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Clinical Orthopaedics and Related Research®

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01-02-2012 | Symposium: Papers Presented at the Annual Meetings of The Hip Society

Causes of Failure of Ceramic-on-Ceramic and Metal-on-Metal Hip Arthroplasties

Authors: Manny Porat, MD, Javad Parvizi, MD, FRCS, Peter F. Sharkey, MD, Keith R. Berend, MD, Adolph V. Lombardi Jr, MD, FACS, Robert L. Barrack, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 2/2012

Abstract

Background

Few large series of hard bearing surfaces have reported on reasons for early failure. A number of unique mechanisms of failure, including fracture, squeaking, and adverse tissue reactions, have been reported with these hard bearing surfaces. However, the incidence varies among the published studies.

Questions/purposes

To confirm the incidences, we identified the etiologies of early failures of hard-on-hard bearing surfaces for ceramic-on-ceramic and metal-on-metal THAs.

Methods

We retrospectively reviewed records of 2907 THAs with hard-on-hard bearing surfaces implanted between 1996 and 2009; 1697 (58%) had ceramic-on-ceramic and 1210 (42%) had metal-on-metal bearing surfaces. We recorded bearing-related complications and compared them to nonspecific reasons for revision THA. The minimum followup of the ceramic-on-ceramic and metal-on-metal cohorts was 6 months (mean, 48 months; range, 6–97 months) and 24 months (mean, 60 months; range, 24–178 months), respectively.

Results

The overall revision rate for ceramic-on-ceramic THA was 2.2% (38 of 1697), with aseptic loosening accounting for 55% of revisions (femur or acetabulum). The bearing accounted for 13% of the revisions in the ceramic-on-ceramic THA cohort. The overall metal-on-metal revision rate was 5.4% (65 of 1210), 17 involving adverse tissue reactions related to the metal-on-metal bearing surface (17 of 1210, 1.4% of cases; 17 of 65, 26% of revisions).

Conclusions

Twenty-six percent of the revisions from metal-on-metal and 13% of ceramic-on ceramic were bearing related. The overall short- to medium-term revision rate was 2.2% and 5.4% for ceramic-on-ceramic and metal-on-metal, respectively. The most common etiology of failure was loosening of the femoral or acetabular components.

Level of Evidence

Level IV, therapeutic study. See the Guidelines for Authors for a complete description of level of evidence.

Bozic KJ, Kurtz S, Lau E, Ong K, Chiu V, Vail TP, Rubash HE, Berry DJ. The epidemiology of bearing surface usage in total hip arthroplasty in the United States. J Bone Joint Surg Am. 2009;91:1614–1620.PubMedCrossRef

Browne JA, Bechtold CD, Berry DJ, Hanssen AD, Lewallen DG. Failed metal-on-metal hip arthroplasties: a spectrum of clinical presentations and operative findings. Clin Orthop Relat Res. 2010;468:2313–2320.PubMedCrossRef

Capello WN, D’Antonio JA, Feinberg JR, Manley MT, Naughton M. Ceramic-on-ceramic total hip arthroplasty: update. J Arthroplasty. 2008;23:39–43.PubMedCrossRef

Capello WN, D’Antonio JA, Ramakrishnan R, Naughton M. Continued improved wear with an annealed highly cross-linked polyethylene. Clin Orthop Relat Res. 2011;469:825–830.PubMedCrossRef

Clarke IC, Good V, Williams P, Schroeder D, Anissian L, Stark A, Oonishi H, Schuldies J, Gustafson G. Ultra-low wear rates for rigid-on-rigid bearings in total hip replacements. Proc Inst Mech Eng H. 2000;214:331–347.PubMedCrossRef

Dastane MR, Long WT, Wan Z, Chao L, Dorr LD. Metal-on-metal hip arthroplasty does equally well in osteonecrosis and osteoarthritis. Clin Orthop Relat Res. 2008;466:1148–1153.PubMedCrossRef

Dorr LD, Wan Z, Longjohn DB, Dubois B, Murken R. Total hip arthroplasty with use of the Metasul metal-on-metal articulation: four to seven-year results. J Bone Joint Surg Am. 2000;82:789–798.PubMed

Elkins JM, O’Brien MK, Stroud NJ, Pedersen DR, Callaghan JJ, Brown TD. Hard-on-hard total hip impingement causes extreme contact stress concentrations. Clin Orthop Relat Res. 2011;469:454–463.PubMedCrossRef

Hamilton WG, McAuley JP, Dennis DA, Murphy JA, Blumenfeld TJ, Politi J. THA with Delta ceramic on ceramic: results of a multicenter investigational device exemption trial. Clin Orthop Relat Res. 2010;468:358–366.PubMedCrossRef

10.

Hardinge K. The direct lateral approach to the hip. J Bone Joint Surg Br. 1982;64:17–19.PubMed

11.

Havelin LI, Espehaug B, Vollset SE, Engesaeter LB. Early aseptic loosening of uncemented femoral components in primary total hip replacement: a review based on the Norwegian Arthroplasty Register. J Bone Joint Surg Br. 1995;77:11–17.PubMed

12.

Iwakiri K, Iwaki H, Minoda Y, Ohashi H, Takaoka K. Alumina inlay failure in cemented polyethylene-backed total hip arthroplasty. Clin Orthop Relat Res. 2008;466:1186–1192.PubMedCrossRef

13.

Jacobs CA, Christensen CP, Greenwald AS, McKellop H. Clinical performance of highly cross-linked polyethylenes in total hip arthroplasty. J Bone Joint Surg Am. 2007;89:2779–2786.PubMedCrossRef

14.

Jacobs JJ, Urban RM, Hallab NJ, Skipor AK, Fischer A, Wimmer MA. Metal-on-metal bearing surfaces. J Am Acad Orthop Surg. 2009;17:69–76.PubMed

15.

Jacobs M, Gorab R, Mattingly D, Trick L, Southworth C. Three- to six-year results with the Ultima metal-on-metal hip articulation for primary total hip arthroplasty. J Arthroplasty. 2004;19:48–53.PubMedCrossRef

16.

Keurentjes JC, Kuipers RM, Wever DJ, Schreurs BW. High incidence of squeaking in THAs with alumina ceramic-on-ceramic bearings. Clin Orthop Relat Res. 2008;466:1438–1443.PubMedCrossRef

17.

Korovessis P, Petsinis G, Repanti M, Repantis T. Metallosis after contemporary metal-on-metal total hip arthroplasty: five to nine-year follow-up. J Bone Joint Surg Am. 2006;88:1183–1191.PubMedCrossRef

18.

Lee YK, Ha YC, Yoo JJ, Koo KH, Yoon KS, Kim HJ. Alumina-on-alumina total hip arthroplasty: a concise follow-up, at a minimum of ten years, of a previous report. J Bone Joint Surg Am. 2010;92:1715–1719.PubMedCrossRef

19.

Lewis PM, Al-Belooshi A, Olsen M, Schemitch EH, Waddell JP. Prospective randomized trial comparing alumina ceramic-on-ceramic with ceramic-on-conventional polyethylene bearings in total hip arthroplasty. J Arthroplasty. 2010;25:392–397.PubMedCrossRef

20.

Lombardi AV Jr, Berend KR, Seng BE, Clarke IC, Adams JB. Delta ceramic-on-alumina ceramic articulation in primary THA: prospective, randomized FDA-IDE study and retrieval analysis. Clin Orthop Relat Res. 2010;468:367–374.PubMedCrossRef

21.

Lombardi AV Jr, Skeels MD, Berend KR, Adams JB, Franchi OJ. Do large heads enhance stability and restore native anatomy in primary total hip arthroplasty? Clin Orthop Relat Res. 2011;469:1547–1553.PubMedCrossRef

22.

Long WT, Dastane M, Harris MJ, Wan Z, Dorr LD. Failure of the Durom Metasul^® acetabular component. Clin Orthop Relat Res. 2010;468:400–405.PubMedCrossRef

23.

Milosev I, Trebse R, Kovac S, Cör A, Pisot V. Survivorship and retrieval analysis of Sikomet metal-on-metal total hip replacements at a mean of seven years. J Bone Joint Surg Am. 2006;88:1173–1182.PubMedCrossRef

24.

Neumann DR, Thaler C, Hitzl W, Huber M, Hofstädter T, Dorn U. Long-term results of a contemporary metal-on-metal total hip arthroplasty: a 10-year follow-up study. J Arthroplasty. 2010;25:700–708.PubMedCrossRef

25.

Petsatodis GE, Papadopoulos PP, Papavasiliou KA, Hatzokos IG, Agathangelidis FG, Christodoulou AG. Primary cementless total hip arthroplasty with an alumina ceramic-on-ceramic bearing: results after a minimum of twenty years of follow-up. J Bone Joint Surg Am. 2010;92:639–644.PubMedCrossRef

26.

Sexton SA, Walter WL, Jackson MP, De Steiger R, Stanford T. Ceramic-on-ceramic bearing surface and risk of revision due to dislocation after primary total hip replacement. J Bone Joint Surg Br. 2009;91:1448–1153.

27.

Sharma V, Ranawat AS, Rasquinha VJ, Weiskopf J, Howard H, Ranawat CS. Revision total hip arthroplasty for ceramic head fracture: a long-term follow-up. J Arthroplasty. 2010;25:342–347.PubMedCrossRef

28.

Walter WL, Waters TS, Gillies M, Donohoo S, Kurtz SM, Ranawat AS, Hozack WJ, Tuke MA. Squeaking hips. J Bone Joint Surg Am. 2008;90(suppl 4):102–111.PubMedCrossRef

29.

Wan Z, Boutary M, Dorr LD. The influence of acetabular component position on wear in total hip arthroplasty. J Arthroplasty. 2008;23:51–56.PubMedCrossRef

30.

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

31.

Zywiel MG, Sayeed SA, Johnson AJ, Schmalzried TP, Mont MA. Survival of hard-on-hard bearings in total hip arthroplasty: a systematic review. Clin Orthop Relat Res. 2011;469:1536–1546.PubMedCrossRef

Title: Causes of Failure of Ceramic-on-Ceramic and Metal-on-Metal Hip Arthroplasties
Authors: Manny Porat, MD
Javad Parvizi, MD, FRCS
Peter F. Sharkey, MD
Keith R. Berend, MD
Adolph V. Lombardi Jr, MD, FACS
Robert L. Barrack, MD
Publication date: 01-02-2012
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 2/2012
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-011-2161-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Causes of Failure of Ceramic-on-Ceramic and Metal-on-Metal Hip Arthroplasties

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

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