Monday, January 16, 2012

Ceramic bearings for total hip arthroplasty have high survivorship at 10 years.

Clin Orthop Relat Res. 2012 Feb;470(2):373-81.

 

D'Antonio JA, Capello WN, Naughton M.

Source

Greater Pittsburgh Orthopaedics Association, 725 Cherrington Parkway, Suite 200, Moon Township, PA, 15108, USA, dantonioja@me.com.

Abstract

BACKGROUND:

Ceramic bearings were introduced to reduce wear and increase long-term survivorship of total hip arthroplasty. In a previous study comparing ceramic with metal-on-polyethylene at 5 to 8 years, we found higher survivorship and no osteolysis for the ceramic bearings.

QUESTIONS/PURPOSES:

We asked whether ceramic bearings have equal or superior survivorship compared with that for metal-on-polyethylene at longer followup; we also determined survivorship of the implant systems, the presence or absence of radiographic osteolysis, and incidence of device squeaking.

METHODS:

Five surgeons at five sites have followed 189 patients (216 hips) for a minimum of 10 years and average of 10.3 years (range, 10-12.4 years) comparing alumina ceramic bearings (144 hips) with cobalt chrome-on-polyethylene bearings (72 hips). We determined Kaplan-Meier survivorship of the bearing surface and implant systems and collected radiographic and clinical data.

RESULTS:

We observed no difference between the control metal-on-polyethylene and the alumina-bearing couple cohorts with regard to bearing-related failures (98.9% versus 99.1%). Revisions for any reason occurred in 10.5% of the control patients and 3.1% of the patients with alumina bearings. All femoral implants remain well fixed (100%), whereas one acetabular component (1%) is unstable in the control group. Osteolysis occurred in 26% of the control patients and in none of the patients with alumina bearings. Squeaking occurred in two of 144 hips (1.4%) of the patients with ceramic bearings.

CONCLUSIONS:

Patients receiving the ceramic-on-ceramic bearings had fewer revisions for any reason and less osteolysis than the control metal-on-polyethylene at 10 years. Our data suggest ceramic bearings continue to provide an option for the young and more active patient and provide for a measure to compare other new alternative bearings that are currently available.

5 comments:

  1. Connie, please see UKTrunnion study. It appears it should be changed. Your thoughts?

    http://www.jbjs.org.uk/media/55176/27749-resub.pdf

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    Replies
    1. Do you know who wrote this paper or when??

      I have had a chance to read it now. Seems consistant with the comments on other papers re the wear debris generated from the trunion/taper/stem.

      the key things I got out of this paper is after reviewing 111 of the component hips, the tapers/stem/trunion from 3 manufactures (Dupuy, Smith and Nephew and Zimmer :

      -showed that 102 of the 111 stems showed signs of corrosion.
      -corrosion did not influence the levels of Co or Cr in the blood (interesting)
      -seems that the study claims this was the first study to quantify the severity of the MOM THR devices
      -claims also that this was the largest analyis of retrieved ASR MOM hips perfomed to date.
      -their hypothesis was that the ASSR device would demonstrate more corrosion than the other two hips given its recall I guess. This was not the case however according to this unpublished paper.

      Most important point was that the paper overall supported the view that the head-trunnion junction is a significant source of material loss and thus may be a contributor towards the accumulation of the m etal ions in the blood.

      If you can send me the author and when it was written..specify whether it can be published or not.

      Thanks for sending this.

      connie

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  2. Hi,

    First, thanks for the paper. I will read this in detail but did have a glance at it. Looks like an unpublished paper? Are you the author?

    The question is: changed from what to what?

    What type of feedback are you looking for from a consumer and interested party in this subject matter.

    Have you shown this paper to Tom Joyce? I think he would be interested in this and is a far better person to comment on it.

    Did you want me to share the paper with the readers? I generally need to see the credentials on the paper as I am no expert in this area so like to make sure that the paper has gone through some peer review.

    Peer review or not, I am certainly interested in reading this. Perhaps you can send me an e-mail with this information or...not...depends on what your objective is.

    Given I have this internally generated rule for peer review, perhaps I can comment back to you directly if that works for you. As you can well imagine, I am not in any postion to provide any expert comments on a paper like this but I can provide consumer feedback?

    this topic is of interest to me though.

    Regards,

    Connie

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  3. Hi no comment needed,. I thought you might find it interesting per the post about the total number oa parts received back from pathology. I found out that the taper sleeve adapter was not changed out during either of my my revisions and as I'm having major issues 14 months post op, this is probably my problem now. Please poat if you feel it is valid or use at your discetio

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  4. Hi,

    Will read this weekend. Looks like your question was : Should the trunion be changed?

    I really have no idea but this has become an issue due to the tribology people posting data on debris comming from this part as well. Best to ask the Orth surgeon but you might ask the surgeon if he can order the MAVRIK protocal for the MRI. Resolution is good for that purpose. need to have a specialist like Hollis Potter MD in NY Hospital for Special Surgery to run that MRI>

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