Primary Cementless Total Hip Arthroplasty with a Ceramic Sandwich Liner and a Third Zweymuller Stem: Minimum 8-Year Follow up Results / 대한고관절학회지

PURPOSE: The purpose of this study is to evaluate the minimum eight-year follow up results of primary total hip arthroplasty (THA) performed using an alumina sandwich liner and the third Zweymuller stem. MATERIALS AND METHODS: A total of 86 patients (107 hips) who underwent a THA with alumina sandwich liners and the third Zweymuller stems from July 2001 to December 2003 were analyzed. Mean age of patients at the time of THA was 50.8 years (range, 17-77 years) and the mean follow-up period was 112 months (range, 98-127 months). Clinical evaluation was performed using the Harris hip score and level of thigh pain. The radiographic evaluation was performed in terms of the radiolucent line, subsidence of the stem, migration of the acetabular cup, and proof of loosening. RESULTS: At the final follow-up, mean Harris hip score had improved from 57.8 points to 91.9 points. Radiolucent line was observed at Gruen zone 1 in 40 cases (37%) and at zone 7 in 35 cases (33%); however, no detectable loosening was observed. There were six cases (5.6%) of fracture of the ceramic liner, one case of ceramic liner dissociation, and one case of stem loosening due to infection. CONCLUSION: At the minimum eight-year follow up, survival rate of the third Zweymuller stem was 99.1%. However, owing to the high rate of fractures of the ceramic sandwich liners, the survival rate of the ceramic liner was 93.5%.

Total Hip Arthroplasty using Sandwich type Ceramic-Ceramic Articulation: Minimal 2 years follow-up / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical and radiological results of total hip replacement arthroplasty using a cementless, sandwich (alumina-polyethylene-titanium) acetabular component and the cause of three ceramic liner fracture. MATERIALS AND METHODS: From June 1999 to December 2001, one hundred and twenty eight (110 patients) among 146 cases (129 patients) who were underwent total hip replacement arthroplasty using a sandwich type acetabular component, were followed up for minimum 24 months (range, 54-24 months). Among 110 patients, 85 patients (101 cases) were men and 25 patients (27 cases) were women. Their mean age was 48.8 years (range, 17-78 years) old. The patients were examined clinically and radiologically at postoperative 1 month, 3 months, 6 months, 1 year and every year, thereafter. RESULTS: At the median followup of 32 months, the average Merle d'Aubigne and Postel score had improved from 8.4 to 16.7. Results were graded as excellent in 110 hips (86%), and very good in 18 hips (14%). At the last followup, all component including acetabular cup and femoral stem acquired firm bony union. Neither component migration nor acetabular osteolysis was detected. Finally three fracture and dislocation of ceramic liner developed and the fractured liners were changed other sandwich type or polyethylene liner. CONCLUSION: Even though short-term clinical result of total hip replacement arthroplasty using sandwich type acetabular component is excellent, two percent of the ceramic liner fracture incidence is unexpected high. So we have to caution with using sandwich acetabular cup. In addition, ceramic acetabular cup need more precising surgical technique.

Dissociation of Sandwich Ceramic Liner: A Case Report / 대한정형외과학회잡지

In total hip replacement with a sandwich ceramic liner, liner dissociation is rare. We experienced one case of sandwich ceramic liner dissociation at 3 years 7 months after total hip replacement in avascular necrosis of the femoral head. The patient was treated by revisional total hip arthroplasty and a new sandwich liner and head were fitted. We describe this one rare case and review the literature.