Comparison of Surgical Outcomes and Implant Wear Between Ceramic-Ceramic and Ceramic-Polyethylene Articulations in Total Hip Arthroplasty

Department of Orthopaedic Surgery, University of California at Davis Medical Center, Sacramento, California 95817, USA.
The Journal of arthroplasty (Impact Factor: 2.67). 06/2011; 26(6 Suppl):72-7. DOI: 10.1016/j.arth.2011.04.032
Source: PubMed


The results of a prospective multicenter trial comparing 357 hips randomized to total hip arthroplasty with either ceramic-ceramic or ceramic-polyethylene couplings are presented. No statistically significant difference in clinical outcomes scores between the ceramic-ceramic and ceramic-polyethylene groups was observed at any time interval. The mean linear rate was statistically lower (P < .001) in the ceramic-ceramic group (30.5 μm/year) when compared with the ceramic-polyethylene group (218.2 μm/year). The rates of ceramic implant fracture (2.6%) and audible component-related noise (3.1%) were statistically higher in the ceramic-ceramic group when compared with the ceramic-polyethylene group (P < .05). Lastly, there was no statistically significant difference in the dislocation or revision rate between the groups at the time of last clinical follow-up.

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Available from: Paul Dicesare, Jan 17, 2014
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    • "However, there is a concern about ceramic head fracture, therefore, ceramic head with polyethylene liner has been introduced. Several laboratory and clinical studies6,10 found that ceramic-on-polyethylene articulations have lower wear rate than those of metal-on-polyethylene articulation. The fracture rate of ceramic head in ceramic-on-ceramic articulation has been shown to range from 0.004% to 0.05%.5 "
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    ABSTRACT: Revision rates of total hip arthroplasty have decreased after introducing total hip arthroplasty (THA) using ceramic component, since ceramic components could reduce components wear and osteolysis. The fracture of a ceramic component is a rare but potentially serious event. Thus, ceramic on polyethylene articulation is gradually spotlighted to reduce ceramic component fracture. There are a few recent reports of ceramic head fracture with polyethylene liner. Herein, we describe a case of a ceramic head component fracture with polyethylene liner. The fractured ceramic head was 28 mm short neck with conventional polyethylene liner. We treated the patient by total revision arthroplasty using 4th generation ceramic on ceramic components.
    Full-text · Article · Nov 2013 · Yonsei medical journal
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    ABSTRACT: Ceramic on ceramic (COC) total hip arthroplasty (THA) was developed to reduce wear debris and accordingly, the occurrence of osteolysis and aseptic loosening especially in younger patients. Based on the excellent tribological behavior of current COC bearings and the relatively low biological activity of ceramic particles, significant improvement in survivorship of these implants is expected. We used manual search to identify all relevant studies reporting clinical data on COC THAs in PubMed. The objective was to determine whether current COC THA offers a better clinical outcome and survivorship than non-COC THA. Studies with early generation ceramic bearings yielded 68% to 84% mean survivorship at 20 years follow-up which is comparable with the survivorship of non-COC THAs. Studies on current ceramic bearings report a 10-year revision-free interval of 92% to 99%. These outcomes are comparable to the survivorship of the best non-COC THAs. However, there are still concerns regarding fracture of sandwich ceramic liners, squeaking, and impingement of the femoral neck on the rim of the ceramic liner leading to chipping, especially in younger and physically active patients. Current COC THA leads to equivalent but not improved survivorship at 10 years follow-up in comparison to the best non-COC THA. Based on this review, we recommend that surgeons weigh the potential advantages and disadvantages of current COC THA in comparison to other bearing surfaces when considering young very active patients who are candidates for THA.
    Preview · Article · Sep 2012 · Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia
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    ABSTRACT: BACKGROUND: Hypothesized risk factors for fracture of ceramic liners include impingement, edge-loading, and cup malpositioning. These risk factors are similar to those for generation of stripe wear. However, it is unclear whether the biomechanical conditions contributing to stripe wear generation also increase the risk for ceramic liner fracture QUESTIONS/PURPOSES: We asked whether (1) head stripe wear propensity; and (2) cup orientation would correlate with alumina liner fracture risk for instances of normal and elevated body weight. METHODS: An eXtended Finite Element Method (XFEM) model was developed to investigate these mechanisms. Liner fracture risk for 36-mm alumina bearings was studied by simulating two fracture-prone motions: stooping and squatting. Twenty-five distinct cup orientations were considered with variants of both acetabular inclination and anteversion. Four separate body mass indices were considered: normal (25 kg/m(2)) and three levels of obesity (33, 42, and 50 kg/m(2)). Material properties were modified to simulate alumina with and without the presence of dispersed microflaws. The model was validated by corroboration with two previously published ceramic liner fracture studies. RESULTS: Of 200 XFEM simulations with flaw-free alumina, fracture occurred in eight instances, all of them involving obesity. Each of these occurred with cups in ≤ 37° inclination and in 0° anteversion. For 200 corresponding simulations with microflawed alumina, fracture propensity was greatest for cups with higher (edge loading-associated) scraping wear. Fracture risk was greatest for cups with lower inclination (average 42° for fractured cases versus 48° for nonfractured cases) and lower anteversion (9° versus 20°). CONCLUSIONS: Fracture propensity for 36-mm liners was elevated for cups with decreased anteversion and/or inclination and under conditions of patient obesity. CLINICAL RELEVANCE: Factors causing stripe wear, including obesity and cup malpositioning, also involve increased risk of ceramic liner fracture and merit heightened concern.
    No preview · Article · Sep 2012 · Clinical Orthopaedics and Related Research
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