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Clinical Orthopaedics and Related Research®

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01-11-2012 | Symposium: Papers Presented at the 2011 Meeting of the International Hip Society

Head Material Influences Survival of a Cemented Total Hip Prosthesis in the Norwegian Arthroplasty Register

Authors: Thomas Kadar, MD, Eva Dybvik, MSc, Geir Hallan, MD, PhD, Ove Furnes, MD, PhD, Leif Ivar Havelin, MD, PhD

Published in: Clinical Orthopaedics and Related Research® | Issue 11/2012

Abstract

Background

High prosthesis survival is reported for total hip prostheses with metal and alumina heads, but direct comparisons of a single prosthesis design with one of two different head materials has seldom been studied. Prostheses with zirconia heads are less commonly used than metal and alumina heads, and the few reports suggest variable results with zirconia heads.

Questions/Purposes

We therefore asked: (1) Would metal heads provide better survival of a cemented total hip arthroplasty (THA) than alumina heads? (2) Would metal heads provide better survival of a cemented THA than zirconia heads?

Methods

We searched in the Norwegian Arthroplasty Register for cemented primary THA cup/stem combinations that simultaneously had been used with different head materials. The only THA that fulfilled these inclusion criteria was the cemented Reflection All-Poly/Spectron EF (cup/stem) that had during 2001 to 2006 been used both with alumina (n = 448) and cobalt-chromium (n = 5229) heads; that implant had also been used with zirconia (n = 275) and cobalt-chromium heads (n = 3195) during 1997 to 2003, and we included patients with this THA from these two time intervals in the study. All cups were conventional polyethylene. We estimated prosthesis survival and relative revision risks adjusting for age, sex, and diagnosis. The followup in the two study materials was until December 2010.

Results

The survival at 8 years of the Spectron EF/Reflection THAs, inserted with alumina and cobalt-chromium heads during 2001 to 2006, was 92.3% and 94.0%, respectively. The Reflection/Spectron EF THA had inferior survival with zirconia heads compared with cobalt-chromium heads (relative risk, 1.7). At 12 years, the survival rate was 88.1% with cobalt-chromium heads and 74.8% with zirconia heads.

Conclusions

Alumina femoral heads provided no advantage over cobalt-chromium heads on midterm prosthesis survival. THAs with zirconia heads had inferior survival.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Allain J, Roudot-Thoraval F, Delecrin J, Anract P, Migaud H, Goutallier D. Revision total hip arthroplasty performed after fracture of a ceramic femoral head. A multicenter survivorship study. J Bone Joint Surg Am. 2003;85:825–830.PubMed

Bradford L, Baker D, Ries MD, Pruitt LA. Fatigue crack propagation resistance of highly crosslinked polyethylene. Clin Orthop Relat Res. 2004;429:68–72.PubMedCrossRef

Christel P, Meunier A, Heller M, Torre JP, Peille CN. Mechanical properties and short-term in-vivo evaluation of yttrium-oxide-partially-stabilized zirconia. J Biomed Mater Res. 1989;23:45–61.PubMedCrossRef

Cooper JR, Dowson D, Fisher J, Jobbins B. Ceramic bearing surfaces in total artificial joints: resistance to third body wear damage from bone cement particles. J Med Eng Technol. 1991;15:63–67.PubMedCrossRef

Dahl J, Soderlund P, Nivbrant B, Nordsletten L, Rohrl SM. Less wear with aluminium-oxide heads than cobalt-chrome heads with ultra high molecular weight cemented polyethylene cups: a ten-year follow-up with radiostereometry. Int Orthop. 2012;36:485–490.PubMedCrossRef

Digas G, Karrholm J, Thanner J. Addition of fluoride to acrylic bone cement does not improve fixation of a total hip arthroplasty stem. Clin Orthop Relat Res. 2006;448:58–66.PubMedCrossRef

Digas G, Karrholm J, Thanner J, Herberts P. 5-year experience of highly cross-linked polyethylene in cemented and uncemented sockets: two randomized studies using radiostereometric analysis. Acta Orthop. 2007;78:746–754.PubMedCrossRef

Espehaug B, Furnes O, Engesaeter LB, Havelin LI. 18 years of results with cemented primary hip prostheses in the Norwegian Arthroplasty Register. Acta Orthop. 2009;80:402–412.PubMedCrossRef

Espehaug B, Furnes O, Havelin LI, Engesaeter LB, Vollset SE, Kindseth O. Registration completeness in the Norwegian Arthroplasty Register. Acta Orthop. 2006;77:49–56.PubMedCrossRef

10.

Gonzalez D, Rana A, Nestor B, Bostrom M, Westrich G, Salvati EA. Metallic shedding, surface finish changes, and extensive femoral osteolysis in the loose Spectron EF stem. Clin Orthop Relat Res. 2006;442:165–170.CrossRef

11.

Good V, Ries M, Barrack RL, Widding K, Hunter G, Heuer D. Reduced wear with oxidized zirconium femoral heads. J Bone Joint Surg Am. 2003;85(Suppl 4):105–110.PubMed

12.

Grose A, Gonzalez D, Bullough P, Lyman S, Tomek I, Pellicci P. High failure rate of a modern, proximally roughened, cemented stem for total hip arthroplasty. Int Orthop. 2006;30:243–247.PubMedCrossRef

13.

Hallan G, Dybvik E, Furnes O, Havelin LI. Metal-backed acetabular components with conventional polyethylene: a review of 9113 primary components with a follow-up of 20 years. J Bone Joint Surg Br. 2010;92:196–201.PubMed

14.

Haraguchi K, Sugano N, Nishii T, Miki H, Oka K, Yoshikawa H. Phase transformation of a zirconia ceramic head after total hip arthroplasty. J Bone Joint Surg Br. 2001;83:996–1000.PubMedCrossRef

15.

Harris WH. Osteolysis and particle disease in hip replacement. A review. Acta Orthop Scand. 1994;65:113–123.PubMedCrossRef

16.

Havelin LI, Engesaeter LB, Espehaug B, Furnes O, Lie SA, Vollset SE. The Norwegian Arthroplasty Register: 11 years and 73,000 arthroplasties. Acta Orthop Scand. 2000;71:337–353.PubMedCrossRef

17.

Havelin LI, Espehaug B, Engesaeter LB. The performance of two hydroxyapatite-coated acetabular cups compared with Charnley cups. From the Norwegian Arthroplasty Register. J Bone Joint Surg Br. 2002;84:839–845.PubMedCrossRef

18.

Hernigou P, Bahrami T. Zirconia and alumina ceramics in comparison with stainless-steel heads. Polyethylene wear after a minimum ten-year follow-up. J Bone Joint Surg Br. 2003;85:504–509.PubMedCrossRef

19.

Kadar T, Hallan G, Aamodt A, Indrekvam K, Badawy M, Havelin LI, Stokke T, Haugan K, Espehaug B, Furnes O. A randomized study on migration of the Spectron EF and the Charnley flanged 40 cemented femoral components using radiostereometric analysis at 2 years. Acta Orthop. 2011;82:538–544.PubMedCrossRef

20.

Kadar T, Hallan G, Aamodt A, Indrekvam K, Badawy M, Skredderstuen A, Havelin LI, Stokke T, Haugan K, Espehaug B, Furnes O. Wear and migration of highly cross-linked and conventional cemented polyethylene cups with cobalt chrome or Oxinium femoral heads: a randomized radiostereometric study of 150 patients. J Orthop Res. 2011;29:1222–1229.PubMedCrossRef

21.

Kawanabe K, Tanaka K, Tamura J, Shimizu M, Onishi E, Iida H, Nakamura T. Effect of alumina femoral head on clinical results in cemented total hip arthroplasty: old versus current alumina. J Orthop Sci. 2005;10:378–384.PubMedCrossRef

22.

Lee JH, Lee BW, Lee BJ, Kim SY. Midterm results of primary total hip arthroplasty using highly cross-linked polyethylene minimum 7-year follow-up study. J Arthroplasty. 2011;26:1014–1019.PubMedCrossRef

23.

Minakawa H, Stone MH, Wroblewski BM, Lancaster JG, Ingham E, Fisher J. Quantification of third-body damage and its effect on UHMWPE wear with different types of femoral head. J Bone Joint Surg Br. 1998;80:894–899.PubMedCrossRef

24.

Piconi C, Maccauro G, Angeloni M, Rossi B, Learmonth ID. Zirconia heads in perspective: a survey of zirconia outcomes in total hip replacement. Hip Int. 2007;17:119–130.PubMed

25.

Roy ME, Whiteside LA, Katerberg BJ, Steiger JA, Nayfeh T. Not all zirconia femoral heads degrade in vivo. Clin Orthop Relat Res. 2007;465:220–226.PubMed

26.

Scheerlinck T, Casteleyn PP. The design features of cemented femoral hip implants. J Bone Joint Surg Br. 2006;88:1409–1418.PubMedCrossRef

27.

Stilling M, Nielsen KA, Søballe K, Rahbek O. Clinical comparison of polyethylene wear with zirconia or cobalt-chromium femoral heads. Clin Orthop Relat Res. 2009;467:2644–2650.PubMedCrossRef

28.

Thomas GER, Simpson DJ, Mehmood S, Taylor A, McLardy-Smith P, Gill HS, Murray DW, Glyn-Jones S. The seven-year wear of highly cross-linked polyethylene in total hip arthroplasty: a double-blind, randomized controlled trial using radiostereometric analysis. J Bone Joint Surg Am. 2011;93:716–722.PubMedCrossRef

29.

Willmann G. Ceramic femoral head retrieval data. Clin Orthop Relat Res. 2000;379:22–28.PubMedCrossRef

30.

Yoshitomi H, Shikata S, Ito H, Nakayama T, Nakamura T. Manufacturers affect clinical results of THA with zirconia heads: a systematic review. Clin Orthop Relat Res. 2009;467:2349–2355.PubMedCrossRef

Title: Head Material Influences Survival of a Cemented Total Hip Prosthesis in the Norwegian Arthroplasty Register
Authors: Thomas Kadar, MD
Eva Dybvik, MSc
Geir Hallan, MD, PhD
Ove Furnes, MD, PhD
Leif Ivar Havelin, MD, PhD
Publication date: 01-11-2012
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 11/2012
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-012-2396-2

2024 ASCO Annual Meeting

Springer Medicine

Head Material Influences Survival of a Cemented Total Hip Prosthesis in the Norwegian Arthroplasty Register

Abstract

Background

Questions/Purposes

Methods

Results

Conclusions

Level of Evidence

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Questions/Purposes

Methods

Results

Conclusions

Level of Evidence

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