Abstract
This study aimed to evaluate (1) the overall reasons for first revision in CoC THAs; (2) whether the reasons for revision differ between third-generation and fourth-generation CoC THAs; and (3) the specific factors associated with bearing-related problems as the reason for revision. We retrospectively reviewed 2045 patients (2194 hips) who underwent first revision THA between 2004 and 2013, among which 146 hips with CoC bearings underwent revision. There were 92 hips with third-generation ceramic bearings and 54 hips with fourth-generation ceramic bearings. The major reasons for CoC THA revisions were ceramic fracture and loosening of the cup or stem. When ceramic fracture, squeaking, incorrect ceramic insertion, and unexplained pain were defined as directly related or potentially related to ceramic use, 28.8% (42/146) of CoC revisions were associated with bearing-related problems. Among the third-generation ceramic bearings, revision was performed in 41.3% (38/92) of cases owing to bearing-related problems whereas revisions were performed for only 7.4% (4/54) of cases with fourth-generation ceramic bearings owing to bearing-related problems (p < 0.001). Younger age, lower American Society of Anesthesiologists (ASA) grade, and preoperative diagnosis of osteonecrosis were factors related to CoC THA revisions due to bearing-related problems.
Highlights
Ceramic-on-ceramic (CoC) bearing was introduced in total hip arthroplasty (THA) in the early 1970s because its properties of high-wear resistance and biocompatibility were superior to those of the alloys and polymers in use at the time[1]
According to the diameter of the ceramic bearing, ceramic fracture was a major reason for 28 mm-head THA revisions, whereas prosthesis loosening was a major reason for 32 or 36 mm-head THA revisions (Fig. 3)
When the reasons directly or potentially related to ceramic use were defined as bearing-related problems, the third-generation CoC THA revisions were associated with a higher proportion of bearing-related problems than the fourth-generation CoC THAs [38/92 (41.3%) vs. 4/54 (7.4%), p < 0.001]
Summary
Ceramic-on-ceramic (CoC) bearing was introduced in total hip arthroplasty (THA) in the early 1970s because its properties of high-wear resistance and biocompatibility were superior to those of the alloys and polymers in use at the time[1]. The third-generation of alumina ceramics has showed promising results in CoC THA, concerns such as limited sizing options, stripe wear, breakage and squeaking persist[4,5,6]. Further improvements in the mechanical and wear performance led to the development of the fourth-generation of CoC bearing (Biolox Delta; CeramTec AG). Despite the increased use of CoC bearings in recent years, the reasons behind the need for revisions of CoC THAs are not well understood. A 10-year minimum follow-up data of 301 CoC THAs showed that out of nine revisions, four occurred due to periprosthetic femoral f racture[8]. We sought to determine (1) the overall reasons for first revision in CoC THAs; (2) whether the reasons for revision differ between the third- and fourth-generation CoC THAs; and (3) the specific factors related to bearing problems as the reason for revision
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