Top

Clinical Orthopaedics and Related Research®

Published in:

01-12-2010 | Symposium: Papers Presented at the 2009 Closed Meeting of the International Hip Society

Is There a Risk in Placing a Ceramic Head on a Previously Implanted Trunion?

Authors: Didier Hannouche, MD, PhD, Jérôme Delambre, MD, Frédéric Zadegan, MD, Laurent Sedel, MD, Rémy Nizard, MD, PhD

Published in: Clinical Orthopaedics and Related Research® | Issue 12/2010

Abstract

Background

Strategies for revising a ceramic-on-ceramic total hip prosthesis are controversial. Some consider reimplantation of a ceramic head on a well-fixed femoral stem inadvisable as it may lead to a fracture of the newly implanted head.

Questions/purposes

We assessed (1) the risk of fracture when a new ceramic head was placed on a previously implanted trunion; (2) the survival rate of the revised hips; and (3) hip function and acetabular and femoral component loosening at midterm followup.

Patients and Methods

We retrospectively reviewed all 126 patients (139 hips) who had revision of alumina-alumina hip arthroplasties between January 1977 and December 2005. Of these, 99 patients (110 hips) had revision of the socket only with retention of the femoral component. The femoral head was left in place in 33 hips, the same alumina head was re-implanted in seven hips, a new alumina head was implanted in 45 hips, a metallic head in 16, and a zirconia head in nine. Twenty-six patients (29 hips) died and nine (10 hips) were lost to followup before 5 years; this left 71 hips for review. Minimum followup was 60 months (mean, 112 months; range, 60–319 months).

Results

Eighteen hips required rerevision surgery, 11 for aseptic loosening, two for septic loosening, two for fracture of a ceramic liner, one for recurrent dislocation, one for ipsilateral femoral fracture, and one for unexplained pain. Among the 61 ceramic heads implanted on a well-fixed stem, no fracture of the head occurred at a mean 88 months’ followup. The survival rate at 10 years with mechanical failure as the end point was 81.6%.

Conclusions

We observed no fractures of the ceramic heads implanted on a previous titanium trunion. This approach is possible if inspection shows no major imperfection of the Morse taper.

Level of Evidence

Level IV, 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

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.CrossRefPubMed

Bizot P, Hannouche D, Nizard R, Witvoet J, Sedel L. Hybrid alumina total hip arthroplasty using a press-fit metal-backed socket in patients younger than 55 years: a six- to 11-year evaluation. J Bone Joint Surg Br. 2004;86:190–194.CrossRefPubMed

Bizot P, Nizard R, Hamadouche M, Hannouche D, Sedel L. Prevention of wear and osteolysis: alumina-on-alumina bearing. Clin Orthop Relat Res. 2001;393:85–93.CrossRefPubMed

Bohler M, Mochida Y, Bauer TW, Plenk H Jr, Salzer M. Wear debris from two different alumina-on-alumina total hip arthroplasties. J Bone Joint Surg Br. 2000;82:901–909.CrossRefPubMed

Brown C, Williams S, Tipper JL, Fisher J, Ingham E. Characterisation of wear particles produced by metal on metal and ceramic on metal hip prostheses under standard and microseparation simulation. J Mater Sci Mater Med. 2007;18:819–827.CrossRefPubMed

Christel PS. Biocompatibility of surgical-grade dense polycrystalline alumina. Clin Orthop Relat Res. 1992;282:10–18.PubMed

Clarke IC, Gustafson A, Jung H, Fujisawa A. Hip-simulator ranking of polyethylene wear: comparisons between ceramic heads of different sizes. Acta Orthop Scand. 1996;67:128–132.PubMed

D’Antonio J, McCarthy JC, Bargar WL, Borden LS, Cappelo WN, Collis DK, Steinberg ME, Wedge JH. Classification of femoral abnormalities in total hip arthroplasty. Clin Orthop Relat Res. 1993;296:133–139.PubMed

10.

D’Antonio JA, Capello WN, Borden LS, Bargar WL, Bierbaum BF, Boettcher WG, Steinberg ME, Stulberg SD, Wedge JH. Classification and management of acetabular abnormalities in total hip arthroplasty. Clin Orthop Relat Res. 1989;243:126–137.PubMed

11.

D’Aubigné RM, Postel M. Cotation chiffrée de la fonction de la hanche. Rev Chir Orthop Reparatrice Appar Mot. 1970;56:481–486.

12.

Ebramzadeh E, Sangiorgio SN, Lattuada F, Kang JS, Chiesa R, McKellop HA, Dorr LD. Accuracy of measurement of polyethylene wear with use of radiographs of total hip replacements. J Bone Joint Surg Am. 2003;85:2378–2384.PubMed

13.

Figueiredo-Pina CG, Yan Y, Neville A, Fisher J. Understanding the differences between the wear of metal-on-metal and ceramic-on-metal total hip replacements. Proc Inst Mech Eng H. 2008;222:285–296.PubMed

14.

Fye MA, Huo MH, Zatorski LE, Keggi KJ. Total hip arthroplasty performed without cement in patients with femoral head osteonecrosis who are less than 50 years old. J Arthroplasty. 1998;13:876–881.CrossRefPubMed

15.

Gore SM. Assessing methods—survival. Br Med J (Clin Res Ed). 1981;283:840–843.CrossRef

16.

Gruen TA, McNeice GM, Amstutz HC. Modes of failure of cemented stem type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979;141:17–27.PubMed

17.

Gualtieri G, Nigrisoli M, Dallari D, Catamo L, Gualtieri I. A study of the mechanical and biological behavior of bioceramic hip arthroplasty followed-up after more than 10 years. Chir Organi Mov. 1993;78:213–222.PubMed

18.

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

19.

Hannouche D, Hamadouche M, Nizard R, Bizot P, Meunier A, Sedel L. Ceramics in total hip replacement. Clin Orthop Relat Res. 2005;430:62–71.CrossRefPubMed

20.

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

21.

Huo MH, Martin RP, Zatorski LE, Keggi KJ. Ceramic total hip replacement done without cement: long term follow-up study. Orthop Trans. 1995;19:400–401.

22.

Ilchmann T, Neher S, Maurer F, Weise K. Modes of failure of a threaded acetabular cup: a radiographic study with EBRA of 42 revised cups. Int Orthop. 2007;31:211–216.CrossRefPubMed

23.

Jarrett CA, Ranawat AS, Bruzzone M, Blum YC, Rodriguez JA, Ranawat CS. The squeaking hip: a phenomenon of ceramic-on-ceramic total hip arthroplasty. J Bone Joint Surg Am. 2009;91:1344–1349.CrossRefPubMed

24.

Kempf I, Semlitsch M. Massive wear of a steel ball head by ceramic fragments in the polyethylene acetabular cup after revision of a total hip prosthesis with fractured ceramic ball. Arch Orthop Trauma Surg. 1990;109:284–287.CrossRefPubMed

25.

Livermore J, Ilstrup D, Morrey B. Effect of femoral head size on wear of the polyethylene acetabular component. J Bone Joint Surg Am. 1990;72:518–528.PubMed

26.

Mai K, Verioti C, Ezzet KA, Copp SN, Walker RH, Colwell CW Jr. Incidence of “squeaking after ceramic-on-ceramic total hip arthroplasty. Clin Orthop Relat Res. 2010;468:413–417.CrossRefPubMed

27.

Mittelmeier H, Heisel J. Sixteen-years’ experience with ceramic hip prostheses. Clin Orthop Relat Res. 1992;282:64–72.PubMed

28.

Nevelos JE, Prudhommeaux F, Hamadouche M, Doyle C, Ingham E, Meunier A, Nevelos AB, Sedel L, Fisher J. Comparative analysis of two different types of alumina-alumina hip prosthesis retrieved for aseptic loosening. J Bone Joint Surg Br. 2001;83:598–603.PubMed

29.

Nizard R, Sedel L, Hannouche D, Hamadouche M, Bizot P. Alumina pairing in total hip replacement. J Bone Joint Surg Br. 2005;87:755–758.CrossRefPubMed

30.

Nizard RS, Sedel L, Christel P, Meunier A, Soudry M, Witvoet J. Ten-year survivorship of cemented ceramic-ceramic total hip prosthesis. Clin Orthop Relat Res. 1992;282:53–63.PubMed

31.

Prudhommeaux F, Hamadouche M, Nevelos J, Doyle C, Meunier A, Sedel L. Wear of alumina-on-alumina total hip arthroplasties at a mean 11-year followup. Clin Orthop Relat Res. 2000;379:113–122.CrossRefPubMed

32.

Pulliam IT, Trousdale RT. Fracture of a ceramic femoral head after a revision operation: a case report. J Bone Joint Surg Am. 1997;79:118–121.PubMed

33.

Pupparo F, Engh CA. Comparison of porous-threaded and smooth-threaded acetabular components of identical design: two- to four-year results. Clin Orthop Relat Res. 1991;271:201–206.PubMed

34.

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.CrossRefPubMed

35.

Willmann G. Ceramics for total hip replacement—what a surgeon should know. Orthopedics. 1998;21:173–177.PubMed

36.

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

37.

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.CrossRefPubMed

Title: Is There a Risk in Placing a Ceramic Head on a Previously Implanted Trunion?
Authors: Didier Hannouche, MD, PhD
Jérôme Delambre, MD
Frédéric Zadegan, MD
Laurent Sedel, MD
Rémy Nizard, MD, PhD
Publication date: 01-12-2010
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 12/2010
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-010-1505-3

At a glance: The STEP trials

Springer Medicine

Is There a Risk in Placing a Ceramic Head on a Previously Implanted Trunion?

Abstract

Background

Questions/purposes

Patients and Methods

Results

Conclusions

Level of Evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Questions/purposes

Patients and Methods

Results

Conclusions

Level of Evidence

Please log in to get access to this content

Other articles of this Issue 12/2010

Transtrochanteric Rotational Osteotomy for a Subchondral Insufficiency Fracture of the Femoral Head in Young Adults

Femoral Morphologic Differences in Subtypes of High Developmental Dislocation of the Hip

Combining C-reactive Protein and Interleukin-6 May Be Useful to Detect Periprosthetic Hip Infection

Femoral Insufficiency Fractures Associated with Prolonged Bisphosphonate Therapy

Erratum to: Shoulder Arthroplasties have Fewer Complications than Hip or Knee Arthroplasties in US Veterans

Editorial: The Imperative to Authenticate Cell Lines