Ceramic-on-ceramic total hip arthroplasty: incidence of instability and noise.

Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY10021, USA.
Clinical Orthopaedics and Related Research (Impact Factor: 2.79). 02/2011; 469(2):437-42. DOI: 10.1007/s11999-010-1574-3
Source: PubMed

ABSTRACT Alternative bearing materials in THA have been developed to reduce the incidence of osteolysis. Alumina-on-alumina bearings exhibit extremely low wear rates in vitro, but concerns exist regarding component impingement with the potential for dislocation and the occurrence of noise.
We determined generation of squeaking and the relationship between squeaking and component position.
We prospectively entered 436 alumina-on-alumina, cementless, primary THAs in 364 patients into our institutional database. All procedures were performed with the same surgical technique and the same implant. We obtained Harris Hip scores and a noise questionnaire and assessed radiographic component position and loosening. We determined the difference in abduction angle between squeakers and nonsqueakers. Minimum followup was 2 years (average, 3.5 years; range, 2.0-6.2 years).
The mean Harris hip score increased from 51.9 preoperatively to 94.4 at latest followup. Six hips underwent reoperation: four hips (1.1%) for dislocation and two (0.53%) for periprosthetic fracture after trauma. The incidence of noise of any type was 11%, with the most common type of noise being clicking or snapping. Squeaking was reported by 1.9% of patients, with no patient being revised for this phenomenon. We found no association between component position and squeaking.
At average 3 years followup, 98% of ceramic-on-ceramic THAs did not require a revision, with 1.1% of hips having been revised for dislocation. Fewer than 2% of patients reported hearing an audible squeak, with no association found between component position and squeaking.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Ceramic-on-ceramic (CoC) bearings have excellent tribologic properties because of the smoothness, hardness, and wettability of the material. Therefore, their use has been proposed in younger, active patients who may wear out a traditional metal-on-polyethylene bearing. The same material properties that are beneficial to tribology may also create problems, however. For example, squeaking and fracture of the bearing materials have been reported to occur. The purpose of this paper was to investigate the literature reporting the complications of ceramic bearings and attempt to provide insight into their implications. The US National Library of Medicine Database (PubMed) was searched using the terms "ceramic-ceramic total hip replacement," "complications," "squeaking," and "fracture." Only clinical studies with a clear reporting of the incidence of these complications were included. The literature reports that squeaking of the CoC bearing occurs in a certain percentage of patients and is likely indicative of edge loading and excessive wear. Other factors, such as patient height, weight, range of motion, and implant design, may contribute to the propensity for squeaking. Fracture is a unique risk of the CoC articulation that requires revision surgery. Though improvements in manufacturing techniques have reduced the fracture risk to a very low percentage, the ceramic material remains susceptible to this complication by impingement and component malposition. Because of these possible negative outcomes associated with the ceramic material, the CoC bearing is too unpredictable to use regularly, and its use should be limited to patients who would benefit the most from it.
    HSS Journal 10/2012; 8(3):287-290.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose There have been some reports of incomplete seating of the ceramic liner in the Stryker Trident acetabular system. We sought to prevent incomplete seating through the use of intraoperative radiography. Method We retrospectively reviewed 21 hips in 18 patients who had undergone total hip arthroplasty using a posterolateral approach with a Stryker Trident ceramic liner. All procedures included an intraoperative anteroposterior view radiograph to evaluate liner seating. If incomplete seating was recognized we reinserted the liner. We investigated whether this technique made it possible to detect and correct incomplete seating. Results Six of the 21 hips evidenced incomplete seating. In four of these hips, the incomplete seating was revealed on the intraoperative radiograph: two were reinserted properly, one was replaced with a polyethylene liner, and in the last one the incomplete seating was missed despite the radiographical evidence. The location of the gap between the socket and liner caused by the incomplete seating was inferior in all these cases. Intraoperative radiography did not indicate incomplete seating in two hips in which the location of the gap was anterior; the problem was revealed by postoperative lateral view radiography. Conclusion With a posterolateral approach in a lateral decubitus position, the use of intraoperative radiography was effective when the gaps were superior or inferior. However, this approach made it easy to miss anterior gaps and intraoperative radiography did not reveal them.
    European Orthopaedics and Traumatology. 4(1).
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: A spherical pressfit cup with a new ceramic liner was introduced in a clinical trial in order to improve range of motion and reduce wear induced problems. The early clinical and radiological outcome was assessed. In a prospective cohort study 181 hips received a seleXys TH+<sup>®</sup> cup (Mathys, Bettlach, Switzerland) in combination with a third generation ceramic liner (ceramys<sup>®</sup>, Mathys, Bettlach, Switzerland). The Harris Hip Score (HHS), pain (VAS) and range of motion (ROM) were recorded, cup migration and inclination were measured. Experience of any noise was documented. Fourteen hips were radiologically loose, seven of them were revised. Two-year survival of the cup was 92% with radiological loosening as the endpoint. There was no correlation between head size and ROM, no patient had a dislocation. There were no ceramic fractures. Two patients experienced squeaking and three clicking at final follow-up. Reasons for loosening might have been multifactorial but the rate of failure was unacceptably high. The use of large heads did not improve the ROM and development of noise could not be prevented with the modern ceramic. We abandoned the use of this implant system.
    Hip international: the journal of clinical and experimental research on hip pathology and therapy 02/2014; · 0.34 Impact Factor

Full-text (2 Sources)

Available from
May 31, 2014