Primary Total Hip Arthroplasty Using Third Generation Ceramic-Ceramic Articulation: Results after a Minimum of Three-years of Follow-up / 대한고관절학회지

PURPOSE: This study assessed the short term clinicoradiological results of primary total hip arthroplasty using third generation ceramic-ceramic articulation Accolade TMZF femoral stems. MATERIALS AND METHODS: Two hundred and seventy two patients (294 hips) with primary total hip arthroplasty using third generation ceramic-ceramic articulation Accolade TMZF femoral stems who had been followed-up for a minimum of 3 years were included. Clinicoradiological results were analyzed and postoperative complications were observed. RESULTS: At final follow-up, mean Harris hip score was increased from 52 to 94 points. On radiogical evaluation, the average acetabular inclination was 42 degrees and the average acetabular anteversion was 15 degrees. Neither osteolysis nor loosening were observed around the acetabulum or proximal femur. Among 294 acetabular cups, 293 cups (99.66%) achieved stable fixation. Regarding the 294 femoral stems, 286 (97.28%) had bony fixation, 7 (2.38%) had fibrous fixation, and none were found to have unstable stem fixation. Proximal bone resorption was observed in 17 hips (5.78%; only Grade 1) and radiolucent lines were observed in 88 hips (29.93%), however, all were around the distal smooth portion of the stems. Postoperative complications included dislocation in 6 hips (2.04%), heterotopic ossification in 3 hips (1.02%), ceramic fractures in 4 hips (1.36%), superficial infection in 1 hip (0.34%), and squeaking in 8 hips (2.72%). CONCLUSION: The short term clinicoradiological results of primary total hip arthroplasty using third generation ceramic-ceramic articulation and Accolade TMZF femoral stems together with Secur-Fit acetabular cups were satisfactory. However, problems such as ceramic fractures and squeaking after arthroplasty were observed. Additional studies are necessary in order to develop methods that may reduce or eliminate these complications.

Cementless Total Hip Arthroplasty Using a Ceramic on Ceramic Bearing Surface: The Clinical Results of a Minimum 10-year Follow-up for Patients with Short Term Follow-up / 대한고관절학회지

PURPOSE: The purpose of this study is to report on the clinical results of more than 10 years of follow-up after ceramic articulation total hip arthroplasty in patients younger than 50 years old who had reported a result of short-term follow-up. MATERIALS AND METHODS: We studied 25 patients who underwent cementless THA using ceramic on ceramic articulation between Jan 1998 and Dec 2001. They were followed up for 2-4 years, with good results, and could be followed up for more than 10 years. The evaluation of clinical results included Harris hip score (HHS) and occurrence of thigh pain. Radiologic evaluation was based on osteolysis and the stability of components. RESULTS: The mean HHS improved from 57.7 to 93.3 during the period of 2-4 years of follow-up and 91.0 at more than 10 years of follow-up. Two patients experienced thigh pain during the period of 2-4 years of follow-up and none of the patients had thigh pain at more than 10 years of follow-up. On the last radiographs, stable fixation was observed in all cases, except for one case of ceramic fracture. CONCLUSION: Clinical and radiologic observations of cementless ceramic on ceramic articulation THA in active patients younger than 50 years old who reported a favorable short-term result showed a satisfactory long-term result.

Repeated Ceramic Head Fracture after Ceramic-on-ceramic Total Hip Arthroplasty

Alumina ceramic-on-ceramic total hip arthroplasty is a widely-adopted option, especially for younger patients, due low wear, scratch resistance, the wettable characteristics of alumina ceramics, and because of the relatively low biological reactivites of ceramic wear particles. However, fracture remains a significant problem because ceramics are inherently brittle, and few reports have been issued on short head fractures. In the described case, a ceramic head fracture occurred only 8 months after replacing the original head and with a new 28 mm head and liner. Both of these incidents may have been caused by head-to-liner impingement due to excessive anteversion of the metal shell. During the second revision surgery, this situation was managed successfully using a conventional elevated-polyethylene liner and a CoCr metal head, while retaining all metal implants.

Primary Cementless Total Hip Arthroplasty with a Sandwich Type in Ceramic-Ceramic Articulation (Minimum 10-Year Follow up Results)

PURPOSE: To evaluate the minimum 10-year follow up results of primary total hip arthroplasty (THA) performed using a sandwich-type (alumina-polyethylene-titanium) ceramic bearing. MATERIALS AND METHODS: Thirty four patients (40 hips) who underwent a THA with sandwich typed liners from November 1998 to December 2000 were analyzed. Among the 34 patients, 25 were men and nine were women. Mean follow-up was 134 months (range, 120~145 months) and mean patient age at the time of THA was 47.1 years (range, 24~65 years). The clinical results were evaluated using the Harris hip score and level of thigh pain with a limping gait. The radiographic evaluation was done in terms of the endosteal new bone formation, radiolucent line, subsidence of the stem, migration of the acetabular cup, and proof of loosening. RESULTS: The mean preoperative Harris hip score of 50.2 points (range, 31~87 points) was improved to 90.9 points (range, 75~99 points) at the final follow-up and thigh pain with limping gait in one case. All cases had fixation by bony ingrowth. No radiographically detectable loosening was observed in any hip. Fracture of ceramic liner in one case required change of the polyethylene liner. CONCLUSION: At the minimum 10-year follow up, survival rate as the end-point was favorable. However, fracture of the ceramic is still a major problem. Satisfactory results can be obtained by more precise surgical technique for acerabular inclincation and anteversion, and by improving the quality of the ceramic.

Ceramic on Sandwich Ceramic Bearing Primary Cementless Total Hip Arthroplasty (Result of 2 to 5 years follow up) / 대한정형외과학회잡지

PURPOSE: To evaluate the short term clinical and radiological results of ceramic on sandwich ceramic bearing a primary cementless total hip arthroplasty. MATERIALS AND METHODS: Seventy-five hips, which underwent a total hip arthroplasty with sandwich typed liners as an index operation between December 1998 and October 2001 were examined. The mean follow-up period was 34.3 months, and the mean ages at surgery was 56. The clinical results were evaluated using the Harris hip score and the level of thigh pain. In addition, the radiolucent line, the subsidence of the stem, the migration of the acetabular cup, or osteolysis, proving and proof of loosening. RESULTS: The mean preoperative Harris hip score of 51.8 points was improved to 94.3 points at the final follow-up after surgery. Two cases were the fracture of ceramic components in postoperative three year. One of them was a fracture of the ceramic head and the other was a fracture and dislocation of the liner. Radiologically, there was one case of femoral stem subsidence and radiolucent line. CONCLUSION: The minimum 2-year clinical and radiological results of using ceramic sandwich ceramic bearing were satisfactory. However, breakages (fractures) of the ceramics have become an issue. Satisfactory clinical results can be obtained by limiting the acetabular inclination ranges from 40degrees to 45degrees, using a ceramic head with a larger diameter to increase the ratio between the diameter of the femoral head and neck, avoiding the use of a flange, reducing of the diameter of the femoral neck, the use of a thick-rimmed liner and improving the quality of the ceramic set. Therefore, the use of a sandwich ceramic liner needs to be reconsidered.