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Clinical Orthopaedics and Related Research®

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01-12-2012 | Clinical Research

Alumina-on-alumina THA Performed in Patients Younger Than 30 Years: A 10-year Minimum Followup Study

Authors: Hyeong Jo Yoon, MD, Jeong Joon Yoo, MD, Kang Sup Yoon, MD, Kyung-Hoi Koo, MD, Hee Joong Kim, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 12/2012

Abstract

Background

THA in patients younger than 30 years presents challenges because of uncertainties regarding the long-term survivorship of prostheses. Alumina-on-alumina bearings, which exhibit little long-term wear, may be a reasonable option but the long-term survivorship is unknown.

Questions/Purposes

We determined (1) the survival rate of alumina-on-alumina bearings in patients younger than 30 years after a 10-year followup, (2) the incidence of audible hip clicking and squeaking, (3) radiographic evidence of osteolysis, and (4) the effects on pregnancy, childbirth, and career choice.

Methods

We retrospectively reviewed 62 patients who had 75 THAs with alumina-on-alumina bearings followed more than 10 years (average, 11.5; range, 10–13.5 years). Mean patient age at the time of surgery was 24 years (range, 18–30 years). All operations were performed using the same cementless implant at a single center. We determined survival, presence of osteolysis, and function (Harris hip score, WOMAC).

Results

The 10-year survival rate of alumina-on-alumina bearings in THAs, with revision for any reason as the end point, was 98.9%. Audible hip clicking and squeaking were identified in 10 hips and two hips, respectively. No osteolysis was detected. None of the 11 patients who became pregnant had been affected by their THA during pregnancy or childbirth. Seven of the 14 patients who were unemployed at the time of index surgery stated that their THA affected their job choice.

Conclusions

We found a high 10-year survival of cementless alumina-on-alumina bearings in THAs in patients younger than 30 years. Lifetime events such as job choice, pregnancy, and childbirth should be considered when choosing THA for patients younger than 30 years.

Level of Evidence

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

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Baek SH, Kim SY. Cementless total hip arthroplasty with alumina bearings in patients younger than fifty with femoral head osteonecrosis. J Bone Joint Surg Am. 2008;90:1314–1320.PubMedCrossRef

Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833–1840.PubMed

Bizot P, Banallec L, Sedel L, Nizard R. Alumina-on-alumina total hip prostheses in patients 40 years of age or younger. Clin Orthop Relat Res. 2000;379:68–76.PubMedCrossRef

Brodner W, Grohs JG, Bancher-Todesca D, Dorotka R, Meisinger V, Gottsauner-Wolf F, Kotz R. Does the placenta inhibit the passage of chromium and cobalt after metal-on-metal total hip arthroplasty? J Arthroplasty. 2004;19(8 suppl 3):102–106.PubMedCrossRef

Chandler HP, Reineck FT, Wixson RL, McCarthy JC. Total hip replacement in patients younger than thirty years old: a five-year follow-up study. J Bone Joint Surg Am. 1981;63:1426–1434.PubMed

Devane PA, Horne JG, Martin K, Coldham G, Krause B. Three-dimensional polyethylene wear of a press-fit titanium prosthesis: factors influencing generation of polyethylene debris. J Arthroplasty. 1997;12:256–266.PubMedCrossRef

Domingo JL. Metal-induced developmental toxicity in mammals: a review. J Toxicol Environ Health. 1994;42:123–141.PubMedCrossRef

Dudkiewicz I, Salai M, Ganel A, Blankstein A, Chechik A. Total hip arthroplasty in patients younger than 30 years of age following developmental dysplasia of hip (DDH) in infancy. Arch Orthop Trauma Surg. 2002;122:139–142.PubMedCrossRef

Engh CA, Bobyn JD, Glassman AH. Porous-coated hip replacement: the factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg Br. 1987;69:45–55.PubMed

10.

Finkbone PR, Severson EP, Cabanela ME, Trousdale RT. Ceramic-on-ceramic total hip arthroplasty in patients younger than 20 years. J Arthroplasty. 2012;27:213–219.PubMedCrossRef

11.

Garcia-Rey E, Cruz-Pardos A, Garcia-Cimbrelo E. Alumina-on-alumina total hip arthroplasty in young patients: diagnosis is more important than age. Clin Orthop Relat Res. 2009;467:2281–2289.PubMedCrossRef

12.

Girard J, Bocquet D, Autissier G, Fouilleron N, Fron D, Migaud H. Metal-on-metal hip arthroplasty in patients thirty years of age or younger. J Bone Joint Surg Am. 2010;92:2419–2426.PubMedCrossRef

13.

Halley DK, Wroblewski BM. Long-term results of low-friction arthroplasty in patients 30 years of age or younger. Clin Orthop Relat Res. 1986;211:43–50.PubMed

14.

Hamadouche M, Boutin P, Daussange J, Bolander ME, Sedel L. Alumina-on-alumina total hip arthroplasty: a minimum 18.5-year follow-up study. J Bone Joint Surg Am. 2002;84:69–77.PubMed

15.

Hannouche D, Nich C, Bizot P, Meunier A, Nizard R, Sedel L. Fractures of ceramic bearings: history and present status. Clin Orthop Relat Res. 2003;417:19–26.PubMed

16.

Hannouche D, Zaoui A, Zadegan F, Sedel L, Nizard R. Thirty years of experience with alumina-on-alumina bearings in total hip arthroplasty. Int Orthop. 2011;35:207–213.PubMedCrossRef

17.

Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737–755.PubMed

18.

Hernigou P, Zilber S, Filippini P, Poignard A. Ceramic-ceramic bearing decreases osteolysis: a 20-year study versus ceramic-polyethylene on the contralateral hip. Clin Orthop Relat Res. 2009;467:2274–2280.PubMedCrossRef

19.

Hyder N, Nevelos AB, Barabas TG. Cementless ceramic hip arthroplasties in patients less than 30 years old. J Arthroplasty. 1996;11:679–686.PubMedCrossRef

20.

Joshi RP, Eftekhar NS, McMahon DJ, Nercessian OA. Osteolysis after Charnley primary low-friction arthroplasty: a comparison of two matched paired groups. J Bone Joint Surg Br. 1998;80:585–590.PubMedCrossRef

21.

Kim YH, Choi Y, Kim JS. Cementless total hip arthroplasty with ceramic-on-ceramic bearing in patients younger than 45 years with femoral-head osteonecrosis. Int Orthop. 2010;34:1123–1127.PubMedCrossRef

22.

Kitamura N, Leung SB, Engh CA Sr. Characteristics of pelvic osteolysis on computed tomography after total hip arthroplasty. Clin Orthop Relat Res. 2005;441:291–297.PubMedCrossRef

23.

Kress AM, Schmidt R, Holzwarth U, Forst R, Mueller LA. Excellent results with cementless total hip arthroplasty and alumina-on-alumina pairing: minimum ten-year follow-up. Int Orthop. 2011;35:195–200.PubMedCrossRef

24.

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

25.

Mahoney OM, Dimon JH 3rd. Unsatisfactory results with a ceramic total hip prosthesis. J Bone Joint Surg Am. 1990;72:663–671.PubMed

26.

Martell JM, Pierson RH 3rd, Jacobs JJ, Rosenberg AG, Maley M, Galante JO. Primary total hip reconstruction with a titanium fiber-coated prosthesis inserted without cement. J Bone Joint Surg Am. 1993;75:554–571.PubMed

27.

Meldrum R, Feinberg JR, Capello WN, Detterline AJ. Clinical outcome and incidence of pregnancy after bipolar and total hip arthroplasty in young women. J Arthroplasty. 2003;18:879–885.PubMedCrossRef

28.

Murphy SB, Ecker TM, Tannast M. Two- to 9-year clinical results of alumina ceramic-on-ceramic THA. Clin Orthop Relat Res. 2006;453:97–102.PubMedCrossRef

29.

Nam KW, Yoo JJ, Lae Kim Y, Kim YM, Lee MH, Kim HJ. Alumina-debris-induced osteolysis in contemporary alumina-on-alumina total hip arthroplasty: a case report. J Bone Joint Surg Am. 2007;89:2499–2503.PubMedCrossRef

30.

Nizard R, Pourreyron D, Raould A, Hannouche D, Sedel L. Alumina-on-alumina hip arthroplasty in patients younger than 30 years old. Clin Orthop Relat Res. 2008;466:317–323.PubMedCrossRef

31.

Park YS, Park SJ, Lim SJ. Ten-year results after cementless THA with a sandwich-type alumina ceramic bearing. Orthopedics. 2010;33:796.PubMed

32.

Puri L, Wixson RL, Stern SH, Kohli J, Hendrix RW, Stulberg SD. Use of helical computed tomography for the assessment of acetabular osteolysis after total hip arthroplasty. J Bone Joint Surg Am. 2002;84:609–614.PubMed

33.

Restrepo C, Post ZD, Kai B, Hozack WJ. The effect of stem design on the prevalence of squeaking following ceramic-on-ceramic bearing total hip arthroplasty. J Bone Joint Surg Am. 2010;92:550–557.PubMedCrossRef

34.

Sarmiento A, Gruen TA. Radiographic analysis of a low-modulus titanium-alloy femoral total hip component: two to six-year follow-up. J Bone Joint Surg Am. 1985;67:48–56.PubMed

35.

Sierra RJ, Trousdale RT, Cabanela ME. Pregnancy and childbirth after total hip arthroplasty. J Bone Joint Surg Br. 2005;87:21–24.PubMed

36.

Sochart DH, Porter ML. Long-term results of cemented Charnley low-friction arthroplasty in patients aged less than 30 years. J Arthroplasty. 1998;13:123–131.PubMedCrossRef

37.

Torchia ME, Klassen RA, Bianco AJ. Total hip arthroplasty with cement in patients less than twenty years old: long-term results. J Bone Joint Surg Am. 1996;78:995–1003.PubMedCrossRef

38.

Yoo JJ, Kim YM, Yoon KS, Koo KH, Kim JW, Nam KW, Kim HJ. Contemporary alumina-on-alumina total hip arthroplasty performed in patients younger than forty years: a 5-year minimum follow-up study. J Biomed Mater Res B Appl Biomater. 2006;78:70–75.PubMed

39.

Yoo JJ, Kim YM, Yoon KS, Koo KH, Song WS, Kim HJ. Alumina-on-alumina total hip arthroplasty: a five-year minimum follow-up study. J Bone Joint Surg Am. 2005;87:530–535.PubMedCrossRef

40.

Zahiri CA, Schmalzried TP, Szuszczewicz ES, Amstutz HC. Assessing activity in joint replacement patients. J Arthroplasty. 1998;13:890–895.PubMedCrossRef

41.

Ziaee H, Daniel J, Datta AK, Blunt S, McMinn DJ. Transplacental transfer of cobalt and chromium in patients with metal-on-metal hip arthroplasty: a controlled study. J Bone Joint Surg Br. 2007;89:301–305.PubMed

42.

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: Alumina-on-alumina THA Performed in Patients Younger Than 30 Years: A 10-year Minimum Followup Study
Authors: Hyeong Jo Yoon, MD
Jeong Joon Yoo, MD
Kang Sup Yoon, MD
Kyung-Hoi Koo, MD
Hee Joong Kim, MD
Publication date: 01-12-2012
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 12/2012
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-012-2493-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Alumina-on-alumina THA Performed in Patients Younger Than 30 Years: A 10-year Minimum Followup Study

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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