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Clinical Orthopaedics and Related Research®

Published in:

01-12-2013 | Symposium: 2012 International Hip Society Proceedings

Ceramic-on-ceramic Bearing Decreases the Cumulative Long-term Risk of Dislocation

Authors: Philippe Hernigou, MD, Yasuhiro Homma, MD, Olivier Pidet, MD, Isaac Guissou, MD, Jacques Hernigou, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 12/2013

Abstract

Background

It is unclear whether late THA dislocations are related to mechanical impingement or to a biological mechanism that decreases the stability provided by the capsule (eg, inflammation secondary to osteolysis). It is also unknown if alumina-on-alumina bearing couples decrease the risk of late dislocation as a result of the absence of wear and osteolysis.

Question/purposes

We asked (1) whether the cumulative number of dislocations differed with alumina-on-alumina (AL/AL) or alumina-on-polyethylene bearings (AL/PE); (2) whether patient factors (age, sex, and diseases) affect risk of late dislocation; (3) whether mechanical factors (component malposition, penetration resulting from creep and wear) or (4) biologic hip factors at revision (thickness of the capsule, volume of joint fluid removed at surgery, histology) differed with the two bearing couples.

Methods

One hundred twenty-six patients (252 hips) with bilateral THA (one AL/AL and the contralateral AL/PE) received the same cemented implants except for the cup PE cup or an AL cup. The cumulative risk of dislocation (first-time and recurrent dislocation) was calculated at a minimum of 27 years. We measured cup position, creep and wear, and capsular thickness in the hips that had revision.

Results

AL/PE and AL/AL hips differed by the cumulative number of dislocation (31 with AL/PE versus four with AL/AL) and by the number of late dislocations (none with AL/AL, 28 with AL/PE). Cause of osteonecrosis, age, and sex affected the number of dislocations. The frequency of component malposition did not differ between the two bearing couples. The risk of late dislocation appeared less in AL/AL hips with increased capsular thickness (mean, 4.5 mm; range, 3–7 mm) compared with the thinnest (mean, 1.2 mm; range, 0.2–2 mm) capsule of AL/PE hips.

Conclusions

AL/AL bearing couples decreased the cumulative risk of dislocation as compared with AL/PE bearing couples.

Level of Evidence

Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Title: Ceramic-on-ceramic Bearing Decreases the Cumulative Long-term Risk of Dislocation
Authors: Philippe Hernigou, MD
Yasuhiro Homma, MD
Olivier Pidet, MD
Isaac Guissou, MD
Jacques Hernigou, MD
Publication date: 01-12-2013
Publisher: Springer US
Published in: Clinical Orthopaedics and Related Research® / Issue 12/2013
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-013-2857-2

At a glance: The STEP trials

Springer Medicine

Ceramic-on-ceramic Bearing Decreases the Cumulative Long-term Risk of Dislocation

Abstract

Background

Question/purposes

Methods

Results

Conclusions

Level of Evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Question/purposes

Methods

Results

Conclusions

Level of Evidence

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