative diagnosis.

Highlights

One of the most successful operations in the orthopedic surgery field is prosthetic hip replacement, owing to the excellent immediate results, and in the long term, it is possible to obtain a rapid recovery with great satisfaction from patients
Avascular necrosis (AVN) or osteonecrosis of the femoral head is caused by a lack of blood supply in the region; in the later stages of the disease, bone is reabsorbed and the epiphysis collapses: it is obvious that hip replacement with THA, which provides immediate pain relief and excellent functional outcomes, should be considered the preferred treatment
Berry et al [28] examined the cumulative incidence of dislocation in a cohort of over 6000 prosthetic hips and found it to be more than doubled (14.1% compared to 6.4%) in patients with osteonecrosis than in those with osteoarthritis; their research found that dislocation rates rise with extended durations of follow-up, possibly reflecting the impact of neuromuscular degeneration and, in particular, wear at the metal-on-polyethylene articulating surface

Summary

Introduction

One of the most successful operations in the orthopedic surgery field is prosthetic hip replacement (total hip arthroplasty, THA), owing to the excellent immediate results, and in the long term, it is possible to obtain a rapid recovery with great satisfaction from patients.Over the years, there has been continuous research in order to obtain an improvement in the components of prostheses in order to reduce complications and maximize results.From a tribological point of view, there has been a continuous development of materials and a continuous search for the best combinations of materials, especially in terms of duration and complications. One of the most successful operations in the orthopedic surgery field is prosthetic hip replacement (total hip arthroplasty, THA), owing to the excellent immediate results, and in the long term, it is possible to obtain a rapid recovery with great satisfaction from patients. There has been continuous research in order to obtain an improvement in the components of prostheses in order to reduce complications and maximize results. The choice of materials is, able to influence the functional recovery, to reduce the risk of complications including the formation of debris and to reduce the number of revisions, influencing the long-term duration of prostheses. In 1971, Pierre Boutin introduced the ceramic alumina as a coupling in hip implants, realizing the alumina-on-alumina THA procedure [1]

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